GW1--04220_Well Construction - GW1_20230706

::
WELL CONS I RUC l`ION RECORD t 4i:It*nt:l1 tssr,'ONt s'a
'Rti_s,fori9can:tic(i$0 1 c'tpgf nr nitiltrpk Weds' (, x
1 Nell Cnnlrictur Inform•lt tuns V\ `
14,: ATI RZONl.b:_ : ..:'<.
Zach Thompson ' FROMP 1•TU i, uiCiCRUPTKIN -
O.CPr4ricli+r;t`n*tnti; ft. I ft. ,
4478A ft, I fr. I I '
• NC\ JICo: �1ortenificittunriiiit�cr - pi 1S.'OUTi:RC: ING:(forawitt-c 61'.istli>_OR11hk:Rfttat)olica
uri ble) ;--
1-:FROM1 .1.TO •DIAMETER 'Tt11CKNFS-S ,- -\l.{r1:R1A1: 1
SAEDACCO Inc ft.�. 11:. is i
<iiiripito l;inip, i 1U.11INF.R C 1SI'vG OR'L t1INGU,Sstb renal t:tuctdau y9
. FROM I lb DL111ET ER Tt1ICKNESS }Lt1Ef lAL".
\Yell Co .sttvctimi:Pci iitit,#: WM0601261 _ -0 fi,. `5 fti • 4"• :it SCR-40- • -PVC ..
1.iA c:11 G,p0crrbfr i•.cll pr1)71'6,l(it!:Ctnih:$itrlr;lisriaitt-c;_lt}`sctiut rli J" :ft." ft:- :- lire. _ . -. . . -
3;\\'dl itac tctiecl.ss•clt uce);
1VatcrSupph-Well: • - 1.FROM -i•:TO .nrAMF.TrK 1-si.vT.ur1 I-:TR1(KXJSti 4.uATERt3I,.
' 5" ,fl 1 25 „ft: 4" 'iii. .020 I SC8-40 I PVC
I JAcii vltur,tt- LJ11u ncip.il Titbit,;, !!!
_. _ -.. fl.: i f4 in I
OGeottg vital(ileatinJruC'oolinf.'Siipplt•J iR sidzntial\'i at4r Suplilti tsint�te). , f - I I ] :
LlindtistiialiContoicrc al C1Rcsidential\Viter 5upjlls`(charcd} tR:CROUP a
• FRO11 1 7O MATLRLtL !•EMPLACEMENT ME:1110R A,AMOUNT "•
❑frnratlnll..- . . 0 ft..,I 3 ft. Portland 'Gravity
. .. .. ., g
14an-1b iti:r.$tinii,J'W.C1h•,. t. h, i.
• ❑MoniIonn . SOlicccnrn•'
injection Well: ft, ft I
f7Atjiufc(Ruchart,c 0Groiindtritcr RcniedtIlion 19 SAND`(:R iV EL 1'AC:1i 1d ak,G.into - " -' `1
FM/NI 1"'TO ' i SIS rE RTAI .. .I.VP1.,'.(:,.I STEM AIFTOOD
EagiuftrStoi;ihc II61R'ci-oscr�• 05Tlaiitt R;irn,.f'
4 ft.s 25 -ft. ,Filter Sand #3
0&girifir Tccl 0Sfornlst Itcr Dr91t19�_.c- LI + 1
ft 1
0Exp.,rinicntril is hnoto 17Mibsidcn..c Coitrol- .. .
J 2(i:•DRIL1.ING',LOG(atUch`addifionitl sbccfs if ticccrsan5 - 1.
DCeotherra1(C1us:1t.Loop)` 0Ttacc-- -FROM .TO 1•fllSCRTPti0 ua tr,i,nntntw., aiV,.wl.ttN trainvwact(:i '
DC,otitcriiwl(I1.Stine%CoAIii'is Rcittiitl. DOthet(rspi iii.under4Il Renini;3) 0 :ft;• 25' -ft. Tan/brown sand • ,
11., fl.
4 nett!,%U(s)CglilpletL11 6/13/2023 \\e111DaRW-1 . . .
!t.- fti
tea:\%dlLtcitiun , (.-
Eugene Ezzell Property t = ft.• ft. J JB ^ : 4'23"Fdililk Oc :rNairr: Fdciln 1D°(if pli.zIhlc. — ,.
ft - ft.9908 Dunn Rd., Godwin, NC, 28344 -
a • rl. In6aut=.7Ciefl?i•oo;,4e4!e,g 1;1 :i •
PJnnxal AAddr s.Cit. tnd 7i-O ,21.RIM Rli+' ---D i'P, -
Cumberland - Bentonite seal from 3-4' i'
friti.v.i)."1 l:';rre1 idaiiificalti?itNo;(PIN)
•
b'1Huihidcand I nngttudc In dcgmcs/in nutt•stactonda or;dccim it`dr1,tceS, -22.t?cf1fficattod�:'
til'-(cli Id,illy I t Iiii a 11.4'i6fli"I.rtl) •
• •
35.2162 N.. -.78.6775 AN _ 6/15/2023
• ni Si� lii of l Kifir C,n d't.cil lrr i,l .x. _DM::
6.h.(am)fliea«II(s};;'30Pi nnenmt or"::JTctnporar}'
Hi yrgtii ig t rtr•6iltr 1 lu rcht r rrt/�.00.0•thr••irdli.l i.tti{s-trr j ccnt�tru tcS.,:_p c6;ih, i-r
t i •.1.MI SC,IC:0'C 010(4 of I51 N AC0 C.1120'ttl%it:C,Tr•sti;, ii i sr ,tare,f and ila,r�r
7 Is"this a mien to an icustinl::,,'0l: �,�ti is or $N0,- t -Ar.i' Si,,ri'onl i.b1,.:-t(iti t i,i,td rr hr ,0i'; rOir r,
1 t1t.:`, i ,i f . 1 /}7 i
/ N fr,fill4a�,r ti`ndismi�t�ts�{tt�tzr icrniil rp>;rt..ti4rul;x Gaff,TIiR'tkrrt,re7ir:
rew,.ii:fai rrtS21.nJnarlsSY4i; rsre.UitL h,..t iiftlirkfornm' - 2.3.SIt1dralttaiuor idilitiunatnl:cildetuls: _
\-on may use lit bank of this pa0 to ptos.id jtddiDollal\sell SILL,dOiliii'oL.
r trill.
8 ..I�iirnlicr:iifVellsi.ciiiislrtuted:.1 , _ ..c tistmction.tlklails;.\tdil1015 iluiatnich'additiotiail`pAgs ifti:cessar}.
F r'rntilit,e at{rwn to u,A'it o,r,9ip.,,i it c llx O1\1 k ,i'Irlrfli,-sank itinstrttctIOii t s t tot, -
s,:5nutr,c.,r„rr.�, -sh13!!U i r,w,NSTCr("rIONS'
.Totdt tt ell dcptlt litCdis t Tttd iir fdu':- •25 '(fjc) 24 i. For All:\<<Ils Submit fli s form ss•itlan .zU
'9 • .d i s of;conlnl thin ot'sr ll
For itvlilplriccil,4s,,it7;a ptyrjal1;i.r nrtt:ti44t6.,ti'?-10 rind:2€1O'Y - colistniclioil(o:tho;folloitiny;. • • • '
lt);:Static syatcr level l elusv t°iio,ca+rn;;::r 'OM11i•isturi of\%4Lr Rcsnurtc t;•lnfornra iun Pniccssiil Unit„
• 1J rti r+t li_ir1 tstt;c,c,Yl t,g list:.•'+•.' '1617 Mail Scrsiii.(enter 11a1c►,.tt NC 3769.9 161
II:.ltntelnile iliametct-,10,25" {in.) lib..J For ii ji t.on V.clh OV II in:lddoton,to sendingIN!fi)nn to 111 adtdi:• ;_in
23a'.tbos'e.•also ilibtiiit•a Lops of tills form \.Inure.. 0 d.tss:of coltltilettolt o1-'nti-11
• 12 \Vc11 ctittfitniction nictltnil;ESA ,•cotistinclioti ti!`llk•folloituig: '"
•
fi c ii cr ratan•,4•ible.dirct,t push:ctc.1 - -. - - - -
"Pis-sioit of iYatci•RLsont ce-i Unticrgi outrd lutcctior(:Control Pi•tigriini;.
FOR.\VaTER SUPPLY'WELLS ONLY: 1•63i'Mail Si:rs•icc Ccnlcr.Raleit;b;;YC'276'19:1636-
13 t.,,.•r.dd ruryinlj.. ,1lctiioil.
of test: 2fs.For V.iter Snpplv..&intcit itn\ells:
- Also subrntt S,n co{ip'of tltls'fiiftu u itllin sh d iy4sof wmplettan o[;
• iscll'cnnslnrction tolhr Lnunt}�`health depanrn-'nl'`of:the couttl.r*litre
i3- - 'Uisniiufiuu ripe:;,,, amuitnt:.d .. <e.a..,._.....-_ itnr4mctst1.
FpnnClt .1. -N011 iCatalina fkpart ncnt:ofEti ireuniciitsrttiNatnral ftcsourccs- o Diviiionf%lerRrrolrc ft+is.-d.:\ugttst2t113