GW1--07892_Well Construction - GW1_20231205

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WELL.CONSTRUCTION-RECORD FUr livernailliqe9NLY:. • t
:170.fonn caithe.u.0 NT-.lined ci multipk welk- '
' 1.WeR.COMinetor ft:106'01On:- . . .. . .
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11:..WATERZONES.. • . . .
Scott Hunt, Jr FROM.- 10. DESCRIPTION
WOI COriliattdr Nentd: ' ft; rt, • 1-- : • . . •
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4561-A . . • .rci ft. j .
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"q&.OUTERCASING irahiattlizegitliitilii OR LIINERlifilD'MAIO' ,
NC.Wc1I Conftacior Certillotion Number
ETIoNT • • 'TO -• DIAMETER., THICKNESS • NIATERIAL
SAEDACCO _ftt, , _.:ft. I le.
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Couicanytiaeto, • ' ' - -16ANNEtt CASiNG'ORTUBINakeeiliiiiital eleicil-friejW,,.:-'.- _.. -•,.
most To DIAMETER ItMCFLNESt. - MATERIAL
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.2...WC.111 Coniyuctifiii Fertnit 4:- .• • . o •f!, 20 It, 1 Fli.L. SCH-4 0 . PVC.
Uri aft amificubfe t;reiif pe-410.(ii:egOiry,;SIghi„Ifilrialxv,frVe2ic4 or.,,r "
•R.; ; fl, ! ti.t., ..
X.
.., •- ,. • • .VV.till.1..fs (elteclOiell OSF):
. . 717:SCREEN . • . . .
Water Supply Well: - - EtatIN ER I,. . 70 DIAMET 1 SLOT mu TIRCKTIESS MATERIAL-
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20 . ft:. 30 'rt. 1 • ift;1 010 • SCH-4 0 PVC
CltigliCUliiltal. . r.Altiliidip41)PtibliC ..-, .-- • ,
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' DGeethennal.(HeatingtCoolin ti g Sppl Cl y) itesideittiat Water Sup*tsingle) - 1-
t It: 14,. ,
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DiudiSttiaLr Canuttocial ClResidential WatetSupply(delta) I&GROUT....io.
.MATERCAL.- ENWLACEMENT NIE1110D&AMOUNT
1:1 irrigation.. . , , . . 0 ;11, 16 ft.,. Portland Tremie
• NotiVater Su ppl$Welk . . ' , • . • • .. .
- Itikdenitoring . . Dliceovety .ft.-\. - .- •
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.Injection Welt:' - . - . , . rt. .
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liA9.iiitrAcchairge' 0iOutitinuter Reinediatiop. '19:SAND/GRAVEL.PACKiir optic:OW?,
. . • :Piton. •TO'- ''. M,ILTRUf.41.! -__ .ESIPI.ACEMENT METHOD
. • 11.2.0i0tear-S1090-04 keCeitky :11 .110150,134ri.4- .. 10.. '-'0.• 30 0.- Filter Sand #2
El Auerei'reit .
osioirtiivitePr4i0gc
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..:...M.r, n tea,al.- ohoso. & bOdcncttoOlnal. ' ' '•- 1-I'
iAn:DRRLING LOGIatael;adiltoeitt •
itieits,if itect--0 - - -- •
• 1:0e*nnal.( Itised Loop) L,-,-,Isracer•- "1 -- • _ - -nom 70 DESCRIPTION(color.hardticx+i.toelnick toGtettit Am:tie.1
OGOOlkttuallilealingiCeOlitIg Rid=). - lilibilter(explain u nder.iiliketnattis) 0 :tt,... 17 :.9, red/brown compacted silt - • . ' .
-. . 17 • .-11;,, 20 , . IC boulder
4:1:1titeAv
....;,iti(9:t.....:
. • . tatipletedt 10-19-23 4t411D#Pzw-11 - • • 20 .41. '25 • ft, red•PWR
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54:"Well Locatlork. , ,
25 :ft.,• 30 ft tan white Pilb- t•-- ..,...,r—)1
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• . Apex C&D Waste Landfill . . . . 9.. 9,. i lz VI—LJ
,-- . 7/ ....
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' •F011ityMravrlsituu4 ' FicpitY lijkli*pli'F'uhloi, : .
t.t. (I,: l Orr 0 5 '2023
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5940 Old Smithfield Rd.. , Apex,,NC, 27539 . . ft. t: - ft, . , • •
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P.hyStal.'AtfclssCity.,:,444,OD ' .2..L.Rt., 'ittA'Rics.• . . •
Wake • . . •Bentonite seal from 16-l8.
County•• •
Para/hbutitTotitiou No:(ON) .
' . . 51i;.);,;ititittle'ainl:LMtit Mileind4resInilitutcS/s'eefin04rdceitil•d*.t:;* •.,22 attii16,60,0, . • ..
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(Iti‘leii notch.0411 tat/loit Js.einliicio)
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W :W. Itilif,:11? - - •
10/1/2023
' Sigipt. :.q.Cortut..1,Villceittrqctof- DO4
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6:Is(4i•C)llie.'Well(S)I. ,EPentlatIettt., ..Or -Eriginporary • - •- .. . . . ...,. . .., , . - . . •. . • • .
try stgrlibrit&it fo.irry,;-1 herekv74.001.0.0ig!mire iyelifr).ivar OvOte)cvingiiKte4:4.441rvoniarice• ,
. With'.f 5,4.4VC4C 01C.;o10 or 1.4:NC•1- (PC;MOO.117 CoitierOciion Skiodardsiyid rlior d •
7,Isthis-a rePairto an e,ii4lnit ivellf. Oyes, Or END ,•vriyikof Mrs'irconi San kat joiwiffed raitio.ur iivii,lier,
. eth(s:Iv:a r,6a11",jib'or kpouvl will:co-mm(01°4 kfortoolon owl tixploOr Or norrirt!of rlic• - -.• - -
rilioir oodir 021.-reintirki':-.iiitiin or on Aiic bark.of MIA;ionic.. -23:Site diagrant-or additional well details:
You May.:use the bacletif this pOke,.tO7010Vide4ddiiiOtial well Site.details or Will
- ' g.$tatttherof•Welli eonstriteted: 1 . , _ consnuction delaili-.You may also attach additional panes if itecesS*. - . •
Par sitiliripy irdecrlOor•iiim-tubir iumtrice(ls.ONLY ii*If the.Saffif cOostruittoit,you etoi
igfloilt Or form.. • • - ' - SLIDNIrltAL INSTiTC`.11foNk 1 •
0.701-ilitell..ileptli belaiv land slitfake: . 3° •
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, (0.),72.1a..Far All Wilk". Submit d4 form within.39.days-of cemptetiott'of Wet!
For map*ireitslist iill•deptki(1'4740 ierooipto•-3€.21711'and.20 100) - • ' •constniction to the fOltossi ug:. - -
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19:Staticwatei..,level helOw.top.of easing: • (ft.) DiVisiiitt Of W.iter R60eirt61,'Inforniatien Fideessing Unit,,
'ifer.le I'd IV MIMI,eattog.iie,-"+" 1017.hittil. CiTicc 6Jiter,Raleigh,NO7699-i417-
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Ill barer:die diameter:8..23"14" tiu.) 141);riii•in jection WON ONLY:I In addition to letding.the foot to the adtiress.in
74a aloe*also submit m.eppy of 1 thislortit within 30 daYs of completion of Well
12.,Wclicoostructionmetbod:USA/Air consiniction tti.thefelloWing:-.
(Ia aiscrieamy,eihte,direct luskcCF:}.
' • , - - - Division of Water it0ource'sl,ithaergxouted ItijOitlan Cnotrel.PrOg*t,
FOR WATER SUPPLY WELLSONLY:' 1636 Mail Service Center,Raleigh,-NC 276994636
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2,4e,.For Water'Supply&linjection..Wells:.
11.3p,-Y1FIdtPot) •31eiliod of test: .
• - Also:sobtiiit one toiv of thit fain!within'30.tlays of completiottof- •
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well CoMtraction to the canny h'Ali-department oe the eoimly.t.where.
•134,,ilisinrcetiva,typet Aniount:
. conStructed.
Pena GW,-:1 Nonk Catalina tkpartnient of Enviretuueta pe4 Natural Resa axes-1-Dhis lint ok Water e'etst - Revised August 2013.. •
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