GW1--07876_Well Construction - GW1_20231205

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WELL CONSTRUCTION RECORD' For Irlernalllsc.OtitY;. ;
This form can.bc used for single cr trultip)c welts-
' I.Wdt:Contt:ictbeIntormatfono- • •
Iii. ATERZONFS. • . . • • .
Scott Hunt, Jr FROM. tO DGSCIriP,TIfN •
WcltCotitargorN7 n4 20 ft: '35 ft, tight)silts hard to determine
•• 4561-A f• IL I I
NCtWcllCam>aetarCcriilI i1tonNumilcr •
IS:.OUTER-CASING`trai-niuUlciscif b ORLINER(ir:ap�I7ea61cli .
. Mom.' ' 1 TO :'• DIAMETER, THICKNESS MATERIAL
SAEDACCO (G tt' (id
Company tiaci.C.- • • , _16c_t NER.CASiNG'OR,UJHflNG•(iroitigrel teTrrud4aiiil.'
FROM' TO . - DIAMETRIC THICKNESS'. MATERIAL
2.Wclt Constructiriit Fer'titit R: 0 R. 25 ft. 1 SCR-40 PVC
Liti'ulJrpyalicp6fcisrjfprnRils ti r.;Cputuy,Sttrr.,_Pnriarar.lr gOgi ct74 �' H . . _
3.Well i}'se'(died dl use); • 47:SCREEN - .-
Water Supply Well:' . - PROM• TO [ AMPTR:R -titOTSt7E TiIICK S rMATRRIAI, ,
ElAgrieultutal • ' DMtl]lieipaliPublie 25 it 35 R, 1 i�' 010 3CH-40 PVC
®Geotiteitnai(Heatinglcooling Supply) ®Residential•W,Tter Supply(single) ft. Ft. in-' '
L1ludustrialYConlotercial ®Residential WRter•Stlppl}'(stetted)'. •aBcGROUT�._. _
�ltROhi'. An. riirERt i. -ENTPEACEMENT METHOD VANI0IN'r
Obrigation" . . . .. . . .. .- 0 ft. 21 ft:'. •Portland Tremie
Non`-W.itcr Supply Well:. . . .. . .
• ft,. fh
6dManitori_ng DR.ccu.vcip. ,
Injection Welt: . ft.• rt. ' .,
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CIA.tiatferRaclnrgc' DGtaundwtterRciucdiatian 19 SANDIGILtVHLPACk(ifa(tptIeatlter - -
- •FROM. TO - Ntkru.RrAr,• • -RM1Ip1.ACihlENT HlTlipn •
DDAg Illtbr Storage and Record tDSalinity Hairier 23 fr• 35 Jt. Filter Sand #2
Eld 'kit Q tW 5toena Aijur tcrPr.,itrio c ft.• ff. "
• • ORxpet mental Trclmo(a tJSlibsidcacc Cenirel - 1
'.1a.DRILLING'LOG7ottseti iddltiuoitl shertsir rte&ssruM • "
DGeolhentmt‘Closed Loop) . OTraeer. •FROM' • TO DESCRIPTION foolor.hitrOkt+.siR'nxttgtfciru+nwa cO3
•OGreothennat(IIeatinalCooling Return) E Other,(explain udder.#21 Retnatl;sl 0 :ft. io ft, black/gray silts '
' - 10 -fr.; 20 ft. tight i,tan. compacted silts
- ..Date Weil(S)�Gauipleted: 9-28-23 ,�'CIIMt,PZW=13 •20 f4 35 It tight compacted•silts/pwr red
54 Well cu¢atinn: . n. tc, 1_ n;
Apex CSD Waste Landfill •. . • fl.. " 'ft,• ! .
1
Facilitl,OnocrNarve Facild)1DkGfapplicable). R. • ft. 0EC----012023- -- _,
5940 Old Smithfield Rd. , Apex,,NC, 27539 _ . • - ft., . . • ft, iR ry„ tC,n tPf4;: cj URI
• i'ittsicuf i ddrass.City:;ami Zile 1t:RLtt1ARKS' ' •• , . C>rvv0"8t0
Wake 'Bentonite seal from 21-23'
County Pane]ItdnfiCtcAion No:(PIN)
56 I>atiiudeand"Li?ngitaile in de neSifilinutcs/seconds ai•decimal ile#1'tiss .22.Cer'titiration: '
(Sumtt4td;one tat/long itc$014100 I'
49.kt,
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N• rV_. �; ' • 10/12/2023
' Sigh{• srccnct W'.1Cennnctar"; ` Dafe •
6.Is(trd the:weil(s);-StPrnnuneut. or IDTemporaiy •
Me slsning rhlr foam.-1 hereby arrtrry Oar the tie/16!Mar thi+roJ cW:Op:art;Jo;mx'orrlrmix
.li'irh"154 NGtC 02C;0190 or 154 Ncric O2C,02017 Well Cotu n,i hair Srartd reds mid alxrr a
• 7.Is this arepairtoancxiciin(;r,dlf DYe ,or ®Nu copy of chicrrrritrihytecnpioi'ukiro-brBullc'u,wr,
If ah(s:11-a/Oak fill ccrr.t;rioirh Well conviu tlorilOrmarlOn owl elp(adn the rurrure Of rho
riltrirfader$21'rcvnarf.eicliun or on the b J..Pf oily form: ' 23:Site.dlirrl,inn er,"additional well details:
You Oak.use tli'e back of tl`is page to prosicteadcGUonal Well Site:details,'or*ell
8:fiienlberof w con elt. structed: 1 . . eonsiruclion details; You May also:.nt:eft adtlitionot pages if ne essaty.
For-161 fe irdecrlmr'or,rove-xarrer supply'ells ONLY illrli rlre.sai r catr5rriirt ou,.you coo j
itcbntit orie/aim. - RUBNIF FAL iNSTEJCTIONS ! ,
9.TOtut O'dt depelr Delon land surface. 3s - . (ft.) -2!1a. For Art Weiha Submit this:form within 30 days of coiuptelion'of-Welt
For iiwlalplo i'e rift list all if prhs t fdl('reirt(exmnrtr-3@201'm111;201470) "eonstnictian fo tle fottosing; '
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10.Static Witter!del below top of easbigi 20 Ott) I)ii'isii i of Water Rerciup cit,Infornititign Eincessirig Unit,
ljmtder kw!!is aLare oattg,a ase""+" 1617 Mail.5ert'ice Center,Raleigh,NC•27599-16l7--
II.Borehole diameter:8.25"/4". -( ,) liG,For'Iiticctiori Wells ONLY: in-addition to•sending Alio form to the address in
24a'ahore.also subnut a•copy of;this.fomt within 39 class'of.completion of Well
12.WeU eeustncctiou,luetllod:HSA/Air eonsinictlou to•tlic following:- -
(i_a an;:i.stray,cable,.direct past.eec:i
Rlvi:9lau of Watee.Resources,,Underl r ound In Co jecoan ntr'o1.Progrdui,
FOR WATER SUPPI:YWELLS ONLY 1636 Malt Sers'ice Center,Raleigh.NC 27699-1636
13a In lcld(fi-- .- Method:of test: .24e.For Water Suli(ily.&Injectio�,Welke,.Also submit ono"copy of this-:feint}v1tlutt'30.daySofcotupletion.of
134.Duinfeetcnn type Amount: well cens:ruction-to the county Inapt deportment-of the eoirnty«'here• . .
. eonstnuted,
Form GW-t MrnhCoralina Daaparontei .oCEuvirotntratand Natural Resources-Division orttrater R.&tr -netted-AtrgLnt?013. •