GW1--04885_Well Construction - GW1_20240828

+ \N F;1,1, CONSTRUCTION RECORD Fm Internal I'se ONI V.
•. •,,.,in Ire aced f,x single to multiple netts i
I.W ell Contractor Information:
J la.WATIR ZONES
Scott Hunt, Jr • FROM TO DrScRIPTION 1
Well Connector Name ft. ft,
f. ft.
4561A
NC Well Cinemax Certification Number I .OUTER CASING(tar awYi-eased ee1h�OR LINER(II at Beattie)
FROM TO j m;MFTFR THHCKNiss MOratRI
SAEDACCO ft. n. is.
Compote Name I .INNER('ASIN(;OR'I't BINGtrillerraicIu+.e44uol)
1•141)11 - II) Ut%MFTFR rlllt ANEss MATERI\I
2.Well Construction Pensit ills: 0 ft. 10 ft. 2 in. SCH-40 PVC
11u all applicable well permits(i.e.County.Starr,Variance kyecvcct.-i : -
n. i ft.
i..-----....------
3.Well t;Te(check well tack 17.se RL1:n
Water Supply Well: Pnom ' to Dt4MrTr.R 'dot SIFT tu1(T(mm MAtIntiAt.
10 ft. 20 ft. 2 ia, .010 SCH-40 PVC
0 Agricultural DMunicipal:Alblic
Oeothemtal IHeatingrCooling Supply) DResidential Water Supph(singlet ry' ft. la.
1210
G
OlndustriaiCommcrcial DResidential Water Supply Ishoed) IL1/T
FROM TO MATERIAL. EMPLACEMENT ME11100&AMOUNT
Olmlaation 0 ft. 5 ft. Portland Poured
Non-Water Supph Well:
ft. ft.
EtMonitonng ❑Rceosct)'
Injection Well: n. rt.
0 Aquifer Recharge OGroundwater Rcnedi:uion 1".SA\U(.R X EL PACE L Meahlei
I.Inlet i II) _ MATFRIM. !.Mel At r.M1N1 MITOOI)
OAquifer Storage and Recovery ❑Salim) Barrier 8 R, 1 20 ft. Sand 2
CIAquifer Tess ❑Stonmsatcr Dtainagc
ft, ft.
❑E,petimcntal Tee hnolmby ❑Subsidencef'meml ;,i mkll IiSt.It)(.1 additiestal Ands ifwtcerun)
❑Geothemral iC'Iosed Loop ❑Tracer roost to trscnirnos,r.ler,'swum,onow,'OPT.war rw.ear1
ClGeothermal 4Heatine.C'ouline Rcluml ❑Other lexplain under l 2I Renwtlst 0 ft. 10 ft red brown silts
10 ft. 20 it, yellow/white sandy silt
1.Date Wefh1 Completed: 7-30-24 NelI ID,MW-8
R. ft.
5a.well Location: ft. rt. - *...
. s
Murphy USA n. ft. •
`i 1"
Facilm+Ow tier Name Facilih IDS(ifapplteabkl n AUU r
. : ft. 2 S 2024
801 E. Gannon Ave., Zebulon, NC, 27597 I ft. i ., ft. •
Phi steal Address City.and Zip _ - ,
21.RLMARh1
Bentonite seal 5-8' 1.'
Wake
Coma) I'.a;<11S,atd,�:ntto,No WIN
Sb.Latitude and Longitude in degrcerlminateshteconds or decimal degrees: 22.CerdReildne:
Owen fw•W nts:I:u.h.nf Ix sotrietentl
N W / 7/31/2024
Sigie(ictii,/,-,e-
e:Cea$caaterebr�_... Y Dote
6.le(are)the trellis): 10 Permanent or Temporary gt signingthis ,hereby r don the wags,war sorrel testVlNCted in o YYrldancr
form. 'ems
with 154 NCAC 02C,0100 or 154 NCAC(CC.0200 Well Cc+afrwrrinn Sroud,;rds and that a
7.Is this a repair to an existing well: :l'ca or lS No r,>,•rs of r5s,record ha,hen,pr.rrtded M the rrrll nn+ter.
If meat it a repair,fill oat Aromas sell,!n0.5rtwtrf!M ntfar,narnat Ante C.1p400t the*Mee of the
repair wider 121 remarks section or on the bait of this form. 23.Site diagram or additional well details:
You ntay use the back of this page to provide additional well site details or well
8.Number of wells consanseted: 1 construction details. You may also attach additional pages if mussel!,.
for malrrple tnjecrron,a non-writer tsppl r wells ONLY roth the Faison coaafractioa t,,a,<tn
,abmatone form. SUBMITTAL INSTUCTIONS
9.Total well depth behrw land surface 20 (ft.) 21a. For All Wells: Subnat this form lstthtn III days of completion of well
For malsiplr,. ' t,•r- ,. 1 . 1.9rrenr leamnpfe-te,?(Rr and 20((Oil construction to the foltonin
18.Static water lesel brio).top of eosin': 14 (ft.) Division of Water Resources,Information Processing Unit.
If noire kw,r,above costae,a. - 1617 Mail Service('cater,Rakish,NC 27699-1617
11.Borehole diameter:8.25" (in,) 24h.For Injection Welts ONLY: hi addition to sending the form to the address in
244 abuse. also submit a copy of this form within 3O days of completion of well
12.Well coasinsetion method:Auger col tstntction to the following.
lie.anger.roan,cable.direct push.eic,
Disirinn of Water Resources.Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: I nett.ALtil Service Center.Raleigh.NC 2 7899-1636
I is.N.kid Iwo/ Method of text:
24c.For dater Supply ti Injection'Welly
Also submit one cops of this form vs ilium tm daysofcontplelionof
13h.Disinfection type. Amount: well constnictton to the comity health department of the coats where
cote:nucled
Fomi GW-I Nonh Catalina LAtanneru of Em tromuctu and Natural Resources-Dnsstool of Water amounts Rcr sscsl August NI t