GW1-2022-10431_Well Construction - GW1_20221116

WELL CONS'IRUC'I'ION.RECORD For TnrcnwlttscONLY:
Thy form crin used foi iNgle of multipk na[ls
1.Welt-CantrstetarLttarntatiou:
14.IVATER.ZONES
Brian Ewing FROM TO op-scmprlo
We)tCoMrutorName fL ft.
4240-B 4- fL
NC.Well Cdn1mc14Ccfiftca1i6nNiurlfer 15,OUTER CASING tfni'nulttca red ncEfsl OR LiNERflfi.'e"licabkl
FiTOht TQ. DT.Adr&TER• TniG[iNFS5 hf.4TEPTAL
SAEDACCO Inc IL, iL in.
Cnnrpvt}.Nanrc I6ANNER CASING OR'TLIBING'1•ealb¢rmal cW€ed4ou'
FROh1 TO IA DSIFTER I TIIICkNCSS I MATERL4L
2,Well Construction'Fer'ini,tk: 3 TOCR,_ 15 rL 1. o< SCH-40 PVC
I�rPullr.�'+irnhlev,allpaimrts,(i:a..Cnrrnh�;£'rire•3'nrinrsr,II)reLtlplrlr.} --
3.'Nrell.lYsa(chccl::rrclldse): I7:5CREEN
Water Su(grlr•Rep
r' :, FROM• TO DT.AArFTF,R I SLOTS17f. I Tit(TlcNFSS' I N1ATFRt4%j .
,
DALukulhiTal ONfun.icipaMttific., ie rt. zs R. 1" in. :olo SCH-46 PVC
Mm(hennal(Hea(ing/Cooling Supply) DResidential Water Supply(Single)"
❑hidustrialfConinicrcial ❑Residential lVatef 5upp4'(slvir d) is.-GROG TO. lTATERLlL- I FN[PEACE7,104T 11IETr10D S AhrOLtNT
❑kii"ation
Nou-Water Supply Well:
®$tonitaring, ORCcmrry' tt.
Iujccliou Well:. rt, rL
C1ARuifcr"Recharge CIGrouTdTsliterReinckition 19.SANn1Gwt4EL41ACK[irapplicable)
'FROM 10 111A'MWAL RAIPLA(TAIEST\n:T1101)'
❑At)1t6fCr Storageaiid 9cc44'c1j' 17S91inity BamcT 13 ft.. 25 ft. FILTER SAND # 2
❑Anti ler'Test ❑Stomnvitct Urtiiiagc
ft. ff.
❑t,Xprimcnral TRhnuilogy Q8ub5idCK Cplittpl
20 DRILLING LOG(allach additiamal;t6cels it ucccssanl
❑G:s}ihenual(GlusedLoop) ❑Tracer .FROST 1.70 Deis-RIPY10 rmlor.lmr6c".wix'"tch 13 N, "nwc.dt)
❑G odwnual(Heating4CooUbg Reim) ❑Outer(Lxplaiu under#21 Retua&s) 0 ft. 15 f4 FILL SAND/SILT MOIST TO WET
15 (L " 25 fL MOIST SILTY SAND
4.16It Well
(s)Gdnipleled: 10-10-22 'well TD A6TW-s-01
(t. ft
{a.14re It t trcatirlue rL rL �" r i I "
Seymour Johnson AFB f4 rL
Fact1hyrfJwmrNamc. Facility IDN(ifappliwtilo) ft. ft.
1050 Wright Brothers Ave., Goldsboro, NC, 27534
Pltss`Tcul rtitdi3 ss City,,and Zip '21.REMARI:S r „ M
Wayne BENTONITE 11-131
('Qlrtil}' I�rca1 IlkntiLtC,�liPr1 NP,,(PIN)
at,1[4fitirdr aril T tjngttiidc in d4giccslminutcs,+seconds or ciccimnl cicgrixst o 22.Ccititir rtily
;l it:
orivt,t5tftt w.I;ti,7atrsN. trliieicfit')
>< wBean.Ew�_rg.. 10/4/2022
Siarntu t afCcn(flcd Wcll Centractdr Date
6.]($(lei')the\\'ell(9): I7Perrnanent .or %I)tCD1110rat Bv.signing ihir.fign ,f herebj,rerfify Mai The nrll{xJ vur f krre)cuminrcled br accordance
wial 15A NCACO2C,0100 ov 15A NCAC-a3C,03aa Reu G'oiriti icrfwr Standards and ilurra
7.Is this,a repair to an Csiiting velli 0SP�w .or ®N4v sf0jr.,6f r us ier&d 6;&+err'l,rnriam m4kr im11 tnvirrr.
lfffifr it o rrlxilr fill tmtklti,I it well ev»isriamrl�ru l+rjarrry rlwr d-id-esfib i ttac rw eaa of rile
repair rrmlrrOil n m rrCs av ro r ar an the hoii of ddi form. 23.Site dikiram'or.additional well details:
You[nay tise.t&back of dils pdge to.lpro\;ide additional sell site deta-ils;ar ts•r ll
R.NnkuUer ohve16,instructed: 1-
-tot,mrlrlpre s'up v ivi'fIs ON Y i4rh rlie.same ronstru4iwr,.3va(XID
•rnf,Wilt ane,�i:rTrt; SUBMITTAL iNSTLTCTTON3
9.Toi-d weul depth bctotc'land surfacei 25 {f1) 2aa, Fur All ;`ells,. 'Si bfidt rids ftitn) tcithin 3[3'tlapS Df'contptetioo of 1f011
Forrarrlrl�rJciicfJs'listrrtAif4lrlrsffd{y�ro'nlle1TmuP[e-de+'2m-(ants@t#R) c�u5tnrcCit?dCafhcfplGaTaia�;"
ib:Static water levethdom'top of eminw. 610 Dii'i.Kian of Water Re.m6rc't,informuttnii Prueessing Unit,
if ware`level li ehrrvc*Cdst ax a e"+" 1617'hlail Service Ce'nieri R:deirty,NC-27691-1617
11.Borehole diamet&;2.25- "(in) 24U.For Lifcctiori WcAs ONLY:. Tri addition to sending iha form to Me addrtss in
- 246 aboi'e.Aso'.Stibtidt a copy of this font within.id-da\�s"af completion of hell
12.W,�elfcorstniction method: DRIVEN eraDslnlciiudea;tl .[allo\iing_'
io.atr�l:rudaq',calalc''diiec!Iwsh cr.)
'Division of Ulat' ReaoutYeS.Uudergrouod[irjecilpn Control)nrogram,
FOR hVrITER SiTPLY'"'ELLS 0,NLY:' i636 hi iil Scr•sice Center;Raleigh,ETC 27699.1636
13 t l'icld(gpm) \7ctlrad of test 24r—For Water'Supply&injcet'ioia R'ells:
Also stib6iit uni:copy of this fotiii )sithitl 30,days.of completion of
13ti.f113ir1ftxttnn.wpef Amount: wctl cnnsrmetipn to the colintp health department of the.eountyivltoro-
constnTc[cd.
Farm GW-t Nolih Cwmllm Dc-partm m of Enviroruncut wad Nmittral Resources-D-!Yiston ofVlaterResotrw, Revised atgust 2013