GW1-2022-10414_Well Construction - GW1_20221116

WELL CONSTRUCTION RECORD Fqrlr*mW UscONLY:
This formcan bc,owd mUllip];svcHs:
1.�'Vill 6ntraetor Nforniation:
14.KATER ZONES,
Brian Ewing FRO31, TO PK$CRIPTION,
NWI ft. N.
4240-B ft. ft.
NC,Wc]]ContracidrecrtirkationNiu&er 15.OUTER CASING((44nuffl-6,wil"w 110
0 THOIX: TO OTMHUFFF M-19-111�11MIMI-Itz
SAEDACCO Inc
ConVaity.Nwiw iti.INNER CASING OR BING fiteaghtrib-al ckis;LJ4oaM
-FRONT---- TO DUAIMR THIMIUSS IIATERIAL
2.WalIConstivctionl'clTiwit0 It 15 Ft; 2" .11L SCH-40 PVC
liu 1rl1 alrlilicahle Hell permits ire.Carnh:,•Strilr!,-lrnriaucr,Ivy,-ertiarb ere:)
ft. ft, in.
17.SCREEN
Water S1111liky M.'ell: FROST TO DIANIF.TFIL I SLOTSUX I T111CKNFS1- I MATRRIM.
OAgricii.I.tuml riMunkipalftbl I'k. i5 ft.: 25 fi. SCH-40 PVC
06coftnital(HeatinglCooiing S(ippjy), OResidential Wi(cr Supply(Sil)L]Q)
01tidusffial/Conintercial DReiden(intIViter-Suppb,,(s]-ktrcd) I&GROUT
'FRO51 TO. MATERM, f.E,%IPLACY,,,MNTAtMIOD&,A�NIOUNT
13
Non-Wafer Supply W, 11:
llDMonitoring 13pecoveTy
Injection Well: ttrL
bAquifcr'RwhJrgd' 0dronnftilcr Re'nickafion 19.SANDIGPOLVEL PACK fir dplille;bbic.)
QAtloifcr Sioragiawl kcc'GvcTY' 'Milinily B,1ritice
13 ft. 25 ft. FILTER SAND # 2
IJAqu I fic r Tcit Ellsibrmlnatce brill0l,
9C
dEV- zrimcniii Ttchnt)logy pSahsidcri c 634wl
'20;'DRILLING tA)G(stiach nddifimal iNds,if pKes"' ry)
adeoillernial(C1,qsed Loop) Eitracer FROM TO DEScttirinox rcolor.hmrdtic",vall6pekt) w.)
I 13Gwiltentia.I(1•leatinp?CvoUtg Return) 13011ter{explain wider 921 Retuail's) 0 ft. 15 jL FILL SAND/SILT MOIST TO WET
is ft., 25 fC MOIST TO WET SILT/ CLAY
4."Date'NNPU(s)Cdmp I le�ted: 10-3-22 lD#A2 TW-S-0 1
ft, fL
ft. fG R F F Y.-D
Seymour Johnson AFB ft.
Pkility0b rNr iquitte Fac,t1ii),1M"(if4ppjj&aPje) ft.
1050 Wright Brothers Ave., Goldsboro, KC,. 27534 ft. IL 100,Hna�Uil PrC�C��r Unh
PJx)skH1Add6&Ciiy.and2�p 72-1 RErjARKS
Wayne BENTONITE 11-131
grecs: 22.Certifiraflow.
W. 10/4/2022
SivaaptrtqrCcttifixzdW.dlC6 Dale
6.h(are)the ON-ruianeat or ETeniporary
bhr srg;tbfg hereby ccrfify rljar Me ivell(s)P.:uy(�e�e)romflyefed iry;f1ceordnore
iviffi 15A XCAC.02C.0100 or 15A NCAC 02C.0200 11'elf rp)rsp7icr[o)Y Standards and Awr a
7.IN'thk a relisirtG an,r-xi,.vtingn'ClI: DYL-s or M.No rally 0,'MA-iecvrdiia;hir1j'pi#r4[e4 rq!jN,,uW1 newer,
0103,11 a mmlr.�Rf 4wr kw;Ko well emisinivion Jqforowihm avid explain r1jr outrore ofthe
repyirzo l i#21 remarkv.Wc4iun araq ibc.brrk c f tltts fnrnt. 23.Site diagram or additional will details:
You may,u§e.tli;--back bf this page to-plovide additional well site details or well
Consltuctioltdeiairs: "You'lliav also�a'flacliadditioiml pages if necessary.
can
safm SUBMITTAL INSTETMONS
9.Tiifiil Welldepth fie!*Iand surface: 25 24L For All Wills; `Szibfidt dais fdrui %t�Oin 36 days 4 comptclioli of wc1l
vwf �jdoe're�j;fe._(,To L kff wji�plr Ivelis 16i r"Oe ep*S 1PJ@."I
constniclion'to the folloviing::
10.Static waterlevel Below top Of CaAhW. kes'atire6,Information Prnioes%ing Unit,
if twet lqel Is altore,Lijifaxl ijm + RAlcigli,NC 2761-1617
11.Borebote diameter.2.25 _,01L) tab.F—nr[o[ .tine'Wells ONLY: In addition to sending(lie font to ilia address in
24a kove.also submit a copy of this-fortil witbill 16 dvs.'of Completion.of SWIl
12.Rrcll Co"Stnie.tion'tilathod. DRIVEN conStnictioni to the followhig-
(i.e.3ti-ger,n ary,,cablc' 6ect riusk etc.)
Division of Water Resources,Underground Injection Control VrogrAtis,
FOR WATER SUPPLYNVEW ONLY. i 636 Mail Service Center,Raleigh;ETC i769436
24r-For Water Supply&Injection Wells:
13a.Vidd fto�j) NIctliod'of test:
Also subffift on.-copy of ilds,f6in)„t1vitbin 30 d'ays.of C01110letioll of
'13b.Disinfiectin' wall consin action.tD the coiin"�health department of tiie C
a Amount:.— , I
c.onMicwd,
Faun.MV-1 konh Carolina 11 qamixnt.Df Endrojuncia aftd Natural Resouices-Divis Ibn ofMIniq Resmrtes fteriscd August-V 13