GW1--03244_Well Construction - GW1_20230511

' WELL-CONSTRUCTION RECORD Far Internal use ONLY:
This•fonn can ba used fun single or[midge wells
• II.Well.Cantraetor Information: •
IJc3WATER.•LONFS - '
Brian Ewing FROM TO brtteittPI111N
Well Contractor Name• I ft. ft,
4240-B It, ff.
NC Well Contractor Ccnification Murkier15.,OUTER•CASING Yfor`iiin111-rasid�sellsi OR LiNER'tiraii'lleablcl'. .
FROM 1 TO DIAMETER THICKNESS MATERtA1,
SAEDACCO Inc 0 ft. 22 fi. 2" ; ' in. SCR-40 PVC
C'ninput,-Name. ,Ii NNERCASINGOR-TUBINGa,int6er .iI tried-lonli_'- ..... - ,
FROM TO DIAMETER THICKNESS MATERIAL
2.Wd!Construction['er1eit#: .R. • ft, to.
Lin oil nppilic hlc rNrll pat-mQ1(i.e.County.Site,.trariare r,b,Jap'eel;qr.).
•
ft.• rt. in.
•
3.Wdl I:isc•(chccl:'rt•cll tise): I7: 6 ItF S EN .
Water Supply Well: • FROM I TO DIAMETER ' surf-sin I III ICHNi.s f MATERIAL,
ElAgricultunrl iJhltiriicipallt'ttb!ic 22 ft. 32 ft. 2" • in 010 SCH-40 PVC
l]Geotluemial(Iieating,tCooliogSupply) DResiideutial Water Supply(single) ft, • It. in'
©industrialCotitercial I:Residential Water-Supply(simred) ;1f OM 70 :.-
FR Ti). MATERIAL EMPLACEMENT METHOD .LMOUNT
LIIrriputian• 0 'ft.. 18 ft. PORTLAND TREMI
Npn�WaterSupplyWell: . rt. . . . . ri. . . .
Edtvlanitoring- • . ORceovcig •
Injection Well: It. . ft. '
ClAgnifcrRecharge DGinundwaterRenicdiatian ;19,'SANDICRA ELPACK(ifspplicabtei' - -- .
•.FROM • 10 MATERIAL EMPLACEMENT mEr/oOn • , .
❑Aquifer Storage aid Recovery oSolinity Hairier20 It. 32 ft. FILTER SAND # 2
•
❑Aquifer Test ❑Stotriiwatcrbrilliant: ft.. ft,
❑Rat.^drncatnl Teebnct[oln' 05lrbsidcDcc t;4itiml 40.DRILLiNG'LOG'(altreh•additilmul sheetkit ircee"ssnrr.}: '
DGeo'dlerml(InuredLiiap) •OTr.ucer' FROM TO 1 DESORPTION(c»tir.hnnrncn,uat'nickhtx.min v,dc.1 .
. ❑CkotheunalaleatinuCoolingReturn) bitter(explain under#21 Retuatks) 0 .14 10 - ft. FILL SILT SAND MOIST
10 ' ft. 20 ft. MOIST TO WET SILTY SAND
4.Date Wel(s)Completed: 3-30-23 Well iDi/MW-DE-1 •20 ft. 32 It. WET•SILTY SAND CLAY _
ia.� ell L(tcntfun: fl. ft. 4 kI -
Amanda Dew • ft. 'ft, MAY-1-1-20
1 A•1V�/ �}
Faeility,'C ntc hvmcrNu . FacilityiDY ifapplicable). M -1 1—ZQL'3
R, f1,
4100 Marshwood Lake Rd., Fayetteville, NC,. 28306 rt. . ft. Inrfof'F'raj4it i-r:^.Ca'Ei'i UrT:t
Physical Address,_City.aild Zip ' ,2I_REfnARKS
Cumberland BENTONITE SEAL 18 TO 20'
Coiinty ?reel tdattifl idea No,(PIN}
Sh,-1.iititudcand Langitudc in degrees/minutcs/scconds ar decimal degrees: 22,Ccrtitirativa
(if o ell II I4,oisi!along i,,srdriciese) '
• u
N w Brian a,nE of 4/12/2023
Sigmiur:afCenified Well Contractor Datc�
6.is(are)lie yvell(s)t YlPe lllaltettt or •OTenrlwrat}' fly signing itrk foim;.1 hereby certify that Ihr wdll's)one f1.1rh9 constructed ie•rityord cc
• with'ISA,YCAC 02C,0(09 or IS+t NC.IC g2C.,0200 Well Coitstirtrriai Srcordart/.s,rnd That a
7.Is this a repair to an darting well( DYes or No e iprof Mir iecorri hits•beea provided roiho sn*Id o'ui.r,
If rh(s tt ii rip*,fill tau 47:01'41,yili csane707(rriati htfi,rturkn con!t;sp(obt the Hartle.'oldie
rivair rude?Ai1'revu.ar serliun Or ivi the brick Of this.fern 23:Site diagram or additional to ell details:
You may use the,back of this page,to pro%'ide•additioaat well site details.or%i'ell
S.Nmttberof Wells constructed: 1 cotistiuctiun details. You tunny also attach additional pages if necessary.
For iirnfttple iofecrlim or orxi-miner supply wrfle ONLY with rhe.sarrie ecarstrurliou,you coo
se-Omit one form. SIIBNIFI TAL iNSTI.TCTIONS
9.Total well depth beloic land sttrfacet 32 (ft.) 2da:.For All Wills: Submit this fame within 30 days'of completion of welt
For,n„hfple veils list all depths ifdl7rrent te.ramp(P-3€.2'il.�'anal e@ no) constriction to the folloning:
N.Static water levet below top of casing: ((ti,) Divisitiu of Water Resources,laformutitin Ytucessing Unit,.
if ounce kid is above aisior,ille"+" 1617 Mail.Scry ice tenter,Raleigh,NC 27699-1617
I1,Bnrelnile diameter.8.25" - tin.) tab:For Infection`W'clly ONLY: in addition to•sendiug the font to the address in
24aaboVe, also submit a copy of this foutt isithin 30 days of completion of will
12.Well construction method:AUGER construction to the follon ire:
(i.c.abet;rotas,,cable;direct rush viva
Division of Water Resources,Underground Injection Control,Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 276994636
f3a Yield(Om) Method of test: 24e..For Water Supply Se Injection Wells:.
Also.submit one copy of this fortis within•30•days of completion of
13b.Disinfection type: Amount: well construction to tic county health depanrnent cif die coitnty where
constricted.
Font GW-t Nnnll Carolina Dcpanmeni.of Ens•ita(un:1u and Natural Resources-Lint Ion of Water R mutts Revised August 2013