GW1--00011_Well Construction - GW1_20231218

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WELL CONSTRUC'tION RECORD FC.11 irtcp41 14c ONLY: •
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rib foir.iijCilp bizosei1.for single-0r niuftilde wells
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1,%reit CiittiiIicItir Information: . . .
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--141•11TATER2ONES-.• - • ' -I
Rich Lemire FROM 10 ' nmKattrtmst • • ,
'. WaContraCtorOatno F
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I .2593-A . . '
-;15,•'OUTER CASING iTdititilti4i0elliiillOOKLINER flf'itii-ileibleV,i. . . .
NC Well Contiteior Cc rtifidation Niorber
witom - To• ' - DIAMETER I ''MICKsiES.S. . - NTATERIAL -
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SAEDACCO . I l'i • •
,Organ)!Is'amC... . ' 'IC:INNER CASING ORITUBING.kiicitheithil dosed-loopy":_ •-. _.
FROM- To • DIAMETER. I .TEIICIOVESS- .-MATERIAL
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.2.Well Constrliction Peru*4: +3 ft. 55 ft.' 2 1'11- S CH4 0 PVC .
tjir ugiiiiticahler well penirits fir...eothoy.;Siath..tioriort4v.-.14ectic4l ex:). lit. . - Ai; - k•E04 .
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3.'Well.Use(cItcCI:well ristit t7.SCREEN
WaterSnpplyWell:-
Rion • TO OtamE /OT TKR StSI/X tilICKNE NI SS ATERIAI,
• . 55 .ft.• 65 It-. 2 ir,i; , .016 SCH4 0 PVC. .
CI AgriCullitral • . • .- .. 110tutidipaliPitblid, -.
laGeollterinat(ticatingtOoling.SupplY)- •CiResidetitial Water Supply(Singlo) ' ' '•rt!. • 11;-: .'il''' : .
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ClIndustrial/COmmercial . • PRcsktotial Wnter Suppiy(shared) I*4 Gil°171-7'- .' - ::- •2 .''' '---.• '-• .-- ''-•-'-- - -
FROM• .. .10- • . NIATERL1L . EMPLACEIVIRNThIEHIOD&A.NIOLAT•
EllrriOtiati. . . . . . . • 0 rt., • 45 - ft., PORTLAND ' TREMMIE . . .
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Non-Wiiter'Stipply Wit:. ' . - : - ' - ,. ... .,. . . ...
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. • ft, . - - -
. khloolloring -- . • . Elitccovcry - . . , S .
-Infection Well: . • rt. • ' ft::
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11Anitifet 114hOrge- -ClOrMindtvater RealeMalian - . , tv;9AND,AGRAVEL-PACK(if applkintW
., .- . _ .• -. . -FROM. -TO -• • -MATRREM, . • EMPI Act:VENT mEition
Alta .Ci• iOiRg.. ..e.ao,1 kiiiicS,. - 1:)Salirtity Partici'• ': . .
53 .11., • 65". II SAND• .',' • #2
ElAquirCi teo, EIStosinwater Orafttip,*-, •
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Clpitetiniental T.cchnology. DSithilcienee Control: ' - - i • • ' •
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Ati.,,IIRITILINGILOG'ftittichlliddiliciont'sliiiiii if ilics-snr'vl''- - • ' - -• •
PC,0014e.001(C11)4.L010 . - ' ' .I3Tmcer ' . - . FRONT • To DESGRIPTIO inni N(color.hardnetr, ntekotwrmilti tit4Ndr.1 C1Geothennal tHeatine/Cooting Return)- bathe r tesphlitt under 42.1 Retualksl 0 :ft; ' 2.9 . •ft." RED SILT, . .
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29' -ft.- 63' 'ft.- PWR '
-.1:-Date Well(S)Completed:•13.-2 8 2 023•18M1 Min PZW71 8D . - ' ' ' " • .
,. 63' -ft, . 67' ' '-ft., ROCK
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. 7.• ."..'"•"*.,,7---7.. ..__ •
5a.i Well Eneathini. .. rt. rt. . r •zt L,.r.., .,'ii:, '4 '.„1.4i i',,,..c-A
APEX C/D LAND.FILL .
PZW18D - . • ft,. ft,
-" -------:-- ID‘ . H F-Drfftis,'C'41- 4:::.;:1;G
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FactifipOircr IN/mug . - Factlity'IDP(if appli,010). O,.,,. -
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5940 Old SmitlIfield.Rd., APEX, NC, 27539 . . , . ft. • . ri.,.
• -• --.--,,-.4:-.-2 up3;:f
. . Pitiiir.al AtIdtF'Ss.City.aridZit) ' 'al,ItElUARKS• ,
• • WAKE • • - . . . BENTONITE FROM 50 TO 53' • :
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Couttiy • : - l'at-Vel IdesoiliCation No,(PIN) ,
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. . Mt..I.LiiiitildC"*nii isinevide In degriesOinntistscCOMIS or tkcitititi tikittcp...
. . . . 11:Celli/lotion: -
(if%len 06414'0m oua..is sarlikilt . . . •
. W .:--- -1C-,77 . Oe ••••#.4'.'‘If•-• 12/2/2023
Signittitetif Cc'tti _IfilCiaiirreteir 1.:. ' . . • .Dd.le. 6.Is Mreythe well(): 30Pmnimitent or .61-12ttittorjr,
It signirig,this fonn.•1 ire Thy tvrtify rhiqlrhe in0.4 vFos•Overe.1 velar:melee irr:/kyord.roct•
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. • • with 1M N.C:ttc 02C 43101)*15tt NCAC17,1.4.,021711 We;11 ConSerficifon&oxfords(RIO'that a
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• 7.-IN thitt 0:00ii-jii 4u..tii*r*well:: DYCN -,nr ZINO• - -qtio--.of Misr(wont 1afes ittien itioritiod 14•iffit.itrii(4,ier, •
if rht‘.11.0 f'iVlir;fill oat kotimi wry egontifefiolr Inkinufflon aro!rspkiht the,.Ware of nit
. repair tindir ei 21,rernarl..s fr.xiiiita err' u the hcek of this henr. - - ;231.Site tliagrant Or additional well details;
. Yon may Use the back of this pogo.(Mitiovide-additiotial well site demilS or Well
8.-Nutulterof wellS COOserttefed:'1 ' • Mittslpictitiit'dethils/.)..rott May also attach,additional pages if lIreaSaly.
For sitalrOk llecritm orootiT•livri,r.sitppiy•wellspNI.X with the stptte:coorstrififloft,pth can .- . • - • • -- - • •• . i: •
stthonir one foryo.- ' -- SIIDNIFETAL INSTUCTIONS 1
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• 9.:,T401 Well depth beton.hind.surfaCe. '8-8 - . • .(tf,) .24n. For All Well: •Submit this fano'within.30 days.of:Completion of Well
For:Wild* 11i-Hit all depths if Jiff ereth kr-rompfe-3Q 200'oth12@l47,77 ' ' - .•constinotort to the followl ngt 1 —
10.Static water levet below top,of casing: 55 (it) -Division'af Nyater'Resou're6;InfOrtnan Processing Unit,.
if Wier leve11J Oft1We cosfog.140."+" 1617 Mail Service Cedflei,Ralgigh,-Nc.27699;16 17,
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11:Borehote•diantercr:.8.25/4 'fift.) .24G.ForjAccrino%RI ONLYi, In addition to sending-the fomt to the addiesS.in
24a above,As's:).stilintit a.Copy of this form within 30 days:of completion.Of mill
12..Wc11 construction method: AUGER/CORESARREL CoilSfrutlftut Co the following'
(i.cPger.rodatyr•Cal)1e;direct pork etc.) •
. . Division of Water Resources,Undergro.und InjeCtiott Control Program,
FtDRWATIEg SUPPLYINELLS'ONLY: 1636 Atli Scrvice.Cente'r,Raleigh,NC 276994636
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Ile.For.Vidater Stip ply&Injectidu'Welts:
13:1;Yield'Wm). .Method'of test: •Also'subtnit one copy of this forth within 30'daYS of completion of
' 4311.Disinfection type:- Amount: • well constrotticin to the connty health department of the conitty.where•
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, consituct40.
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Fara)GW4 Norik Caron=ittewoment of Enyftoitruciti•aild Nanual Resources-Div ti ion ot Wafer R=tft:M Revised Atiust 2013
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