GW1-2022-10417_Well Construction - GW1_20221116

WELL CONSn,IUCTION RECORD TQTS�;61�,ty:
TINf9mcan bc'uscd fiT sfuglovi multiple wvlls:-
I.I.AVATER ZON VS,
Brian Ewing FRO51 TO
Well Cqrirjctor Nama, ft, ft.
4240 ft. ft.
NC,Well CaritmclorCciliB ati&nNiiiiliey 15.OUTER CASING lro-r mulit-6411*0
LN
FROM TO DIX SETER To"T11XT1Wi'"P 1—IMN-1111.
SAEDACCO Inc fL, (L
.16.INNER CASING OR TUBING keolhunmal clused-limp)
FROM To DUMETRIt THICKNESS I M,1,TFRLALL
t Will eomqruction P01111; 3 TOCQ. 15 ft. PVC
isi 4i1applirubfv,wdffieh0;(fiek lryecdcn fir.) —
j.well.,usc
Water Sttllplr FROM 70 D[X%fF.TFR I THF(--KNfS-,, I N1ATKR1,%L.
0 A grfeu I Itural CllviunicipalrThtUiic 15 ft, 25 ft.- -1. • 4 6 PVC
0(icothennal fflaidng/Cooii ng Supply) ©Residential INTwer Silipply(Single)
0 lodusailVConintmial OResiftntial Watct Supp4-,(shined) Is.GROUT
FROM TO 1fATERFAI, EMPLACE-NMNTI1tL-HIOD.-.ANIOUNT
NaH 7NNIater Supply Well:
rt
chlanitodPl-" bRec.oNvy ft..
11ij cellou Well: ft. fc
Oftiilcr Rccharg6 [DdroirriNv'cr Remcdiation 19.SANDIG14,AVEL PACK(if aplikable)
'1[4013 70 mvr1;Hm, j P.M JA(X'%1FATN11-"1011
F-IA410cr Storage 1M ttccovcry' 'F-milinity Elih i
13 ft, 25 ft, FILTER SAND # 2 '
I
E]Arlv1krTcsi OT�k`�n"a i.,c
ft.
bE-Vcrimental Tw-linology Mubsikncd f-aWipt
26.DRILLING LOG taftAch ndifilionalibcdflf necessaryl
EiGeodienual(f lused Loop) 11Trjct:r FROM -To
ElGeothennal(HeatiqgpCooling Mum) 00ther(explaitt under#21 Remarks) 0 ft'. 5 ft, IFILL SAND SILT
5 ft., 10 (L SAND SILTY MOIST TO WET
4.'Dmfie%U(sK0Ildeted: 10-5-22 Wj.jljD#A3TW-S-02
10 ib 25 (L SANDY SILT WET
541:NN't.41.1,ocath.i m ft, (L
Seymour Johnson AFB V
Face it)•abivnqr i4attv Facility ID3 ffapplkab ft. k 2077
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft, fL
PltvMcalAddrus�City,and Zip REAIA KS
Wayne BENTONITE SEAL 11-131
Panel 10•,sdirtc4ifipii Nki,(P1.N)
5b,Lititiide:mid Otudc in dcgmcs1mhkjjtcFAcPoud-,or dcclh"l dcgrccs.
22.Certification:
-N %v -.13mil-n-EW-i-ni 10/13/2022
siinmum crCeitifted Well Cantm�lai Date
6.Is(arc)the well()- OPermanent or MiTemporary
1 . �ng,�fim fMf) "( r )By.%ii j iy1 s r ctmyirucied ir;6ecordace
vid 15A MCW 02C.0100 or 15,t NCtC Okh-100 Pr11 Cmrifrsicrkwt StamlarAs and Axi(
7.1 ,this a repaii In an editing 0Ve or ®No 'coy f 0if
reororyf fi47i.Nwj jimi-MIeW rq;.Axr Boll mjier,
I,trltfs is,»rr-1�1'r ill rear�illy live!!r�ruitrirrrfafa larfprraurrlon rrrarl ri�lalrt r1re.rrr�rare at epee
Me hark qfilits'form 13.Site diagram'or additional well details:
You may use iL-.bacl,Of this page io P'fo'%;ide additional well site jetails,or%veil
R.Number of wells constructed: 1 wris(metion de6lls.' You inay also.attacltadditioftai pages if I=essary.
For jrciitipfe it*c-rhm v�vrm-newer nip;ly ire?Is.ONLY midi the sanar oMstrwrim, <kr cATO
SUBMITTAL WSTI]TC-17ONS
9."irbial n•elf:dcptll WOW land sulfae_ (ft.)25 jolm F or liNviii1s; Subfidt1his fiirhi iiijbin 36 d vs of'c&njj)jcIi6u of W'CII
e,
For'malxiwje,�406,'iAifi ' construction to the fiqUoM n,--,
10.Static Water ICVel MOW top of easing: (ft.) WN"Mitni of Water Rev'aurcis,taffirmatibn Prucessi ng Unit,
11-vee level b,above w3fox rue"+ 1617 Mail Service Ceti teep.RA167ji,NC 27699-1617
11.Borehole 41izmctev 2.25
Jin.) 24b.Fnr In[Mijoll WdLq ONLY: In addition to sending the form to the address in
2 'A:q�e.also submit a.copy ofthis form within 40 d ;s of completion of,Neil4a
12.,WCH constructiolt inethod: DRIVEN Consttuctiofa to 11W40116%iing:
6 1q.anger.rola'q,cable,dixa push c1c.)
tur
FOR NVATER SUPPLY'NVELLS ONLY-' 1636 Alail Service Center.Rai.eigh,XC*2 1 7699-1636
13A Yield(glint) Method of 16t: 14c.F60 Water Supply k Injection Wells:
,
Also subunit OPP COP)' Of this f6fffi,ivitbin 30 da}-s o(completion of
13b.'Di inficefli n ty-pet Amount: well cominiction*to the.county kilkh dcipazintalt of ilie'counWwhcrc
conspumd,
Fami.CM-1 North Carolina Mpanuacm of Envimuncia andNaEuval Resources-DIvii Ion ofvlalerlle5pu Revised Aqua 20 13