GW1--07884_Well Construction - GW1_20231205

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WELL CONSTRUCTION RECORD Fininccruai tiw.pf:11..Y;. .
This-form can banscd ffir tingle of multipls wilts- " '
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1.%ICU ntratetor Infortuntion: - •
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ql:AVATIIR'LONES
John Eisenman PROM. 10 ' DESCRIPTION
WCII ContraidrNoint; ' ft: ft. " I i •
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. 1 ;4 439-A . .
NC;Well Contractor Catif-o.Istion Mather' ',I5':-.01.1TER'CASINGWOrifittkisriniefti)OR L1NElattifff'titible).-. ..
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FROM ' ' TO .- •DTAMETRR' - IIIICKNESS ' MATERIAL
' .s - , ,.1.4. . ft. I. '.4.
AEDACCO ' ' . • . . .
thumam-Noum-. . 164NNER.CASING OR;TUBING;43iito1c1Oicil-1oiikL •-
_ • • ,FROM ' 'TO DIAMETER. TIRCIOCESS MATERIAL
2-...'4111.4Congniti1Oit tient*li: . , . 0• - •ft, 33 ft.- 1 :' '° SCH-40 PVC
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Littilliaplifirafga 1Fel cptipells,.(4,.County.;•pau%Vflriapce;KOZO:4(.1c.)• ,
3..*Cliii5O(Ccle, CItifsq).; . 17:SCREEN - • •
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Water snpidY " NI FROM. TO .RIAETER! StOT SIZE '1111004 MS I MAMMA I. I_
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33 .ft: 43 'ft. 1 . li.; :010 SCH-40 PVC
0 Agtkuliiituf ONItiiiidipatiPtibpc..-
D.' - 46. irs,1 . •-
1:1Ge011icmtaiffleatingitootiniStipply) i3Resideidii•Water Sup*(single)
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CHodus1tial/Conuoercial. Catesidential WaterSupp1i•(shared)' ro61,,IPUT'1:,i.0-•_
MATERIAL. EMPLACEMMIT METHOD&AllouNT
CI Irrigation . ... . . . • - 0. ;a.. 29 ,ft.. .Portland Tremie
-. . Noti-Watgr Supply Well:. - •- • ' • ft. • • It
' bilitaaikiting- .'PRornyew • . , ....
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Injection Wc..,It: ' . . • ft. R.. I . •
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. • . ClAiintfar Rc4iitg4. • ' CtOtOtiOdWalcr Refkgiitiou -,twSANDif;RAVEUPACK-(iPlionliconrc) - .- ,_- .. ..-•7..
',FROM •TO • ttLlTERIAL ,tow LAcemE,Nr mrruon
ClAtjuircr 8.10ragcrOni licOp(C4'. -fiStiliniti I3'iiticr .
,.. . .. • - •-_ 31 -R. '43 IL Sand i #2,,... . . .
. CI Agnifcercit . CIStairiarneiPrniiisto .
bENperinictital 17c41rnetes&. 1:1SobSitictIcc.totitni1 •
AO;DRILLINGIOG(atioCk'idditiOniil ihrtiglif ifccnifir) - • - -
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IcipoOthotoutt(Closed Loop) 'Eltracer 'FT4INt• TO DFACRIPTION WAX'.hardam,stillImek"lype:Iragil!SAN(*.I
0. ' i•II. 43 - ft, Silt/sand/clay . ,• '
CIGeolitennal(Realinorooitog Return) C1011ier.(erniaimuoder..#21.Retthilks)
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. • ' -ft.. , It. . ,. :
.i:DitiONOtt(s);Coutplotedt 10-13-23 . dimitimw-18- . • .
ft. ft. , . .. . •
5u:Well LOcathint • • . .
• 11* . IL. - , F.,,....,...E pa. ,E D
N 4...-t_.,.?. ;', V . .• . . .
Apex CM) Waste Landfill . . • B.. .4;
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FacililyMnocriimlic • - Ficilin•og ileapp*blo)... . '
•.R. .t. ft,. Ott 51023
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5940 Old Smithfield Rd., Apex, NC, 27539 . ft
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filci1,XChti#is:City.-011*ip -- .; REMARKS'. • .
VAIZ
Wake .
I11:4-..1
'Bentonite seal from 29-31'
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Calmly . 1.?-4tvel I:finuitication Na,(PIN) ..
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Mi.LittitittIOnit.14OgiattIO iu ticitusttninutts/Pcpindsiir clechitatdmici: .,21..(irith6tio,.
(if-(;co I)d4,oat:,ia1/loogis401:141a) • - •
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• N- W' • .....,,,,... _ . -''-' 10/28/2023
' ' . ' . .54patarett...47'.'v"..Iti7:it:LcEi.;. -.. --.- --r---'-•.---- D4e '.
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4„Is(ore)themen($): VE'etrutaitent. or "EfFemporury 6,sigAig;Iris foloa;`.7-..r4:1F.iiiu.,Lcr-Ant,1 f.,..71=usr4IriKreii tir,, eyorflance -
. - . •.iiitlf 154.Ar4e 02e•,144.. ..fl:7,77Te.,W.,1,7"IC.:010,0 WI cpitstiVilitur Slarka:rds gold APIT a
7.Is thisavre0afr to mip.;%14togueni InVoi-- .0 FIN,. _ -1.41y..'nf thlf ierrird Wei from Pinvidval ii4-6e 4ril pirlier,
if this.1sR F44i5 fill cist.kpoitvi Uill oansuiralemilic,fisrmarikePil e:splqiu fliv,e117.raft,of 1110 .
iitir cadet 021:itniiiria:siwlitha Jo ei.v1 the.bdik Pt this fprnt .-23;4 he.iltagram or attititio.ual.well 4c(taiits:
You ma k use the Well Of this page te....rnovideidditiepal well,sire.thtalls:or*ell
W.Nutuberontells Coustrileted: 1 • • coustiuction details; You may nIsn'aitacti iidditionut liagrs if ttodesDnY.'
For timid& uwi supply 14111.30NLY ulth-cry.srum .constriklion,Om o6u; , „ !
spboUlt a*Pm. . . FITBMITTAL INSTUC.FiONS ,- •
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. 0..Totati.ell depth below land kirftic0 45 . • - • 0•0 .24n..For Alt %PAW' Submit this form within 30.tluys•of-cOniptetiOtrof fl•ell
For-muldpkiiTlls list all ATMS.irdarerop(aro-Imre-JR200'mil 2.0100) — "constriictiop to Ote foltoning; ' - ' . • • •- -
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10:Stueicivater..level lick*.to 11.At'easing: . . . (AO *11hisiiip of Water Re.4rnittei;kiforrnaticiti Fretessidg end,". ;• .+ ,1617.1Siail.SeiTiee(Citri,Raleigh,NC,27659-1617• - •
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11.Borehole diameter:8.25" tim) • ..141):for Inketion Wella ONLY: in addition to-sending Ate form to the address-in
2.14-Obet,also submit&copy of this:fanit within 30 do3;s.•of.coinplOtiOn of Well
12,Nell'eonstrttetiou method:H8A constiuttion intik folloWitte.!: i
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(Lc.ougcr,imam dable;dircct giusb.di} • . i -
- . . . • D.MNion of Water.tti•sourcOt Underground fticO
. Iota Contre1Fregram,
FOR WATER SUPPLY WELLS ONLY:. .1636 Mail Service Cenfc!n,Raleigh,NC 2765941636
• 14-r.For WaterSttpulr&bajfection.Welts:
.1330(icid.(glim) 316thod of tc,st:
Als0.sohniit'coit top), of tins form oithitt'30:do)*of comPletion of-
.Disinfcct 13b. on tnt well conOniction Co theccfunty'mobil;&pitman-oe the:catnip/where'
ife _ 'Anioutz
• f u , constroctal.
FOrm OW-4 NunitComItua itepaluncnt.of EBOIOILIDCIli atiO Natural itcmurces..-Dn't Ion of Water EtTmionos -Hertscd.August 1013.
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