GW1--00009_Well Construction - GW1_20231218

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WELL CONSTRUCTION RECORD RIF hignal 1.4e.ONLY:
; This'Cann can he,nwtlfoi single or ntoltiplinctls
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I.%WI(Cottiritchir Itiftirnaritiori:
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,I.L.WATERZON ES - -Rich Lemire FROM ' to OFSCRIPTION
Welt Coriltaelor Name R. ft. 1 I • .
ft. ft.2593-A • . 1
.ISGIFTER:CASING lrdintrillkiiseinfillsY OR LINER Iran-tlenbk).: . _
NC Well Contractor certification Mother .
Rion 1 TO• KM:TM I TOTtliNTSS. .. • MATFRIAI. .
SAEDACCO . . ft, I ft.: I Illi'" • - -
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_Coluip;oo.Name. 1 t6i-INNERCASING ORTIMING trieOtheiruiAleliged-hioolY: , . •
,.FlIOM TO WANIETER. 1- TOICKICESS, MATERIAL
2.WCit rmstrtietion Permit it: +3 ft. 35 ft, 2 l'iti, SCH4 0{ . PVC • . .
list 41 applirafle W1711 penitits fix.einoity;.Stvo,,VOriatrce;Trialkit r4c..)". . . . .
•ft. •ft. 1:: q.! .
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.3.Well.Use(eltceicWell cis*
Water Supply Well: Ftro5i TO DIAMETER SCOT WE- 1-11ICKNESS. 1 MATERIAL _
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• • - • - 35 ft 45 ft. 2 ii'. .:010 SCH40 PVC
LIAgriettlittral . Olidtiiiieipahltblic.
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.- CIGeotlicinial(Ileatingtociiing.Supply) ClResidential Water Supply(siitgle) - . "! . ft' I '
ClluditstrialiComntercial EIRssidentid Winter Supply(shared)
14;ost°1-1T j To. - -- MA'.. 'DI--'''.• ' EMPLACENIENT METHOD&AMOUNT-
Ellaigatiail ' . , . • . - . ., 0 .ft.. 31 ft., PORTLAND TREMMIE
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• Non.Witcr.Supply Weil:• . " . • . . . . . . .
ilslonitoring .
bliecoyely • • _ ft,.. - -ft. 'i '
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•IrtlectiOn Well:
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ClAnuiferiteeharge• • IZIGMtnidnater Remedialion -• ..!Ise SAN fanlitAVELPACKfir apOtteablet • • -., . . ...
•FRONI TO ' NIATnor.nr; . • EA IP LACEM ENT M ilTtion
P;34-ltrOeitOtnt.. e.tilki l.f03.Vefy llSalittity.nattier. . . 33 .ft; 45 - ft,. SAND ; • #2
ElAquifer Test: OStOrmivatet Dr:dr:tags' . . . . '
.13.: .ft,• . .
DexperitticnItil Technotou• , , EISIthsitIcncd COn001 •
"la,:Wilt LING LOGItillitelinditilitiont S Welti Illtices-saryl - ' " •
CIP1‘.O. theinti1.(c1o4 Loop) - •CITracer FROM - -TO ORSCRIFTIONA:mbri Itivincti,i.illhutr‘tim,:ollii tire,r0t.1
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LIGeothenual(ileatina(Coofing Return), Mather texplaitt'under el Retualks) 0 ft. 2 9 It. RED SIT-0 •
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29' :ft.- 45' .ft, PWR tt--:''.-,...-I--'-'4'-. ,''•', ,,:.''''''-,
. ,.„,.t„...cc''''g 't t,--:C ''- •
4!Dint Wiill(s)CoMpletcd:-12-1-2023 wdr wow-21S
-ft.. 'ft.
So,Wen LocOttnen. . . ft. -ft. . DEC .1 8 10z1
APEX C/D LAND FILL MW-21S It.„ It, Inforrn:24L-271 -
FactlitghmerName ' . Facility.'IBM(ilapplizzb ft,—
ft, '------ --==M-- .1-';.•,;:3:6 SG •
5940 Old Smithfield Rd. , APEX, NC, 27539 • ft. • . ft, , •
PIO.:iical AjdrciEjcitY•an41- 1(3 :70 L•RENIARKS. • . -
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BENTONITE FROM 31' TO 33 .
WAKE
Conoty . 1,nrcel IdentineatIon No.(PIN) l '
Str, lde and Longitude in tiegreesimitiutOisciOuds or(tatlitid(tetras: 22..ccittiwatton: 1,
(J1..011 rod,0. olotv.g wrioout)
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- ' W "-- -----K1 ,e4, 3i,.„,/lir ,..,„:,,...s,..„- 12/2/2023
• Sigtutdeor Ce"rti 4 Weil Centicurr- ! Dale
6.Is(are)the well(s): XPe'rfitartent or IDTemporary
tri,.OgniOg,ariv fano;1 hereby evrtif,vi:liat;ot;ii.M.v)wqs Own!)comrnolert AI;atvonfanct•
. widi/5A Nc01.0 02C.0100 or 154 oVertC132 ..0:69 We Coniirriettorr Staikfards amid a
7.Ls this a-repair to an eiiStiog well:: Oyes or lbl No- •illo,of Mk rneoni hr6.&rdlonwittro'fOlin,..iiill/Owner,.
ifrys.i.t.o&Ark*,Pi alt 4oiro weld comma-low isjonoluloo oil expeohl rile llarlirC of Olt
repair wider-021 remarks*rah:W.0r an Ms hark of thisloi4m. -,24,.Site dial Or additional well details:
You may Use the bad,of this page.to provide additional well site details or welt -
S.Number of wells constructed: 1 . cOnSlitiCtinn derails:-you Oray also attach,additional pages if necessaiy.
For Om**
l} t ikk.erioo1 ttONI7Ir.emply vekONY with riiearcitrsruerlote,yoo no .. •
suinioneforr ' • - - I.
SURNIITTAL INSTUCTIONS
P...TitialWell depth beton'land surfae..e: 48 .04 2ta. For Alt Wells:.'Submit this form within 30 days of completion of.Well
For maple*walls;all ATMs if o0fli.reijr(nroolpfe,74.T200'and 2@ 100). ciMstinctiOn to theToilowing: ' . 11 .
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Ift.Static water levet below tap of easing: 34 (DO Division of Water DeSqurees,infierm Aria lironessing Dolt,
if water li.rei is tiliore rosioixrue"+" 1617 lilatiServieo Center.RAO*,NC-27699-1617
II.Borehole diameter:8.25 (1m) 24b.EaLliljztiou2YAIONLYi To addition to scatting ille.fonn to the add.resS in
24aaboVe,also submit a.copy of this-font: within 30 days'of completion.of twill
1.3.WciIcoustructIon Method:AUGERS construction to the'llolicnying.:' I,
lig.an'ger.iztasy.:041e:direct;ink te..j
. Division Of Water Iteionrecs,Under-ground Injection Co ntrril Program,
FOR WANE R.SUPPLY WELLS.ONLY: 1636 Mail Service Cetite'r,Lieigh,NC 27699.1636
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Ile.For Water Sonnive&Inicetititt Welts:
134,:Vielil tpm) ,74terhoil rif tot:
Also submit one copy of this fans within 30 days of cotunletion of
1311. .Disinfection type: .• Aninimt: .well construction to tire.ecirinly health deportment of the•eourny.whem-
' constateted.
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FamiGW-1 Nonh Corultea D.VOnternt oCEnviroiuinTand Nation'Remoras-Diviiion of Water Re4otrces Revised August lit LI