GW1--07886_Well Construction - GW1_20231205

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WELL.coNsTItICTION RECORD Fuilltctnaltlso011P.v,:
This form can be•usod far single or mmlliplc wells '
1.Well Cantr tctoc Llfornratiotu. '
'LLAVATERZONES . '
John Eiseninan p'RO.1•: RI ,DESCRIPTION
*ItCaiitrudot-N7n]C, ft. ft; i i
ft. R;_ I j . -
4439-A
NC Weil Conl aciarCcniflcaatonNun ei ;tS::OtiTER,CASING'tfai'iiinlii ivied: cf1SfOR-LiNERYttitrntica6ka
most ' TO • DIAMETER TRiCKNE5S ' • MATERIAL
SAEDACCO ,f4. it. in. '
Conlq,;uTtiame•. •.161NVLRCASING'OR_TUBING4b lhemtilclusid-loop},,•
-FRO\i •TO DPAMETER TERCKNESS' MATERIAL
2:Wdll ConatrtictiniiPcrrnitft; . 0 R 19 ft. 1 A SCH-40 PVC
LIS aft npplicalite lfpr±lo14.(1 .Cowity;potc,•Iiirkaireal�jertC!}Ctr,.) R + ,
.;.WC1l:Usc(cltvcIt llc U uSG)j -
.37:SCREEN
• %Yate,rSupillyWcll:-' - roust, • TO - DtAMIP.TF.R Si3OTSTD; TIIICKNISS• MATERIAL,
CIALtti piRlral• CJMtlllicipal:P,itblic. 19 ft: 29 ".ft• 1 io 010 SCH-90 PVC
•
ClGcotitemlat(licating(Cooliog-Supply') DResiidential•WaterSuppl}•(single)• ft: fc is"
DludustrialfConunercial ©Residential Wnter-St] xt(c.GROift•• ... -
Pp>S.(sltatrdl . FIIOM'. TO. MATERIAL. -ESIPLACEMESITMETHOD&AMOUNT. •
El lrlip.iitian . . ... . . 0 'ft.. 15 IT;• Portland Tremie
• Hoa Water Sturdy Well: .
15M4nitoring. tato:o.1m• R, Ct. 1
\
• ItlJeetion Welt: • . • Y4 04
�IAilitifcr'Rccliarre t lGtolllidwiicrRciliccitabou •19:SAND;GRAVEL+PACK7iruilpli6bte"_ - = ---
'FROM - - TO' • MATERIAL EMPL,t'FMENTMITROD •
EIAgntfcr Storagcanti Rccocq''. •i • [)Salinity t3amc
17 R. 29 ft. Sand I r
' #2
El Atinifci Test CJStomiii:itei tiiaiiiage -
fi,• ft!
' CIEVCrinicn:lal Teclinato s []Subsidence Control. 20;DRILL LNG I OG'(ullaeli`addilionutsticets if.neccsuiryl
-DGeodhennat.(ClesedIoop)' - flTracer - ' . . ' i7IOM " TO DRSCRWTIONloAir.arrbnca,vnn,crahtx:',on tidal -
oGeotliemtat(IleatingCoolineReturn}. ElOuter.(explain tntder:#2tRetnatks) a iL 29" ft, silt/s,and/clay
. 1.Date WeUI(s)�Couipleletic'"10=11-23 •Well intfP2W-17 . • ' '
'ft. f4
Sat:Well f imcation: ��..��• ` -,,
f4 1t. ;'• P .it ,�'i ,,,,,,
. Apex C6D Waste Landfill . . f4- - ft; �'. . . li
p...., �t
Fa41111pOn•occ latae Fici14•IDi!(irappiicnbic)... - �•. --._ .fA. P.
• 5940 Old Smithfield Rd., A ex •NC 27539 O ���.
P r r. ft.,. ft.
iflat
t7f(as i 1) ;
filrysicu1-Addicss City:and Zip ' ;21 REIIMARKS- D. „'—o.r,. Lip:
Wake Bentonite seal from 15-17' - '.Lk; -
Coolly . Parrs]It9:rrriftcaiIon No;(PIN)
- Sir..i:.aDludgawlLongitudein.(dcnreslminutes/sccondaardccirnaldegrecst :22,certiff6atioti:
(itiroll held;WA 101o4 i;•grrllci=ld) r'
]i �y - wr . -'c•- l0/28/202_3
Sintutun:af�;r-J.n�, ;;:. :v,a::;•. -'=- = ' Daic -
6:Is(:tie_)the ell(.i): DPermanent or 2lTernporary
• Hg tig,iiiig;lii foi, � 'ar=,!c.,d� !r, ;- fs •Y rr . t7(nY Miami Jmrnvrnmicr
• tuarlif5tACACU%C:; l lr�vll t30f Well CorstrtillnirSrnrclnrdaerndsky a
7.L.this a rrpaiertu ancurstinucllt Oyes, or lNo cmofatif.encordhin-Item
plio.ekled roil+.,It Hail er,
Ifrhi,s:sc a s yell,,fill eO:ly1.:,i ir elletittli icctiol-b arrnarlon.irul t tiln the
of(IT -
r iairmrilei#2.1:rcmurfi+'.sectionor.iatheliraaLof11thjornc. - 23:Site.diagram orad'ditional well details
You[lay use tUe,back of this page to;pro%ide:adiliGonat,tsell site:details:or Well
8,:Numb erof Wells constnreted: 1 • " construction details; You May also'atlach idtlitional pages if necessary:
For amid*lydecrkk,'or a whnwr-er siipplyieuBs.ONEY'frirh thilarrnie mom:rat: m,you can
Fifsnitode form:
SUBMIT•TAL i• NSTECTIONS
9.'eotal}sett iiepllr held*land stirfacie 29 (fr.). -2aa. Fur All Wells: Submit this tann willtiti 30 days of cbmpletion'of well
For nrnhipki�rUslisr all rlepalsslfI rt i:taxw'pte-3e@2(Kr'arul2.8,100'1 constnucttotitothefotloniug: i
10.St'atiehater;evict liclaw top of easing: (ti,) Division of-Water 126oure ,InfornIatipnPiueessing Unit,.
'UMW,'tenet a above eatiry;'iite••+" 1617 M &r ail.Sice CCei ter,Raleigh,NC-27699-1617-
IL.Borehole diameter 8..25". - - .(m) .24It.Fria'infection Wslis ONLY: in-addition to:sendingthe form to the address in
24a aboie;also subunit a-copy of this loan within 30•days of.co mpletlou of Well
12.Well'construction,metltod:HSA • - • • • eotlstiuctionto-tlierollotbingr' I
tic angel;rotary,cable;.direct push,de.) t ..
. . Dtvislott of Watcr.Itesources,Underground InJeitien ContlrblProgranr,
FOR WATER SUFFIX WILLS ONLY:' •1636 Mall Service Caller,Raleigh.NC27699,1636
l3ao,Vic1d(>;iiui) Method of't 21e..For W'ateiSupply.&Infection..Wtis:.
Also subniit One'ciiDy of this:form Within:30'daysofcon]pletion.af "
13h.Uisinfcctiaa•oi- .Imnunt: . .well:construction.to tits caunty health�depalimeut of the_county whcro- .
constrttctrd.
Funu GW-I . onh Carolina Deeparrttma.of EIMUDIturnt aad Natural Resources-Dh'i;lon of\lr]cr Rettitices -Revised August 2'013