GW1-2023-02634_Well Construction - GW1_20230410

'*ELL I
ELL.CONSTRUCIION RECORD FoaEt iailtlsc.0NLY: '
t Th(5 form can he used fur single at tuoltiplc ndIs
If.Vi"cIt.Cantr tctnr frtfarntatiatt:
LLAVATEtt2:ONES
•
Chris Ruffer \ Fl4011 i to orsattP11nN •
Weil C0011ctorMime- • . R; ft. •
4223-A w:..3 . .1.,t 1 . rt.. tG '
NC Well eonftnctarCcnifi lionNwr et 'tS''IDTER CASING tfni'mafli-ctsariict1sl QR LINER tif.an ncaRkl- .
pPR. ® Z�Z3 FROM • ' to 1)1.43 ,itiR• 1111chNESi NtATEAtAI.
SAEDACCO 'Inc l! 0 •f4 50 fL 2 'in. SCR-40 PVC
Company Nan - '):- '• :L6:INNEltCASING'Olt:1118ENG'iiijintkcrm.t'eDuud-lonjit ..
< most . TO nrA3tt±'6ha 'iLUCKN\ESS SI�LTERL L .
2.Wd[•Construction Permit R: Tn'' r y , _ _
R, it.
l ur oft r itirpble ter/1 pcitei,••(ire.Cpunty::Sttttr...Variaa e.14-03;f0.cit.-.)
•R. tG ire. .
3Alrcifilite{CfrCcic.i rill014`): • I7:SC'REEN . . - - .
Winer SuppFvWdL - mcost 10, -nmAatET1R t srlrrSus: Tt11CKtirss 1 IIrATERrtr.-
ela ri:rtctllfaf C114ltirdcipat/P iW1c. •50 ft- 55 •IL: 2" ins .010 SCH-40 PVC
IJG:otln.nmt(ElcatingiCooling•Supply') pies dental ElraterSupply(single) ft". ft'. ru.
®IudusBrial/Conwtmcial taResidenteal Writer SupplY i GRt7UT: _,. :-
PP15(slYtrrd} FROM i.to._ • . araTERIAL LTJ[PLACENIENT MEir OD&ANIotrvr
't3Btrieatian• . . • . . . . 0 R. 40 tt, Portland Trieme
Natl.-WaterSuppl}Wit:
' . 551',0niipring • . f iCC4i.t tg R, ft.
IttjeetitItt 1,ill •rt,
flAgi(cfer Recharge. - Cltiiottiidtf:ttetRcincdiatian ts:SANE)CUAVIL1ACKiir�niydi hr,.t:° `-, _ - -- --.
- .-.Ft4u 1 ' -1p"- MATERIAL NtpLAcint&:\T cireetOn -
lJAgiufcrStOragc ID3 Recoscig' IDS,dlinitt R'trrier. 48 R. 55 R,• sand #2
ElAquiferTcst E1Stornin-atcrIr;lia;7ge ft.- ft.
DHSTeri ncnial Teehncitot - ❑Sndsidcncc.Catdrel -I( DRILLINGLOGialtichradditioniitstrcetss ess if .
i7Geotltemul(ClosedLooO DTrdcer I FROM TU nrs'sc r TPUN(wtr.hardmi.i,OlVitick Oracidltu;e.cet:I
• DGautlietlttal(€leatittgiCuollne%Anil) DOtlter(etipIain wnier:#2I Retuatirs) 1 fit- it,
ft: I
-1.Date Wett(s)-C Ilrleted: 3/14/2023 tTry+ LlD#SMiWU350-MW38-55
' ft. 'See Gott'a Notes •
S t.%f ncatinn: .fL ft,
Camp Lejeune SWMU 350 ' it., it, -
Facr1itytDunc.rNamr. . Facility IDR(ifappli:S61e}, R. ft:• '
84 Iwo Jima Blvd.,, Jacksonville, NC, 28543 ft. ft. -
Plns,cii tlddnss.City:airdZip 21sRi_iilARK " . '• .
onslow Bentonite seal from 40-48'
•
t;ttettly . . - P rccl 1dt irtirtr ai orr No:0'111) i
56,Latitude and'I:ongftwrticindegt s/mniutcs/seconrfsOr.deeim.Fdcgirts: -,,:e tcntiaen:
(anent lucid.one i.•W9onk issafrleicnll It 'W. Chris. -Rufr:e 3/17/2023
' Signitur afCcitiH Welt C Date antrrctar'
6.iS Qptre)aho'tcell(tti: 701?ertttartettt ar C1Tgntporarvily.sighing th:: no-P herrhyanrti i'that the rirl){s)ruts it.avet arattnircted La eret:nitrecr
rill k 154 NCACQ2C.0.190 or 154 rCAC 11I 112C, Q0 Weil C'ofrilascsion Sraraicrrrls crud Aim sr •
ti 7.IN this a pair n tat a etistin„well!: i�fcc or KNo 1-41rofrlydx r rorrl/tns firm 7imritted Mlbe err/l mrnrr.
If rlris.is o O'il.h fill 1.9r krroiwi lett('row/timLNoti ittkro tilen andt.ipfln the.rum re oldie •
rc*rirwrrleri 21"rctnartsan irera uriv'the btiek.efdiii for.ii 23.Site_dui ri'8naiar_iulilitionitf well detttifm
You may.use the bark of this page Co.provide additional well site details:or Welt
8.)tiutherof'teens Coatstrerctecl: 1 . ' consutietion details. You may also attach additional pages if tmcessan•_
FormairoOalaietrltotarrich-aeversupply aett.t ONLY a J'the.srreteettirstrurfiar,Youeiso
.vannittri�e pan. - - St1DAIiTTAI�iNSTLTCTIONS
- 1).Ttotat Well depth En:WWIand stiliac% 55 - (ft.) ?Ai..Far Aft Wc11N. Siihtnit'this font within 30 days'of completion of well
For'multiple'iiAls isr alltftpd)ri•ifdf1,rrrirt tcrt piptc-.7@2QQ'(xril.2,g1 Wily cons niCtion to the tultoniud: -
1(t.Static wttter.levet Melon top of easingi • M.) Divisiuu at Water Resources,Information Processing Unit,.
If miler 4414!S above'easin;etsc"+" - 1617 Maetit$ -icc C titer,Raleigly NC7127699-1617 .
U.Bareltote diameter,6" (in,) tab.For linievion WO ONiLY: In addition to-setlapg the form to the address in.
244above,also submit a Map at this font nitltin i0•days of completion of Welt '
•I2.-Well concrrnerroo method: Sonic . constmctiort to the fiillowing::
(Lc.au-gcr,rodary,cable direct push etc.} •
. . Divisiott of Water Resources,llndergr•ouitd Injection Control_Progrram,
FOR WATER.SUPPLY WELLS ONLY:' 1636 hint Serviee Center,Raleigh,NC 2769t11636
[3:�add tin) 1ti thou of test 2de.For Water Suiiplt;.&Inicetioti!Wetts:
Also submit one"copy of this fomi Within 30:days ofcotupletidrlof
I3h.Disinter_:tiun type: Amount 'well construction to the county ircaitlt department.of the county Oleic-
constructed,
FarsGW-t N:onhCarolina.tkpaianrenrofEtnimnmcnraruiNaturalResources-DitiftioaofWaic RiOtrtts - Revised ituuust1u13