GW1-2022-04900_Well Construction - GW1_20220525

�VELL.CONs,mu TiON-RECORD For irtctual Use ONLY:
niE fonncanti used feisiiiCieor tmil ipkrcdls
I.NV ell Contntctor Information:
14.WATER ZON0*
John Eisenlnan FROM 1 Tv 1 DF3CRIPl ION
WallCtxmatcurNatnc
4439A It. ft
NC�YcIIContiattiirCcnifieationNuirbct iS.OUTER CA.SiNGfrormulii-dscd'xcFlsIOR LINER iitn kabk)
FROM. TO nTv%IF;WR TInN CKESS 3TATERTAL
SAEDACCO Inc0 !t. 65 ft,. 6 in. SCH 40 PVC
CpufPaiiy Kallx tti.1NNER CASING OR 7 t1BING t ealk 7l11 CM,s d tOil .'
FRONT TO I MANFTI:R I TBICKNF.SS. I NIA7TRL\I:
2.Well Construction Permit#: 0 ft. 70 ri. 2 SCR 40 PVC
List uR rly,Jic,Gle kill permits fix,Counnt Susr,.tutor.:e,(rtt`e:dCfZ ra.j
fl. Ft. in.
3.Well,liselchtcl:well nsc): t7.SCREEN
��'atcrSuprh"Well:" FROM TO DI.ANIFUR! SLOTSIrr. TnICKNIxS I 111.ATF.RIAL
'ater Supply
tin' 70
70 ft. 80 ft. l 2 in. .010 SCH 40 PVC
0Gcothern)aiWeatingtoo ling Supply): ©ResidentialW.-arSilpply'tsingle} (I.18.GROUT
fL
t7hidustriaUConuucrcial ❑Residential Water Supply'(shared) FRONT TO NIATERIIII. 1 ENIPL%Cr.VENT SICHIOD&`AMOUNT -
❑FrTi 'uiou 62 ft. 3 ft. AquaGu:ard ITr—ie
Non-Water SupplyWell: 3 (1. 0 r1: Portland pour
❑blonifoting_ t]Rcco\'cry
injection Well: W. h.
❑Aquifer Recharge ❑Groundivater Rcmcdiation 19.SANDIGRA4EL PACK fit ,ilicabk)
FRONT TO' �L\TFHL\L- k�1FIAC.EVr:NT\71T11011
l7ARtiifcr.Stor.Igc.nJ.R`ccoicry DSalinity�Barrier 80 -ft,: 67 ft. SAND #2
❑Agirt,fcr'em. ❑5lormnalcrDmilLlac
ft. ft.
❑Expciimcntal Tcchnology, ❑Subsidence Control
20.URiLLI\G LOG(atucll additional slrccts if nccesvin"1
❑Gmthenlml(Clused Loop)" ❑Tricer. FRONT I -T(1 wit-•kii tw, till Vic,OM
❑pe tltCnllll(IlexiogL' )all11E RCWm). ❑0tlkr(ex lain w)der�u2(Rcumtfisj 0 :a... 80 ft.' I silt sand clay -
(t. fl.
d.Date NYcll(s)Completed: 3-18-22 Well ID#MW-34B
it. ft
$a;Wi11 Locattoo ft: ft.
ft. ft. ,. —
Facilit}rOl�i rNatra Facility iDn(iCappliableS
3900 Electronics Drive Raleigh, NC-Wake County 35., ft•, -
Piq sisal Addr.•ss Citc,and Zip 21.RENIARK.S _
Bentonite seal 67-63
Casntlr Parcel Ideuiift6aiionNo,(PIN)
5b.latitude and Longitude in dcgmes/minuiesAcconds or.decirnal(Icgimk 22.Certification:
(if�tctl fwld,wa:Iablong issitllici
3/20/2022
Si�tutate� 1 r Date
6.hi(art)the well(s): BtPernianent or ❑Temlioran' tt, ,isnb. h,r rv,ar.�r�� d� °r `s 'i��' t i gr,runclrTJ hi ion' ,
u irA 1 Sd NCaC f1�C:f; "t•:"CriC.;;X.n?oo Well Consirvicrion srnryfurds cuid;Jun ci
7.1_c this u repalrto in existing;hell;•-. OVes' or '$'NI►. ,<•7ii ojrPus rrrtird hri5 lh rn pn ucfed7n;h4.`rn`ll nunPr:
/jtSis'srn'JV,lr,filr e,•Cain���rtctf•csear:thus;;fair.'urreunurdcrpinhtdre,Ntrurc•r�d�r -_ ,"
re wirtuidrr PP2 nm.,rLsserliar,rrcv7 23 Site diagram or additional n64 details:
You tray,use the back of this page to ptot•ide additional Trell site details or well
S.Ntimlicrof iiells 6itn itucted• 1 constmction details. .Ybu"niay'also'aliach additional pagtis if uccessaty.
For',nirlllple kjr ell#11 or:rtnn'=u`r,ie r n,pph•trell:04VIA.tritfi rhr`some corestr,reffRn.}'rvr can
subn:ironrjarrn: S 1 iMl_� ITTAL11VS9' TANS
9.Totilvvell:depth lielow'land surface' 80 (D,) 24a.,.For All %Vellss Sub itil this.fonn within 3U days of completion of(Yell
FaY,te,lJflpJc k'i'I!s liar r7lJilrjAJlf��a j'i'rtnl(cxcmpPe•,T 'a 'ar>J:rt 1 'I') 6tistn1C1ion to thic,61101iing;
1U,Static\yater le\'d below full uFrasing (fL) Division of Water,Resiaurees,Information Ptncessing Unit,
If gala r h vrl u rrJ urr rasiii�,rs< "t" 1617 Mail Service Center.Ralcivh.NC 2 7 699-16 17
tiAlorchole diamcter:12/6 '010 tab.For iyIrSd8n Wellc ONLY: In addition to sending.jhl fonn to the address.in
24 1l>ove. also subinit'a.copy�of this:fonn:lvithiti 10 days of completion of licit
12:Well construction method:HSA/Mud COItStiudioti to the fyllaa'ing_
(i.e.migcL"naiar),cable.dimd push,ctc j
Di►hloa of Water Resources.Underground tnjeciion Control Program,
FOR,WATER SUPPLY WELLS ONLY'- 1636 Mail Sen'ice Clutter.Raleigh;NC 27699-1636
13a.,Vidd.(g \kill of test 24c.For Water Supply&iniMi6n Wells:
_Also submit one copy-of this fain) within+P_daysof Completion,of
I31i.UiainfeCtiiln"type:` - __ Amunnt• «•ell cousiniclion to the County tiCalth department of the coutuy.wherc
corLstnictcd.
Farm GW-t Nonli Cramlina Dcpar(ntui of Enviimiucacia and Naturyl Resources=D.Mion of water RmalrCF; Rcv'iscd_,tLgttst 3tr13