GW1--04884_Well Construction - GW1_20240828

WELL CONSTRUCTION RECORD F«Internal Use ONLY.
The form can tic used for sinl:k or mi.ltipk udis
I.Well Contractor Information:
14.WA71tk 1+ONtg
Scott Hunt, Jr ntIOW TO DIS('RI►TIU'I
Well(•nrsr,'cii+r N.inte R. R.
4561A R. R.
NC Well Contractor Certification Number f 11.OOTER CASING der nolli'eased milk)OR MIER Of atatreahk)
,Rose ; To q•1\IFTFR T111CKNIFSS 1 NTT,RINI
SAEDACCO 0 ft. 30 it. 6 ie. SCH-40 PVC
("output)Name It INNER CASINGln ORTUBINGIreibenealced4laup)
E
MOM TO DI V.IFTFR TBi('k\WS5 N\TFRLII.
2.Well Construction Permit t1: 0 ft. 45 ft. 2 in- SCH-40 PVC
List all applicable%ref permit:(Le.County..St rtr.Vurina-r.foection asr.l
R. ft. iL.
3.Well hit(check well use): 17. — —
Water Supply Well: !ROM TO DINMITER MOT,trr I Tttt(lciiots I M.AYERINI.
❑Agricultural DMlmicipa4Atblic 45 R. 50 R. 2 1e• .010 1SCH-40 PVC
OGeotheat tHeating.Cooling Supply) OResidcntial Water Supply!single) h. ft. ie. i
mt
❑hdustrialIComnfercial OResidential WaterStl(Ip)s Ishared1 1a'GROtIT —
nROM i0 -MATERIAI. _ t,Irl NI I Si!\I Nil 11101 A to ,I .
❑lmgation 0 R. 30 ft. Portland Tremie
Non-Water Supply Well: 0 R 35 ft. Portland Tremie
MMonitoring ❑Rccoscn ..
Injection Well: IL ft.
O.Aquifer Recharge ❑Cmnndualer Remedial ion It SAND/GRAVEL PACK Of applied/lei
room to w.'TrRttt. ' o SIMSill \I 1 Ni \r MtTROD •
❑Aquifer Storage and Recover ❑Salinity Hamer 43 ft. 50 ft. Sand 2 ~
❑Aquifer Test ❑Stomnurtcr Drainage
ft. R.
❑Expcnnlcntal Technology ❑Sabsideuce Control
*MY1LtIIG LOG Mead ad lleaal Meets if aecetrsrsl
❑Geothemull(Closed Loop l ❑Tracer I MOM To ocsCRtnT ON roofer,%anima,wwnek DIM Drab dam.ie t
DGeothennal tHeaungl'Cooling Return) DOther(explain under M2I Retlalks) 0 ft. 10 ft. red brown silts
10 ft. 30 ft, yellow/white sandy silt
4.Date Well(st Completed: 7-30-24 Well IDNMS4-6D
30 R 50 it. red/yellow sandy silt
5a.Well Location: ft. n. s .
s s.-. 5._ ' 'r S..
Murphy USA fL ft.
FacilirylOa net None Fxilin tTkrifapplicable) n. it. i AUG 9 b Z024
801 E. Gannon Ave., Zebulon, NC, 27597
It-'-;,;
Physical Ad iess.Ow.and i,1' IasiRio .,; - ,-- - r
Wake Bentonite seal from 35-43'
Count) P.n,cl Irk Ind..i tntr N0. PI.NI
5b.Latitude and longitude in degrees/minutes/seconds or decimal degreme 122.Cerdficat so:
of o.lt I:-W ins St long I..IJ1lcrcalI
I
N W / i' 7/31/2024
Sigtai CM$ a 'c11 Contractor :'arc
6.Is(are)the well(s): ElPelmanent or ❑Temperar,' gy signing dm f,,,,,,.L ke„d„•rertife that the relitsl urn iwerrl cvartnts-red m acrwrrba.Y'
with 1 SA NCAC 02C.0100 or 15A NCAC 172C.0200 Wed Co mtrw'nrw Sas,Jards aril rhos.r
7.Is this a repair to an existing well: ❑Yes or EI No coma).thAr record 4m-been prei'a'kd to 264.urn na•nrr.
flak;is n repair,fill.H,t inua.,I.,err, rn:ri.rm iaforwonkut and rsplmri rho'nrrrrre of Mr
repair wider I?1 remark.,.r.iian or on the brrt of this form. 23.Site diagram or additional well details:
You may use the back of this pcige to pros ide additional well site details or well
8.Number of wells eoestructed: 1 colseructiml details. You alas also attach additional pages if tte(:essan.
Fur anal:;Jr sue,rddl id nrml.uorrr supply wells ONLY WWI Mr same ciwuwwcfaws tow con
:tibriw one l:-urn. SIIBMITTAL INSTUCTIONS
9.Total well depth belom land surface 50 (fl.) hit. For Al Wells: Submit this Imo n noun 1i1 days of conipktion of hell
Fur muluplr morph tut,cdl,trtuh,efdtfrernr'crumple-30100'and?8'1001 construction to the following
ie.Static water level below top of many 15 fin,1 Division of Water Resources,Information Processing l nit.
If miler kvr,it above rating.ate"+ 1617 Mail Semite Center,Raleigh.NC 27699-1617
I I.Borehole diameter:12•25"/6" (ice,) 24b.For jaigthsta Wells ONLY: In addition to sending the form to the address in
24aabase. also submit a copy of this form within ttl dos of completion of well
12.Well cuustnstrim,owIhn.t: Auger/Mud Rotary construction to the following.
SIC anger.moo.,.d-.b.. rn,..•,
DhIdos of Water Resources.Undeeenlund Injection Control Pnogrant.
FOR WATER Sl 1'1'1 1 11 FITS ONLI: 16.34 Mail Seri ire Center.Raleigh.NC 2'699.1636
t3a tii(Id 1 14e.For Water Supply &Injection Welly:
Qpml Method of iesi.
Also submit one copy of this form is hint ;u do.s of completion,of
1313.Disinfection type: lnnnni!_ well construction to the counts hcahh department of the county where- continicled
Fenn GW-I Noah Catalina Depcmnrtu of Ens tmmtxtiu and Natural Resources-Dimino of W.n.r R€-soircn Re.Ked August HII