GW1--05436_Well Construction - GW1_20240909

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multipk cells
I.Well Contractor Information:
II.wrATER ZONES
Rich Lemire rOOM TO OMSC'RDttON
Well Concica•t 1.rue ft, ft.
2593A ft, n.
13,OUTER CASING(for
NC Well Comacror Candi:anon Number mYi eatd wNhl OR LINER(Y ale)
roost . TO j m1 AMFTFR TNRI01,NS I M11TTRIkl
SAEDACCO O. O. is.
t'on4rur)Nan` i NI.INNER CASINGORTUBING therUd.srd-loop)
FROM ' TO PIADRTRR _TOR A\i.- MAITR1.t1
2.Well('onatroetion Pen•nait#: 0 ft. 5 ft. 2 M. SCH-40 PVC list all all applicable e.rll penman tie.Cowin-.Starr,Variance. {err.! --'tea
ft. R. M.
3.Well Car(check well tier: 17.SCREEN
Water Supply Well: room , TO DIA tltti , anr,in nor Axtia WAIUTAl,
--------- - --
LIAgtrculturai OMInicipalPublic 5 ft. 10 It. 2 in, .010 SCH-40 PVC
OGeothemral lHealing,Cooling Supply) OReii6ennal Water Supph.(single) ft. ft is
❑lndustriaUComnlercial ORaddentl:d Water Sttpph tsktred) 1R t7RO0T
IROM TO MATERNI. EMPr.1CFMESi M1.MOO A MOUNT
0kogatiou 0 ft. 4 ft. BENTONITE POURED
Non-Water Suppls Well:
D. n.
RMotatonnr ❑ vRcco cn _ _
injection Well• n. (I.
LAquifcr Recharge OGrouMwakr Remediatioe 19.SAND.(.R%A l.I.r At I.ill ytpbe.ihkt
FROM -_.I" MiiFR1U. RMA(N. t_vr'.TMPTT1On
❑Aquifer Storage and Recovery ❑Salim`(♦•Barrier 4 II, 10 ri, l SAND I#2
❑Aquifer Test OSIorin eater fhainaagc
II, II,
❑Experimental Technology ❑Sabsiderrc(•omml I
2a,DRILUSG LOG I abaci addtliooal sheets it accesses".t
OGeothemwl(Closed Loup t ❑Tracer PROM TO arSCRrr DON.oehr,hard.cw,rrLL5n. hp.Pal,S.me.)
OGeothennai 1Heaung(ooling Return) 00111er ie'plant under 021 Remarks) 0 ft. 10 n. RIVER SAND
ft. ft.
4.DateWAN(a)Completed: 8-22-2024 ♦..�IIOmrTW-3
Sa.WeU Location: It. It. .i`p L 7 1�r'' i
OLD RALEIGH LANDFILL #6 ft. ft., SEP (I 9 2O
I
Emilios i.ncrMors Facility ION(ifapplicabkl R. V ?
1850 Fayetteville St., RALEIGH, NC, 27603 -- R. A. 1
Physical Addntnts City.and Zip `21.REMARK' 3 j
WAKE
('multi Parcel Identification No INN)
Sb.Latitude and IAingitwk in degrecs/minwtealaecnnds nr decimal degrees: 22.Certification:
(If cell held,is lal.loug is srdl-iCical)
N W 4,4 o�P ,.,.�. 8/22/2024
Signature ofCenr Well Contractor Date
6.IS late the w ell(st: 'PermaneN or EITrm)wtran M-signing thin fatnn,I hrrehr rernfv that the MelN.l wilts forret arnartruered ire accordance
with 15.4 NCAC OW.01011 or 1 SA NCAC 02C.0200 Well Constantinrr Standards and that a
7.Is this a repair to an diet` g well: Mai or It No rapt of rhl,record ha,here(pt.rrwled to the'turn n.'ner,
If mkt is in repaie,fill out beniu(Pell r rmutru.ram!n/imnanr,n ran)..edam the Pattern of OW
repair ender I21 remarks mlw,,or all rho hock r,f this form 23.She diagram or aiiYtional well(elms:
You may use Ilk'back of this page to pros ide additional well site details or well
8.Number of wells coestni ted: 1 connslnletion details. You nnas also attach additional pages if niecessan.
for multiple tnje,rhm,a awt-Wont'r rupph nulls ONLY with the s.mv CONISPw•rkrt w.tr Pon
meant,eale form. SUBMITTAL INSTUCTLONS
9.Total well depth below lard surface: 10 (f1.) 21a. For All Wdla: Submit this loon tsohm ;it dass of completion of%sell
for m illiple Wrlh hot all drpltr ifdt/reevil ieaamip(r. toe.jrsi'.au/'no hAY1 construction to the folkinrng-
10.Stack water level below sap of easimr 5 (f1•) Division of Water Resources,laformasiw Processing l nit.
1617 Mail Service(•cRler.Raleigh,NC 27699-1617
11.Borehole diameter:8.25" (is) 2db.For Inkxtion Wclt.ONLY: In addition to sending the form to the address in
24aabove. also submit a copy of this form within t(1 days of completion of well
12.Well com®1rwetion method: BSA constttrclion to the folios%mg
tic.auger.ratan.cable.direct pc.i i.
Division of Water Resources.lindergrimnd Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: I1136 NI Ail 3cn ICC(rmcr.Raleigh.NC 27699-1636
l3a Yield 21c.For Kato Supple 5.Injection Wells:
Igpa) Ncdiod of test:
Also submit one cops of this funs wtllnn art dass of completion of
13b-Disinfection gpsi __- Amount: well constriction to the coimes health dm-mon-in of the counts where
constructed
Fenn GW-1 Nonh Carolina banner(of Ens iroiutrm and Natural Resources-Division of Water Rearms He,Ned August 1-I