_Well Construction - GW1_20230315 (38)

WELL CONSTRUCTION RECORD For trtcnml Use ONLY:
Tbb farm can be mcd for single or oudtipk hells
1.Well Contractor Ileformation:
tJ.WATER ZONES
Scott Hunt, -Jr FROM TO DHSCRIPT1O1t
Well CoraraclorNimc ft. ft,
4561-A fL fL
NC Nell CommctorCenification Niu&er `15.OUTER CASING foe iaufll eired ecflsl OR LIPtER itf-a' [Imbkl,
FRONT TO ntna9ETER T1IICt. Ess MATERIAL
SAEDACCO Inc (f. fL [rr
Canrp:my Nam,C MINN CASING OR,- UBING' ikrm d eWsedaoo ti
PROM TO DE MISTER THICKNESS MATERIAL
2.�YdtCOnstiuctionl'el'mii#i w=o5o1112 R, ft. n1.
List all rM71 r able roll pen"frs fix.Cormm�State,:trnrinrrre.Ir}recD�eti-.I
ft ft. to
3.Welt Use(Chccic%Vd1 vSc): __ S[;KEEN
Water Supply Well: - _ FROM TO I DrAMETER I StAT517.F I 710CKMS6 AIATftRTAI.
C1tlgrfcultural, 0municipal tblic fl' R' in.
Meotbennal(Heatingitooiing Supply) OResidential Water Supply(single)' fL fL Irv,
131ndustrial(Conuumial I311csidential Water Supply(shared) ta:GROUT
FROM TO NATERIAL E4IPLICENMT AM11010 R AA10nDrr
❑lri-atioll ft. fL .
NOrt-Water Supply Well:
I[Monitoring [Mccoyccy fL
injection Well: R. ft.
[]Aquifer Recharge QGround9catcr Rentcdialion 49:'SANDIGIf tvEL PACT{far r Aicabtcl
• vRml TO arnxr.Rcu. HMPt�tiC9:MYVTMET190n
❑Agaifcr Storage and Rccomy !]Salinity Harrier
QAtprifer Tcst 1751ormwamr Drainage
R. Its
❑EV.crimcnial Tt o idology ASitbsidmi;Co»tnrl
"2o?DRILL1i11 LOG(allach additiond4cai if necrsmn
❑Geothemlal(Closed Loop) ❑Tracer FROM TO OFSCRIMOX h»br.hardnevi toWnrek rr fit.oWn*4 ca.)
❑Gmthennal(HeatinalCooling Return) ®Outer(explain under##21 Retut)tls) tL fL �:.
ft. fL
4.Date,Well(s)C1dmpleled: 2-17-23 VC111D#B-1-B34 (odd number '
fL fL
Sa.Well Location: ft, ft. '
Former Grocery Boy Jr #5 ft: fL E!r;a
Facility)10ivmrNanre Facility tDk(ifappli able) ft, ft, °""_` '`-
602 W. Chatham St., Cary, NC, 27511 R, fl.
P1rys9c d.Addgss.City.and Zip 2t:REM1IARItS'
Wake DPT injection through bentonite packed-6"
0muly lsarvelldenlifrcillon No,(FIN) boring
Sir.Latitude and Longttude in degmslminutes/seconds or decimal degrees; 22.Cer•tificaflim:
(Irocll field,Urta L•tfttong IS smmcktrd)
11 `9r 2/28/2023
Si;tutura oreeo<ir>�a Wen can ar Dale
6.is(are)fhc.ivell(s). rVennanent or MTienporary fly-signing rhfr farm,1 irer[l71'c•errffy rlirf rite nett(s)xw(Krnr)C7Jr1YfNCICtI 1p(aiY'Of1ilrl[Y
n0 Mt MAC 02C,0100 or l s t NOW 01C,0.00 11 ell Coustmeriwr'Srnrviards and that a
7.Cv tfL6 a rcpair to an existing wcll:' bYm or M No copy e0hif reeorrl bra'LYcn pmvr'rrM to 0m..Hell miner.
rfthls it o repair,frl oarbuiova reellvwwnrctlam brformrrdoar marl erpldbi roe tmrare oft0e
re7irirnrrlcr l rrrnrtrCy srcaian ar ar 18r.hcik of tiles jnrar. 23.Site diagrain or additional 99'eil details:
You ntay,use the back'of[iris page to provide additional%veil site details or isell
8.Nuntber,of wells copstmited: 17 cousttucti0n deiaits. You may also attach additional pages if necessaq.
Forrmalrlple lefcrrim orom-pYrrersupXv nvells MLY trldi diemeteceirsrmidotb you Perm
sn(nrtfrene form _ STI_tb1ITTAL iNSTUCTIONS
9.Total well depth belowland surface: 20.25 �lq,} 24a. For All Wells: Subudl this fann within 30 days of completion of well
For anahiple!fells.Rv 711 depths llrllffereait(e mmpfe-J@20'atul 20100) Colv5lnrCtion to file fotioning;
Ia.Stage water level below top of lasing: 12 (D,) Division of Water Resources,Iaformatiau Processing Unit,
if reaper level is above cuslttg,use"t^ 1617 Mail So-vice Center,Rulcigh,NC 27699-1617
11.Borehole diameter.2.25" ( } 24b-Fnr 1i111IS11 11 Mth.ONLY: in addition to sending the foml to file address in
24aabom also submit a coo of'this fort within 30 days of completion of tall
12.Well Construction method: DPT Lons fraction to the followille
0.c.auk r.rolaq,cable dileti pasta etc-) Division of Water Resoumes,Underground Ietjeetion Control Prop ant,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.V field(arm) Xcthod of test.• 24e.For.Watc Supply&19j9•ctioa WOW.
Also submit one copy of this form within 30 days of completion of
13h.Disinfection type: Amaunt• well construction to the connay ltc.l lab department of the county where
constmctcd.
Fa no G1tr-1 Knab Carolina Ueparintem of Em irarrtnom and Nantral Resources-Divi;Ion of RralcrReso.1i Revised August 2013