GW1--05437_Well Construction - GW1_20240909

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple ad15
1.Well Contractor Information:
114.WATTR ZONKS
Rich Lemire YMOM tO 0166(1tIPtN)v
Wdl Collimator haute n. n.
2593A
NC Well Coraractar Ccnificalion Number 15.OUTER CASING(for muM(-easrd wells)OR LINER(U aAle)
norm I t0 ) ntsMrTTR TnuTi\TWS v\TTNl t
sARDAcco ft. i ft. in.
Comport)Name t 16,INNER CASING OR TIRING ljs'athereinl dn.ed-a..npt
rRlril r(1D15NtrF'R rUI(It.{+� NI NI II
2.Weil Construction Permit N: 0 rt. 3 ft. 2 r. SCH-40 PVC
1isr all applicable aril porn),,ire.County..Sraer.Variance Iqe teat n,.., —
ft.
1 ft. in.
3.Well Use(check well use):
1'7.SCREEN
Water Supply Well: .nom TO DIAMrn:R si01 stir tau t,v., st5 DRtat.
LIAgricultural DMunicipal.Public 3 ft. 5 ft. 2 010 SCH-40 PVC
❑Geothermal iHeating,Cooling Simply) °Residential Water Slpph'(single) ft. ft. m
t7lndustriat Commercial °Residential Water Supph)shared t IA GROUT
( ,ROM TO MATERIAI_ EMPLSCEMENT MFT11O0 a AMOUNT
❑lmgation 0 ft. 3 ft. BENTONITE POURED
Non-Water Supply Well:
R. n.
®hlonimnng ❑Rccmrn'
Injection Well: It. n.
_
ElAquiferRecharge ❑fim n undwatcrRecdiation .,i. q 19.SANWGRAVELPACIY(ifa . t -__
►'N0\t TO MATEutAt. IMPI.sI EMVNT MI-TIN)D
❑Aquifer Storage and Recovery ❑Sahnin Ramer 3 ft. 5 ft. SAND 112
❑Aquifer Test ❑Siormuatcr Drainage !-- n,J- ft.
❑ENtcnnirntai Tcchnotogv ❑Subsidcrt`c Comm!
It DRILUNG LOG(ratach additiaeai shirts if eecessars 1
❑Geothermal(Closed Loop t ❑Tracer nom 1 to nastiOPtnuNrt.Vr,harder,,,,.,i0nr4npe.woks viai.SOW
❑Geodknttal(HeatingCoolittg Return ❑Oilier iesplam under#11 Retuaikst 0 ft. 5 ft. RIVER SAND
ft. ft.
4.Date WrR(st fompleled: 8-22-2024 Well IDITW-2
ft. ft. _
5a.Well location: ft. n. ' f ` , . .a j,_ . ,
_t
OLD RALEIGH LANDFILL #6 n, ft. SEP
Facility)+Ou rcr Nan; Facilm R)4 of applicabkt p '` S 2024
ft.1850 Fayetteville St., RALEIGH, NC, 27603 ft, ft. Ir.I4;a;,;{„'r 7.
,1.. ... Adams.Cin.and lip !L R<MAu s D rr:.,0'2 t; a
WAKE
k'.i,u,l, 1'.n.,:l I&nl.l I..iiiail No.INN
Sh.Latitude and I.nngirude in rk 2rres;ntinutrstseconds or decimal degrees: 22.Certification:
Ul ac11 lick] oft:Ian I,,,..I.,,nlli.•..11
e,
S NA' e_. _Qi1r.r�ti 8/22/2024
Signalarc of Cent Well Contractor �q Onto
O.I..(are)the edits): 'Permanent kr IC Irm(irtran Bt'rigmng(his funs.I hereby certifyAN the Heals)tear(wort rato»n'red in acconianc
with 15.4 NCAC 02C.0100 or 15 A NCAC(12C.0200 WuU emanation Standards and that it
7.Is this a repair to an esisti.g well: =Ness or ANo ropy of thin record has been ero.'nkd h,shr Noll owner.
If MN 11 as repair.fill raft burn well r{norm rum.4m,u irnal aide{plats(rhr norare of rhr
repair ruler I21 remarks.,ercuan or,.vs the hark of this funs. 23.She diagram or additional well details:
You may use the back of this page to prostyle additional well site details or well
8.Number of welb cis fruited• 1 construction details. You may also attach additional pages if necessary.
For multiple injerrw,l of neat-n,vr rupplr Weil:ONLY...rlO thr.muee cuanrrrrrl.e n<w rsta
M Askir one fora. SUBMITTAL INSTUCTIONS
9.Total well depth below laud surface 5 (ft,t 24a. For All Wells: Slftnat this font' \\ohm in days of completion of well
Far multiple trA,Sr,dl depth,rf dtfterrns iananep(e-.f 200'cad 20100) constriction to the folkiwtreg
le.Stank water kstl below top of casing: 3 (DJ Division of Water Resources,hnformatian Processing l nit,
if owner keel a glover cube(.to - 1617 Mad Service Center,Raleigh,NC 27699-1617
11.Borehole diameter:8,25" sin) 24b.Far Injection W'eib ONLY: In addition to sending the form to the address in
24a abos e. also submit a copy of this form within SQ dins of completion of well
12,Well construction method:BSA conllmctiun to the following_
ti c.atHer.reran.cable.diced puck etc I
Division of Water Resources.Undergntund injection(-unity!Pni ram,
FOR WATER SUPPLY WELLS ONLY: Ito oft Nail Ncr\ice(ester.Raleigh,Si 21rtrN)-1636
13a Yield It!Pmt Nlcthud of test: __ 24c.For Water Suppls S.Injection Vieth:
Also submit one copy of this form nittun t0 days of completion of
11h.Disinfection ripe: Amount: - — well contraction to the county health department of the county oli`re
constntcted
Fenn GW-I sons Calabria Daponiti tit of Het n.t...:lit and Natural Resources-On loon of Wak`r Reiman Revised Atttet 2013