GW1-2022-10432_Well Construction - GW1_20221116

-WELL CONSMUCITION RECORD For lrucrnnliJsoklNLl`.
This fortricall be used fi stnglkar m0lipk nctls;
1.Will 6t►tmaorlu$arnfation:
Ia.Ii;ITER ZONES
Brian Ewing FROST. 10 or-s(VIPTIO\
IVr)i£nritrularTtame, ft. It.
4240-B ft, ft'.
NC,WellCoritmdor-CertificafioaNturber 15.OUTER CASING(foi multi-&WiI-WCT)s1 OR LiNER1, a°Ticahk)
FRONT TO. DT,IDLBTER TlIiCK\C MATEflTAL
SAEDACCO Inc ft, fL
Cmrtjrutl•.Naanc- 16.INNER CASING ORI 18ING figeothyinat ciesed-loo
FRONT TO I D1,01FTER I THICKNESS I AIATERTAL
2.Wl ilConstt•uct6ni?crrnitjr: 3 TOM. 7 rt: 1^ d! SCH-4o PVC
IiFffrllrppili�iibJrv.-c(lpeinrft;-(isr..Cotrnh�&ftitC;'-lrnrinr:cr,fr}reC(l e1c;1 ----------
ft. itr
3.'Wc1t I>1sa(checL-w0l U iel. 17.SCRFFN
Water Snlglh•1Ve11:, FRONT r-TO I urAart:Tsrt I 51.OTSIZY. I 7J11(—CNr--tS aIATRRTAL
DAgrieultural C]Fitmicip-ITUlilic ft. 17 ft. 1^ i": 016 SCH-46 PVC
1lGeotherial(HcatinglCooling Sgiply�) EiResidential Water Supply(single) tt. fL. 61
❑lndustrialfConmiercial DResidential Water Suppy.(shared) I& ROUTFRONT TO ArATERtAI I E,1tpLACFNIENT]1fEir10D 4'A3fOLNT
❑hii;atinn ft. ft
Non-ANrat0r Supply Well: ft.. f1.
®fvtonttoring- ❑Rccnlrry
Iujcctlan Welk 1L (L
QAquiferRcchtirge 00rouridss;ncrRcritediation I4.SAND,'GP,%VELI'ACK fir artlieLibic)
FRnar TU DtA`rF;RLAL 1i1Ip1ACtAIENTMETHOu
11A401(cr Stora&-a id lkc: riI•c y' i7 ilinity 6aiiici 5 R. 17 ft. FILTER SAND # 2
gFitlirkPcrlest ❑S16nin atcil]r►maoc
ft. ft.
11txp:rimental Tbbnot9g, pSabsidcncc Co1d,Tpl
20,'DRiLLiIG LOG(flmich mddifiopal sheds if nccrrsury)
❑Gmther ttal.(Clusetl Loop) O.Tracer FRONT TO DFSCR4PnoS cc�>�r.n,nrric�:x>'nwk li ."�ntn ~rt.tK l
❑GmItennal(IleathepCoolfng Reluni) ❑Oilier(explain ultder#21 Retuutls) 0 ft. 15 fL FILL SAND/SILT MOIST TO WET
15 ft, 17 fL MOIST SILTY SAND
.Di.tt''Well(s)Cdnipl6ted: 10-12-22 4*yclllD#A1TW-S-01
i;l;AAWI Gicatinn: f4 fL . f t
6 P
Seymour Johnson AFB ft. fL
Fac,flitp' 'vmrNamc Fact1hylDmtifapPlicablej ft., ft. nib. ZL
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft'. ft. (fh`Or6iI531OS1;7f.�g„agyi7,�VOA
Physieu A�d6s.City.itnd Zip 2L REIIIARKS ^�
Wayne BENTONITE 3-51
�ct,tuL+ }?areC]1tl:riliC�G'tNtm Na•,(PI\t)
Sh,i ttihrdrand I aniitttli lA de�'rlC5In111tlAtC3I�CCnndS 4r tteeimRl ilc�rccsc 22.Ccrtwtioti:-
(ifult toeld pig lai'7pr is arc(iu k all
r ■.
N W 10/4/2022
Sia:nt , ofCcitilicd Well Cautiacidr T Date
6.Is(are)the well(o)r oPeruiAnent or .mTe►nlwrary. t)r.ris form;1Irerrbr rerfify thuf 4he n•rl)(r)was(i,•err.)crmxlrucfed itr accordimee
ivl;h 15A NCAC 02C,QIM or ISA A1C,0 X AZ01911'ell Co;rstrricdon Stnru(urds and dwi a
7.Lthi.Ssgrel. lirtuan•cxhtinrls'elli ❑Yes Or ®NII 'C�}�7y' f(hJ4r1C(r�YJ1ra;&,rirr;rxsrirJ:'dtoitr iWIimcitrr,
j#rt"ts Jgi rcd�i'r.fi't� r kT cniw t)t11-texurntcvlata htfMiWT wt and ewobbt rdit,nornre of the
arwrrr rusr/er ?l rrnvnrCs a rriun a ran relic hrcr E nrtPds fnrur. 23.Site 41agrant or additional wetl details.-
You niay use lbie bbeli'bf this p6&to Pride addlGonal well site detailS,of 1`411.
8.I1um}lcrof dells rnnstrtucted: 1 co»stmction details: You ittai also allac[fudrlitiolt�[pages if tt:cessary.
Fur irridrinte JgfcYrkut sir atta i-?Feuer W.14 Ir`i•its O,StGY wj1rh the some construetiar,,yMi trm
zsjwritur�e J:nn: SURNIITTrlL iNSTUCTIONS
p:Total well depth bclnlc,lan,d sttrfuce 17 qp 24a. lair All Wilk 'Sutlutit dos fdnil wi(hin 30 days;af completion of W611
For airy driph Weds Use�t'Pdi e drs Ira i rrni terar•btr;��?t>ai'zuud;*rep Jary constmct[t?n'to(kc foltci%ing;
10.Static water level,below tap of casiuw:, ((1,) bi�•is[tin of Water RCsbu rues,Informatian Yitieessin;,�Unit,
/firvttcvh'vel 1,ah.ae cnsbig am"�" 1617'11taii Ser1•ice C iitcr,Raleigh,NG-2'7699-1617
11.'BOrL110IC(Iiemctcr:2.25 246.For i ,fl;i WeIIq ONLY:; in addition to sending lfi form to the address in
oe 24 abe.also subtuit a copy of'this-form within,30 d3v's'of completion of u•oll
12.'Wcllconstnte-tloTitinetbod: DRIVEN constnictio►ttOtlu ft)llti{i'i1lg:'
6i.c.super.rraiuty,ccnbk. .lira gush.ctc)
pt►•islun of\Voter Resources,Undcrgrouud Injccflon Control CraQt-gin►,
FOR WATER SU'PPI:V WELLS ONLY 1636 Atall Service Center,Raleiah j NC27699-1636
l3a Yield(>;pm) i4fctltod of test• 24c.For Water Supply i,Inicctitln WClls:
Also submit litre"copy of this fonii.'Lsithin St);daysofconipletipnof'
department or
,1*pisinf�titian t�, Amaunt wc1i cictcil. Ili th e.Carmty.whcry
�'A I{•ctl anstini;tian try the conntl*heal,
cons
Fonn,G1V-t North Carolhia Department of Envimltn efu and Nautial Resources-Diviilbn of later Rcsotram Elegised August''2 t13