GW1--07879_Well Construction - GW1_20231205

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WELL:CONSTRUCTION RECORD. FOrfiternal ti4o pNLY:.
T115.1.form can ba•usOcl fir.died or multipk wcI1 .
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' . I.NYCII.00titi4aiit Information:- • - ' • I..
• t LAVATERZONES
John Eisenman FROM '' 10 OPSCRIPTIoN
Syin Cgtilotetot Name, ft; Ft. . I .: ' •
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9439-A .
NC Well Contractor Conification Niudicr ASAUTEft CASINGstfiii*iitOtti=diiiit\ieffil 0 R LINER tlraii"tIcable)-, ,.
now ' To .• DTAIHETER", THICKNESS . STATERIAl.
SAEDACCO . . . . .T,L. . ft:' LIE!'
Compas)-Name, • • - - . • • 7,163NNER.CASINGORTURING•lkielsOnnit'elloici1-loiinK,v. _ ,. r.
• rin eit 4. .FRON 'TO DIAMETER HO:NESS MATERI
2.WelCorttcitrn AL
0 'ft, 40 ft; 1 1 'Ett, SCH-4 0 PVC
Pieliogago14...s•Fe4penit.(4.(i:if.piney;.4.1.0i,%rimer.,fry-ecrio)44,74' . ! ..,
- - •ft- . .. ft, -
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3..Well..iik Meet:lie-11.0pp- - .
17:SCREEN. ,.. •
Water-Supply Well:• . . . - now To. • otAMETER'. St,OT SIZE THICKNESS ' MATERIAL
. ' ClAgriculigiai •
ciiiiiiitiicipallPitbfie.. • 40 ft* 50 'ff. 1 'la!' .010 SCH.40 PVC
"• - ' '..le.I. ! - . .• • • ••-
ElCmothemlat aletitiligiCooliog•SOpply): . esideruiai-Wat S er up*(singe)
C3R l , . . . .
. ClIodu.4021/Coototercial ClResidenti4 WatertSttppli(strtreil)' "ZoGRm,°11T'.„-io.
MATERIAL ENEPEACENIDIT SIETTIOD sq ATIOLIN1' . .
1:1 Irrigation• - . . . . . . . . , 0 ::ft.: 3 6 .It. Portland Tremie
No n.41.,4tet•Su Op ty Weg:1 . - . . . • - . -• • ' • ••
• ft,. - • ft,
RflOoriiigfit* - . Egtegym . - • e . .
_ ' injection Weeit: . . . It.
' CIAAlli1C111,C0iarge - - ' CIPiOutithRIICIr
. l.: . . , -. - . ...Rq•.in Oitop -t9SAND/G
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VE L•PACK,.•firIaP:tTigEilRieMtht-e -E.MP:L' M-E N.T M.E.TH-O- n..dAt fgrgloiRe Ob 1:&il it Oiei
38. •ft- 50 IL Sand i #2• ' '
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. tl Aritifei Test- ElStgigiikiitcf Prlitijoge
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bEs*tittlettiO TcOn.g.:!gg- 13$4§ittoticeConitol, . . .
_ _. . ., .40:DRILLINGIOGIallielt,ilddltioftitl stiOileilocctistir0
. .•. . tgebiltennitt(Plo.sed Loop . . ,tiracer. .
. FROM-'. TO . -- ogsenivroaN tolbbr hant tom,tkietiNt4 ow:lel&4A.k.dr.) •
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1:1Geotheintal(FleatitigiCaolfog.'Retunt} Mother(explain untler:#21.Retumits) 0 :tr.. 50 It..- ,Silt/san 4/clay
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4.4: fL
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4:Dittii.Welt(g).Cattiphiledt 3.0-4-07 3 Itte11116#P;w-7 _.
5 2023 • • .
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5:1.Weil Locattoni ,I:4 ft. ..-...
4.
, . . Pr.....1.0;t... Plifit.„,
Apex C&D Waste Landfill . . .rt.- IL "P.
FacIliiy,Kiwtmy NmuC FON*Iliiii(tf*p*bje),.. __ __ . _ .. -
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. 5940 Old Smithfield Rd., Apex, NC, 27539 . . .
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.. intrirr.-:.--::, -
Pilit)C41- -AikHf.45;.CiLY-Akicl PP . -2,4 RENTARKS-• 1 . ' . - --51T4'.92 L'il
Wake • . Bentonite seal from 36-36' U.:•,;Q/140G .. -
dually• . MMOI IckNaTrplIon No,(PIN)
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Iii,..1;irifititttc and Longitude in dcgreeliminutesistrOnds.iir-dctimalifettieSt ....., e.._.. t.- .o.
4.:•.:,;.a.WIC/300a:
(IN:ell rietti;()tie latnekt ts•sittile.1:10
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N 147' _,....:a,,,..-:":„„...,-.-----• .1.--'--.---.7.4:::::.-----_ 10/26/20,23
ggli=ii,...inc
Si&oluttpi.,...1....i,i'• ,' 0. 4--- - Ode
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6.Is(art.)the:wellOt'VPent4utt.,nt or pTempproty ity.4.0iiiii.erir las aa5Pkii6..°1-1,.,.iiill tk.c:77.„.:.ifi'70 it7Li-7cs 0-r..siriKteif to,,,c4Ordiroce
• . •with 1 M:Nc'AC Ok.'.1.4. 4.‘,.rir.7;;ITCA::,.!;;;ier.,0200.It'd!Comm-or:ion Srandards gni(Ow<I. . .
7.Is•thiS•aptoate.0 iii:0; ....tungellif E1Yot• or KNo • 4..00eithly iec011 WS:tiro evin.iderl roil or hi iimier.
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illh(s:h'a repair fill Ayr,koriipl Vett coliknivioil litforroorian maid(.kploht the of the
ripoir rode 02,1„-iernur1.s.1%intion or NI the brick of this form, .23..pe.illograt.npr additional:well details: • .. .
• You May.use the bad;of this page Mitnovideladiliiiptial well site details or Wilt
it Nonberaf.N'ells koottiteted: 1 - • . , • •copsttliction details i--Yea inay alSO.atideh iddinimal.tiates if ureesSary.
For Jittiiiiii,f0 kiecilim.-iti,orig-ireorr sopply ire up ONLY friplihr.cott,ifeoir.stroiliiilt.);ort eon... . .
.9.6vitif 04 friths. suoKratte.„DisTiTortiosi§ ' 1
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0.Tata well depth land girficin- . •0.).•--itai..For all Wills SOlimit this Than Othia 30 days:of completi9e:.of welt
For mid*i4q1s list Oft depth. irdWerolt K'XIIEIPte-.Y.@.200.m420.114) constutetion to Oa following:
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10.StAtieW4ter.leitel below inti.af easingi • . . . (64 .DivEsitin of Water ReSbuiteit,Informaticin Processing Uisit,:..
'gimlet'?even;above coita.g,,all!"4." . 1617.Mail•Servie'e Ceiiter,Raltigh.;1k1 '.27699-I6 1.7- .
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if,Borehole diameter:8•28",4" . -"(Ict.) .2411:.gir Injection Weill ONLY: inatfclition to•sending.the form to the address in
24a abee,also sithritit a•Ow of this'faith within 36 daIrs of.completion of Well
12.-Welt construction.metho d:-118A/Air conitiuetion to-the fellowiig:: I
(i.e.oligei-,i.ot4),cat.lc,..airal iuslt.oto.:,1. . .. ,
. . Divhloit of Wat4r Resources,Underground fklec'tiort Co utrol.PrOgraut,
FOR WATER SUPPLY WELLS ONLYI 1636 141. 611i SerOce Center,Raleigh,NC 276994636
24e.For WatOr Supply.&fejOoti.ea Wan. •
tp?;,,Yfeld-(tim) Methoiiigf fat:_ _ _
Alsg.sgboiit one- totoy of this.'fiiinitWithirt•30:ijdy of cOttiP16tiott Of
113h.Disiateetion.Opm Amnunt: well:construction_to the county health depaninent at die, when
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FarmGW-i Noah Comliaa 01.-paamempt enviroancni and Natural gcsourccs,Division of Water RuoLtCx5 Revised.August 2013
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