GW1--04887_Well Construction - GW1_20240828

+ - WELL CONSTRUCTION RECORD �A For I tie nudUse ONLY:
The form can be used for single or mullipk wctls
1.Well Contractor Informative:
II ZONE
Scott Hunt, Jr t.oisi Ito OFSI err,Iti'.
Well Contractor Name n, fl.
4561A ft. ft.
NC Welt Contractor Certification Numberj IS.OUTER CASING(tor multi-cased ee!j OR LINER lit aft !kaiak)
FROM To 011MIFTFR TttictoEss NIA TPRI
SAEDACCO II. I I. N.
Compmp Name t�1It1iLBC�A$UIIG OR T]4�G i allcrNal ele+edaunpl
/RO�1 To +N,SNFTFR Tln('k t\. _ Ji_ I\I •
2.Well Construction Permit N: 0 R. 10 R. 2 sl- SCE-40 PVC
i i sr all applicable urn!permits!i_e.County.Star,Variance.!gleam err.I -- - .
R ft.
. R. in-
3.Well I w Irhea:will uwt:
17.S("RL[N �
Water Supply Nell FROM I To DIAMETER st.otSIn 1 Ttthrustss MateNISI.
U AgriculturalOMunieip+vl�Pulrlic
10 rt. 20 ft. 2 i .010 I SCR-40 PVC
DGeothertnl lHeatingrCoohm8 Supply) °Residential Water Suppl )singlet It. h' i`
Olndustrial/Commercial °Residential Water Supph I shored) ill'GROUT
FROM To MATERIAL EMPIACEMEVT METHOD A AMOI\T
Elhntaatlon 0 ft. 5 ft. Portland~Poured
Noe-Water Supply Well: .-- -
ft. ft.
IS Monatomic, ORocoscty
Injection Well: H. , D.
❑Aquifer Recharge °Groundwater Renrediationn Pt SAND/GRAVEL PACK lif;ui tlicabtrl
//ROM TO 'I.Ir WI+i IfMM.s(iilE\T METHOD
°Aquifer Storage and Rccovet °Salinity Barrier 8 R. 20 ft. Sand 2
❑Agmitcr Teal ❑5tonmtiatcr Drainage It. ft.
❑Experimental Technology ❑Subsidence Control
M DRILLING LOG lartaeb aMitlwlal sheen if Necessary)
DGeothemnal(Cloned Loop n ❑Tracer ►Rom In DFWRIPTnO\rtnIsr,►..a.e.,,wiWnwl.Opt.p-uN arr.r«.I
OGeotheal tHealingcuolim_kcninil COUe t r(explain under 021 Retails) 0 R 10 ft red brown silts
tm
10 it 20 ft, • yellow/white sandy silt
4.Date Welts)Completed: 7-30-24 Well 11).MW-7
5a.Well Location: h. n.
Mu h USA t. n . , k ' --
rP Y fl. q } i L,�,..+4. . t 1...L.
Faeilil)'Ow net Name F,o,I I, it,.,,i,•rpl.:abkl R. R.
801 E. Gannon Ave., Zebulon, NC, 27597 fl. ft. AUG 2 s 2024
Plessical Address.Ci}.and Zip 2L RRSMAIKS •
Ire' '.: -_. a--..Sa •,
Wake Bentonite seal from 5-6' C.y, ,.
('oanh I'.re I hdcaldrealirw No ;PIN)
5h.Latitude and longitude in degttesiminmtte/scennds or decimal degrees 22.CatllkmliM:
In 555711 field.rnr I:w1oirg 1%+udliclera)
N W u � ` 7/31/2024
Sip El CMshe ell Contractor pale
D.Is lard)the w ell(vf: XPennanent or fTemporan
M airing tins farm,I kerbs certify that the mike!ego tours constructed or accordance
with I SA NCAC 02C.0100 or I.54 NCAC 02C.0200 Well Conatrnrri.ul Standards rtiet that a
7.Is this a repair to an existieg wet: :Yes or IS No r,ato of Chit rrroni has been provided rn the Err!!owner.
If this Is a rrpah.fill cell*noon wed t eusrrrtrl n ie arfonnarion and specie nc.•/p:nice,.f r.-
rrpair a nder 12i remark,-.,n-w,,or an the bail of this-loon. 23.Site diagram or additional well tktaila:
You may use the buck of this page to pro ode additional well site details or well
8.Number of wells constructed: 1 construction details. You Inav also mach additional pages if necessan.
Far.nalsrplr rn]errbar.a rtan-u ore,tuppt%wells ONLY wah the same construction +..M E no
.+aMnu mw from. S!I BM ITTAI.INSTUCTIONS
9.Total well depth below lard surface: 20 (fy) 24a. Fur AN Wells: Submit this form wohm tit days of completion of well
For multiple Adis list rill rkprhi ifdef(rrrns re onapfr-t 2oo and.' 101r) construction to the following
10.Static water Ind behrw trip of caving: i4 (ft.) Division of Water Resources,information Processing l nit.
If cake kw!is isborr tat'. .• . 1617 Mail Service Center,Raleigh,NC 27699-1617
I I.Raceme diameter:8.25" (In.) 24b.For lnkrtiem Weill ONLY: In addition to sending the form to the address in
24aabose. also submit a copy of thin Mini within 10 days of completion of well
12•Well comtntetinn method:Auger construction to the(ollowing.
le .0 ;r.na.I-.,..it lc.direct push.etc.I '---
Dip ivirn of Water Resources,Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: Ir+3(.Mail Set-sice Center.Raleigh.NC 27699-1636
IJa irid mom) Meth 24e.For«alcr Suppls &Injection Welk:
Also submit one copy of this fonn within !O days of completion of
13b-Disinfection type. AmRtmt well constnicuon to the counts health deportment of the county where
eonsiructcd
Form GW-t NoOk Caloluia Department of Ern Holman and Natural Resources-On room of Walrr Rnsoterm Re,toed Aught 2.1113