GW1-2022-10409_Well Construction - GW1_20221116

WELL CONSTRUCTION-RECORD FarIricntnlFJscON41`.
This form can be uscd roT.sirig{r or multiyk acctls
1.We1CCantrtctbrTafarntatiott:
L1.WATER ZON[S-
Brian Ewing FROM TO DFaCRTPTION
�uctl{nrArtdnr Narne
4240-B
NC.We11 CoufmclorCertifwbtianNunbet AS.OUTER CASING(fni muhl-caged aYAs)OR LiNER iif rt Fcabkl
FRO\r TO PLkNIFTER, 7IIIC[u�tESS -T MATERIAL
SAEDACCO Inc ft. rL i I
Cno�:rnp Nor,w 16:INNER CASING OR 111BING eolNerrnrl clused-loo
FROM I TO DMMETER- THICKNESS I MATERIL
2,Well Construction IIyi.. it 3 TOCR. 15 fY. 2" SC1
-40 PVC
list alJr.,ppil.cahlc Ke1l panruts.(i e.CntrnMt Stti'tr.,-1'nrinrrcr,lf�ecb'p1 rtr;)
rt. Ft.
J.wel[Ise(checl.ivdi use): z7:SCREEN
Water so1 ply.Well; FROM I TO DLtinreTF6t I •51.OTSVT T1nM'NrSs TIATRR(At;.
C1Agricuttttrat 0M.Pliicipi7111�1tbW 15 ft, 25 ft, 2" ta, O10 SCH-40 PVC
®Geo(helntal ftatingXooling Supply) Mesidential Water Sttppl},(single) R. IL
❑ladustriallConmtercial DRcsidcnGal Water Supply(shared) 1N.-GROUT
FROM TO NIAT6RL%L- I E%IPI.ACnJ`0iT AFMOD NNIOt1NT
❑Irii" Lion ft, rl
Non Wiaq Supply Well:
it. ft,
®h,tonitoring. C1l;cco�rr)•
InJertton Well: tt.• fL
0AquiferRcchargc 13Groundls:itcrRcntcdiation 19.SANDlGR4LYeL PACK fit prlicab&c)'
'i'RIlS1' TO S1xrF;Rr1r, 7F RNIPIACEWAT\Ir:THOU
l7AiinikuStoraacarA)`l:mot'ety 13* inily Bardcr
13 R. 1 25 fl. FILTER SAND # 2
CJAquifcrTest �ISivrintirntcrDiatn ;c ft.. rr.
❑bysciimcnial Ttchnologt� bgithsidcrw 6nirvl
20.DRILLING,LOG(l umfi additional sheets if wessan•)
EIG:otllclnml.(Closed ,00p) OTracer FROST TO DESCR1Pr10N(ookr.bantuc".wt1'rnek fir li0m.et.)
❑Geodiermal(fIeating;Ctloling Return) ❑Other(explain under 92 1.Retuad s) 0 it. 15 fL FILL SAND/SILT MOIST TO WET
15 4L, 25 fL MOIST TO WET SILT/ CLAY
4.l?ate:NYell(s)C#niltleled: 9-27-22 We11ID#A4TW-S-03
it. fL
g1 INY111A1C3 iunf tl fL r
'r°~l Fi
Seymour Johnson AFB ft.
FaciliipVwncrNaw.e Fact7ite TWO{1'eappi6bJc) (
ft. rt. NUV 1 6 202t--
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft. ft,
et�l��al'A���S�C�te.,�naz��I ;zt_RF:nL�ltss �,
Wayne BENTONITE 11 TO 13
CtM,nt,' Pomxl 1r6lifu,,j1iuu No,(PIN)
ih.I ttititdc and.[�inlfltllc in Co ar dccitnal degrees: 22.Certification:
(if4ll iEald,t»rl la1.7p ia�fuffiCul)
r W Br n Ewi rig. ® 10/4/2022
Signature o recrtifrcd wti.l Contrxtdr Gate
6.Is(arc)the R'ell(y)t t7Parinanent or ETemporary Mr�i nin•lFis arm,..irerebr crrfe rhaf the n•r11.r t•,Ya ire)rawiruefed in aceordm,re
s h t Yt• (1 . fr•• .
with 151%NCAC 02C.0100 or•1 sA NGtt;'-02C,0200 u�rJ t onsrrrierfafr Srnrt imds and IJurr a
7.h'thisarnpairfo;mcxisti49ivcll•• oyes .or MNo capr'6j0,J1FreC0rd ashrrnptnrid4•draillr'iiedlmcitrr,
tJnSis tt_a n J�rrr fall e�rt Cm�irw i,'cft�xarnmlc7rrlrrjiamu rlrui 4raif r ti?labt rJ,c turmre ojrile
nprarrtem$erb"I rMaIksa x'frianoriv,the bait:e+,i'thdsfarm, 23.Site diagragi"or additional Nelldetaik.-
You may.6se a�ls5cb'of tills phi&to--provide.addid6nil tf,•ell site details of well
S.Number of xtells critrstructed: 1 consituction details: You otnv also attach'rWitionaipiages if necessary.
Farm:�lrl�fr b0'ey%4N(nr Rts%S4vrer fal!J,J,ti•iricll3 Oiti'LI'reed(rh,•.strma tviirstrirertar,}•tu,tvjn
.safta,itmvc,,i:rio: SUBMITTAL INSTUC.TIONS
9.6ial hell depth belazriand surftice: 25 (ft.) 24a. For All.Wells ;Subfdt this fmTn within 3b days of conrptctit d of well
F r attailrlale lrelh li,ti rdi4ep as trdoerefil tcxatn 7c-7 n 00'nrul'.' :Jir(tg con5tntcii0o to the foltnMina:
10.Static' water level hclow tap of casin . (ft.) Division, of wate-r kpd,urcty,]information PrE testeing Unit,
If weller level b above cviskg.tree^+" 1617 Alail Se i-viee Center,,lttleigh,NC 2760-1617
1l,Borehole diatncici:a•zs" (in) tab.Eor UtW- od Weds ONLY: in addition to sending die forni to lire address in
246 6r&e.Aw 6btuit`a copy of this fotill within;o da_�s•of completion of rvell
12.Well construction method: BORED Lons'itudioti to the following!
ti.e.auger rotate.cnbk,'direct Vasil eta.)
Division at'Water Rcsoti to es Undct ground[nJecti(}lt Couttrcil Prrlgra61;
FOR WATERSU•PPLY WELLS ONLY: i636 hf ril Service Center.RnteighiNC.27094636
13a Yield(gent) 21c.Four Water Supply&Injection Wells:
Method of test:
Also subdlit otte cope of tills fonit.within 30 days of completion of
13h.Ditinftxtian fret, Amount atctl conslntctibn to the cormty health department ofthe-cotlnhcic,:wh
consitimcd.
Fenn MIA Nonh Carolina Depaornent of£nvironnxta and Nautral Resources-Divi;Ion ofNA'alcr Ftesotro¢ Revised Atgust-V t3