GW1--07880_Well Construction - GW1_20231205

WELL.CONSTRUCTION.RECORD Far Itganal itc.PNL-Y:.
1ti:s form cat bc•used car.title of multiple wells' -
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I.Well.Contrattatinformatiom • . ., • . • •
Scott Hunt, Jr ROW - TO DESCRertION
Wail Catitteemr Name 60 ft:: ft, fraCtUre in rock
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9561-A • -
NeWell Contracta CertiftMtimi Number -13AUTER CASING-Mr,Wan Veired-Weibi OR LINER:fif isti-tiestbk).• .
FROM - ' -TO ' •-. 'DIAMETER i TIIWKNESS NTATERTAI.
SAEDACCO , . ft.. ft.
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Compani-Name., ,46INNER.C.SING'ORITILMING4tkeiirlaiiinia dige-d-lotitip'-'-., .
. • ' :FROM TO DIAMF.IER., TITICECVESS• • MATERIAL
2..NYelltonitruttion Pettnit li: - 0 ft, 57 ft, 1 . I• II.fiL SCH-40 PVC
14.ft tdi apyilimbre t:Fe.11 perapd.ts(i,fr:-Cfmrity:-Sitge...Variarrre,.freOctiGIA rfr..1' '
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3:Weil_liseAthech well tise) . xi:SCREEN-• . • -.. . . -
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'Water Supply Well:. . - - FROM-- . TO - [Mal-ETTA SLOT ME -11IICKN',SS I MATnRTAL
57 . k•• 67 :R.. I. in.', .010 SCH-90 PVC
CI Agrictlimal. • . t;lMiiiiidipaliFtibli.c.';
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EIGenthetmat(Ileatingtooting•Supply). OResidential•Water Sup*(single) ft:. • .11' . • •
"GROUT', ,.,
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ElludustsialiCommercial. • Clitesidentiat Watet,SupplY(sixted)., :0m. . -ia. mATEREAL ESIPLACEIIIENT METHOD. AMOUNT
1:11rrigation- .. . . . . . , . 0 ' ...ft. 50 ff. Portland. , Trerale •
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• . No tt;•Wittey Supply W .ell: .
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ft,.. ft; ' i . •
it Metiitorin-g ClItccovety ' ." -.- . •. • — ,
fuje,ciMu Welt: • • . D. ft: - . • • . .
CIA:TU(4 Reeiinigi, - - OGRairithiater Rentedialioa . : ,tWSANWGRIVELPACKIildidiunter, - - ' .. .
ria0M• ... TO NI ATRRLI.I. • -FAIFLACEMENT METtlou'
.. 6 A4iiii6:SiOiaaiiiii rtedgy4.4.. - 1:Ialifiity Bartlett' '.
..••._• ..- • 59 . It.- 67 ft. ',Filter Sand #2
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El Aquifer Test C1Stornntatc OM nage•
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EISubSideocelConifeil • 'ft.. ft;- ' '
• . 68S:pctiotental Icelinoto& .
. r[10•:DRILLINGILOG•faitielt additional Sheets-1f iweeksairl • •
tictotultennal. Icised Loop) t1Trager . • FROM- • .TO • ' DEFERIPTION coAr.naratamotanatoraNtaain oze..do
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EIGmtheittial fHeating/COoling Retumi RIOdier(explain under.:42 I Retnails) 0 .ft. 15 ft,. red/brown compacted silt
15 --ft: '•35 ft. red PWR
.4:Date WiellaCianitiletett:•16-3-; Veil III#Pzw-'9 -. - .. • . . •
35 •ft; 45 - ft, tan-white PWR •- , • • .
Sa,Weal Location: . 45 .ft. 67 ft, red pw.F with
• Apex CSD Waste Landfill . -. ft.- . ft; ' ; --.... s
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tacilily,Khvner Nam FacilikV 1DN(if applbable)... ` --- I -I- -0 rt•- ft.
5940 Old Smithfield Rd. , Apex, NC,-27539 , - . . , ft,. "ft, . ' tstrOfirc,1• • '
NF.dC'n Pen., • .
IiiloliCilhic;cai:-..iiiI4 .AP. -32.t:REM1fAltiLS— " Litk_,•,,,-.D64,0,,i,
• . • '" -ff '0`,Z
. . Wake , . . 'Bentonite seal from 50-59'
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Cowl).' ' - Parcel Itlinial14.10011 Na,(PIN)
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$6,..14itiftule and'I.Ongittnie in(legrceihninutestseetinds M.(fLiliiill riciricrii.
- -----. - *'` Cetiffimitiour ' •
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. Of melt litcl,one luttlotia is-Piffle:lel*
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- N w /41i/it. :',,:l.- '—'' . 10/1/2023 •
• ' .Sigm .e.,o'cat&.W.-1:31 centimeter• " ' • Date- •
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4.Is(ate)the:well(s): 30Penflanette or .6Tempotaiy - ••- -•. •.• • • • . • •
#I,.4:goinggrit fiited ireret.y attify Oticifkg wig&,I t.r-e.r Oitte.)cv.tyinwtey?AT,ficwordroice.
. • ..witif 154 Arcitc 02C.0100 ar isANcitc pc 0200 meif COtriinictioa&andel-pis mid sbar a
7.1$1114 a irefiaiiiIR an ,'.ai041,,:l Welk DVei Or FINo : -i•tifiii.!.6f thil-irriiiy11:41,cea proviged raWie iirli awarr,
1/thes:it•a 41.*fill tqa.la7644t irellivaanviaa 1iVaraunkinaa4 rAillahr Mr'ware of air . . .
ripair fordere2rreemarks':simrion or i.vi the bark of 016 knou.. • ' - - -23:4iteillagram•or.additional well details: . .
You may,use the hack'of this page tolinovide'lifilitionaf well Site,details Of Well
8.Nutithet of Wells Constructed: 1 ' - . constniction&Mils: You inay allO•atlacti idditionalfirgeS if necessary.
For'ittalrip;r hdediiiti•t-r noli . , . .
-nr.ver supply trap ONLY Olt•thr.saaaf construraint,Oa ma . •.- . • ..•... 1
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itsbniltoo f(*Tn. SUBMITTAL INSTUCTIONS , '
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0.TO it is I depth heloiv land sinficei • 67 . . - 41.). 724-a. For Alt Willgi Sithntit this form within 30 days-of 6iciptcii§ti of well
For atalripleihlisr all&phi ftififferrat lexamare-3@200°anit2Q100) ' 'canstmotion'to the fottening: • -1 ' •
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110.Statiesitater bid l helti.w tap of casingi 30 " " lihislun of Water ReSoiitiek,Inforfnutiott lkiniessing(hilt,.
• If wah Irirel 4 Thcwe edifag.ale"+" • - - 1617 Mail.Scrvice Center,Raleigh,NC 27099-1417
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11,Barchtik diameter:8•-25"14" (in.) 211h..Friir fotrecitert Wells ONLY: In-addition to•sending.the form to the address in
IldaboVe;.also sObtitit a..e0py of this form within 30'days of completion of well
12.-NclI itu consction method:ZSA/Air constiuttion to the talloWing,.: I
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(i.e.auger,ratar).cal?le.idirect gosh.ctc4
• • Riyhinit of Water.itesourcei,Underground Injection Coigrid.PrOgram,
FOR WATER SUPPLY WELLS ONLY: ' 1636 Mall Service Contr,Raleigh,NC 2769941636
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Ite.For Witei.Supply.&falection Oast
13a,Viet d•(glim) gethod'of test:
' Also Subniit'one"eoPy of tkiS ffirtii.tiithja'30,.tlay pf cOttigetiOii.of
13b.hisinfeetion,typet „Amount: well:eonstoiction to the county licalIti department or the county where
_ Onitnictctl.. . . ,
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Farm GW,1 NorliCarcana Ekpratintearat Enviromacta attql Natural kepaurces-P:hislea ok Water,Reaixas RcOstd:.01.1gust 2013