GW1--00033_Well Construction - GW1_20231218

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.i I
. WELL.CONSTRUCTION.REtORD -
Fnr Itgena11 Usc ONLY:. . _ -
Ilif-form can be used for;Single a:multiple weIls.
l'..W61.1..CORINIEtot IttfOrillailtItt: . S . .
'Lk:WATER ZON . -
ES' • -
, . ... ,
Scott Hunt, Jr • FROM. 'IT) DESCRIPTION
We11CoildisIOrglota' 45 ft; ft. gravel zone that had water •
ft. (6 4561—A • - ‘ • .
IISAIUTER.CASINV-tfoiqiiiillkiiiir-thritISIVR LINEKtifilli
NC Well ComincIar Cenifiestimi Number
FROM . ,TO ,.IRA NIETER- TIIICKNESS MATEMAI. i
SAEDACCO 0 ,iLt. 35 ft.' -2 1 1 In. SCH-40 . PvC
CompasiName, '..t64NNER CASINGOECTIIIIING:tiiinibbritial'etnititionj));q,' .:.
.PRom TO . _DIANIETER. THICKNESS - MATERIAL
• 2..WelitonstrtiCtiati Pertnit.ii , •R. ft. ' 1, ',116. •
Lice id 1 iwiliqike n pripti4(ix.Plumy.l'rele,limiturce,frjalic4 etc.--)• _
ft...- • ft, i; '1.- .
I: • .
0.‘It'llt il,s (e4.1.6iieti nsol: • 17:SEIM:EN
• • - - ' -
.•. . .
.. .._ .... — - FROM. I l'O orsstETER stOr SIM TDICKNESS I SlArr.atm, _
• Watet.S.upply-Well:• -
• 35 ft.! 50 'H. 2 ik .010 SCH74 0 PVC
CltgriCUIDIra) . . 1;11Atinicipalipublie..: : . . _
; ..
•
EIGeOthennal(Peatingtooiing Supply) .1:1Residenfiat Wafer Supply(single) . - ri; ' -'ft' - nr!'.-IfilGROUT.
, MIUduStrial/C011111terciag. . Elltesidentiol Water Supply.(slmted)
FROSI • TO. MATERIAL EMPLACEMENT 31E1110D&AMOUNT
• CI Inigution . . . . . • -- , 0 :ft., 30 ft.. Portland Tremie •
. .
Nan-Water Supply Well: • • . . " c
gii:Iciiitoril* nttgcoviy . •
fRkcIloti We)l: , re.— ——
ft,. • i
. _
_..,. . .. : ..
ClAnniferRceliarge• .- Otnpuiidwatct Rentediatiou • :.,19ZSANDIGIIAIMILMACK'iiriiituilieabter-- " ...,..--.: - . .-.-. ..,
. . . . . „ .rwom To MTE:11113, -RNIPIACEME A7.4t METRO U •
OArittircr.StOragc.and Recovel. •OSalinh3,Barrie( 33 • ft., 50 . .ft. SAND 1:. . #2
. El Ailtsikr Tcsi. . EIStaintuit. tee Oritiougo ft. •. : . . . . .
. h. i .
E3Eiverintental TOhnoloa IDSitbSidence;Crintrol . _ . . .
7,...26.,DRILLING.I.OGIultaihldtl1tiOnitt iltrili,ifii&iSsaiil'. . . •.
. 14CleatIttutal(cItistd Loup) InTetcer ' ' -most- lo ' - DESCRIPTIONtot4r.burdurm.sorinickmx..'utah.-'4,1.,..Ora
. .
OGrothennal(HeatioWCOoliog Retain IJOdier(explain under-int:Remarks) 0 :ft. 5 • ft,. brick and red fill
5 -ft. 20 - "ft, red silt compacted .
' 4:DaM Wai(s)coutpleM41: 11--9-2 P 'win IN i!z-3 . .•
20 'ft: '49:- it, red compacted cl‘ii;Fist..,pwr
. .
Se.Well Location': . ' 50 ft.- 0, r ock., . - --"''"41•-•.-i: Vi".-!I. -,,
Former Clay.Mine. Site . . 'ft.. '- . .ft , •Ur.L• t_s
tarBitykOwozrlstanio Feictlity IDA!KappIiFa.ble) -'• • ' R. ,
.. - ' „ ---Z0-21
ft
I inrfO -r,-
1751 Colon Rd. , Sanford, NC, 27330. - . R.:. - ' O. ' ' : .:!:' .., -
• . !f':g UP
. Phy*:1110.Fss,..cilY-..011 ,ii3 ,2"1::REMARKS' • . .'. ,. , . •-...:1:21 , 1
Lee . -Bentonite seal from 30733' . • •
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County Pan:el Idesulifteuilon Na,(PIN) . .
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51i.LittintdcillId'14110Itile iu Ikgreci/DiiillitcsisectindS•nr tit cints1 ticecCM .21 cc'nificati„,,, •
(If nlI1141d,WO,lavIoua itz.dflIkoit) I'
N .
W 1.'• 11/26/2023
SigelAt'.r.:.0CC/11/.W.r!i C.aiumetar 1 - Doe •
._
G.Is(#4 the well(N) ,X1Permanent or OTcniptiraiy e '•
ity signing thirfelm.1 hereby err*Illa..flitLwellfs)hwar 6vere)eisqtriy.leil it,rterenimice
. with/M KCAC 02C,01(}0 or•iS 4 Are?tc,pac 0200 Weil CalfS.1.117Cliall Stormiards irnd&a.1
7.Is this a repairtl an tiaidl.1 ly int- f.:IVes% or ENO 1.4iiirpf risi!record IIIS'Item l piorideti i01,u!sr,li iiwiwy,
If iiiisA•4 ripak fill ear knoilm ii.,11tvostiocitims Igforiaini6n Rid tiApiain the okirare bf Me 1. -
itifigir redo 021-ierntki arilitIri ei-bn the badhix of tbrar. 23:Site 414r:on-Or athtitiqua)00.thitii .Isi
You may use the hack of this page to...'provido:_additiottal well Site.details or Well
8:Number-of Wells Constructed: 1 ' 'conitnictimi details. You tnay also ailaChadciitioml pages if necessary.
For iimitipie irdecihmor non-ware'suppr,r we0 ONLY witli rhit.satregeowstrudion,you my,
q.thmit°be form. • SUBIVI1TTAL INSTUCTEONS ,
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-0.TOMI Well depth helowlund stirfacei 50 • •. (to, 24a. tlrir AU %Yak Submit this thou tyithiti 3U•days of completion of uell
i'or itythipic ii,elklist di depths if diproy icsapipre-3.@200'athi.20,100) ' . constructinoTo Ilto foIlotting-.
10.Static water level below lap of easing: 19 . Division uf Water ReSunrceS,jnformatiatt Prat essIng Unit,
/plum,/pm/is abovv et1SPAZ iili•"4-" 1617 Alail.Seivice tenter,Raleigh,NC•27499-100-.
•v , •
t I
it,Burelinte diameter:6" - 24b:Fnr Infection Wells ONLY: in addition to-sending.the fomr to ilto address in
24a alioe,also submit a-.copy of this forth.ivithin 30•daYs of completion of tt' ll. .
II Well oanstructiou method;Air Rotary . consimetion to•the folloWing:• i
(i.e.;rigor,tu(ity.-cal?le,direct p.uslt,etc.)
. DIvploit of Water Resources,Enderground itijetion Coutro1Pritgrain,
FOR-WATER SUPPLY WELLS ONLY: .1636 gall_Service tenter,Raleigh,NC 276!)94636
' 24c.For%Vat&Supply&InjrrtiIon!Wells:•
1.3+VIFIII(Out) . Method of test: . .,
Alsb.splunit one copy of tins form vitliiin;t0:cloys of cotoOlOtiOtt.of
13b.h Disinfection typet Amount: well-cot:M.:teflon to the county lienIth en departm. t of the county wheM,
constructed. 1 • .
Farm GIV-I . Noah Carolina Lkpauntent.of&MUMMER!anti Natural RCSOUICCS—piviiloa ot Watcr116aLroz Revised August 201;i
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