GW1-2021-03301_Well Construction - GW1_20210603

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WELL CONSTRUCTION RECORD ParTtrermltlscOlVty:
nh fa racm belawd ra Sitigkar rmdtipk walls
1.We"Contractor iidornmtion:
. ...
Stefan Smith PROM TO OPSCRIMON,
w4l COOMCItrr swme fL A.
3576A
NCWc]lCartmnorC�onifi�iloaTtnnrbcx �i�� OhS1N irftinil'N3aisM�eFFs�1t1lTK/;R. `` �eiiti ,
FROM. 'M PTAMrM TFItCK1FS9 MAMIAt.
SABDACCO Inc 0 M 12 ft. 2° in. SCE-40 PVC
Cn+nPcmt NsnrE FROM, TO _ ArA.UF.TER TH ,.
rC►:N»RSS MA7F.RIAL
2 Wdl-onstr action Pcrmit#: hL
Iiu ail a tirnbte irei!peirrtJt�tie.Cmmty,Sartr.Vadawe.lt�at err:)
tn.
3.Well lisc(check wdl asc):
1CipsllfPhb __
° VATsrrx I)cDct� �►Art:at r»
Water Sappta 1Xtclt: tgaOM TO A[AAtRt'RR
DAjUiC9lhtial ��, iiC .010 SCS-40 PVC Pre-Pick
DGM1heantai(Neatingtooling Suppl}•) i33tesidential wrar Supply(Single) h. f►.. is
0Vd'oSftVCDmme1oinl 01tesidentiai Water Supply(skated)
H. TO➢R dup .
A L- TFtACFMRCr MRn1 0D A@ AMOtAN7
Ohri` tion 0 ft. 7ortland Pour
Non-Water Supply Well:
A.Ikmon torin lnjeetto6 WdhCIAqu,*rRecharge QGround�lterRemodl tilutu
FnOy ytr DtATKRtat.: r.Mru.Acrsxsvr Mr:rR n
0AtpilerStorage and Acm1M CSalinity 88rdcr 10 ft. 30 ft. Sand 2
DAgnifer Tca ❑$tom matcr Dntitwp
ft. tt,
OF-IT r mental Todmolvga DSobsidencc Control
2ti Rlfr[2i\tilAf' 1ifeMiiltTiifori�txtietSftt
DGeabetntat(Closed Loop) OTrdcer FROM TO nFsca o+c4br hoed dnN'n�eti
OGttodenual(ReatingCooA
Return) 130dw in under#21 Rema& 0 fi, 7 ft. Silt '
7 fL 27 fL PiER
4.Date WOW Ornpleted, 4/27/2021 WdIM#MW-3
SO.Well IAICA inn: ti ft
Durham Army Reserve Center <L M
Fw1wgl0%w Neroe Facaip•iDR fifrmpliaabic)
h. rr• Uri
1228 Carroll St., Durham, NC, 27707 h. h jSvY1t)Il
Pfiaiw1 AddMSvCiIY.nnd zip ;2t.2t M �..:
Durham 3 foots bentonite seal from 7 to 10
Caaoit" tyttxet ldetAifkfl W9o,(PIN)
5h.'i:.ntitb4c:And L ngiturde in ticgrecishninate slscOnds or decimui degrees: 22,Cr�tif'rcatinn:
(dwell rtwa mac ftlort Is trsfltcletn)
35.988436 N 78.916287 Syr 5/14/2021
signet or Mwwascclor I Daft
6.is(are)the wdl(6)* AMPermtrient or Memporary
11F sigxrins A/bir farms 1 heiefiy itirtjt rhdr tlAe xxJJ{s)+oar fiwrrel crftriiwied to apt»+ifinrr
w4h M NCAC 02(,01t10 or:l SA MAC 02C.0200 N'rt1 Comtnrrrian Smolards and that a
7.1s 1th a rei►tlir to an existing well: Mim. or MNo ropyVOW nro+r h 'Firm pm0*4 to she IMI anwr.
ffft bra rrpdr,fl)l4me bw 4D wil ewwrowhm wonvwrw Md exptail"I*rairHre of dw
AY�riraAmdrrd?l rvaarkY rerla:ri or"rAn the bdek of this fbrAM 23.Site diagram or tdditionAl well detalis:
You may use the bat:l:of this page to ptovide addidotlal`vivil site details or trail
8.Number of wells constructed: 1 Cottstttuetion details. You may also attaeb Additional pages if necessary.
For omi Mple lnjivdimior am-itwer sWply w1h ONLY 1hithWir name annstnucllan.yaa e m
subma"e farm. SUBAIMA INS(Ilt^TIOI3S
I
9.Total welt depth belm land surface: 27 (t�) 24a. For AFl Wells submit thisifomt ui(Mn 30 dm%.o'completion of vMl
FormWlpinxvils list oh*ftW1fdr$entitlemVie-34300'tuW2D100') consimcdontoftfolloang
i
10.Statlea°ater it: 0 belMl top of casing: (D.) IMiistoa of Water P.006 t es.Information Protesting Unit,
1f water hwI is d601 a edid1q rue t' 1617 Matt Service C66fa.Rsldgb,NC 27600461E
i ,
11.Rot�ht►lc diatnetes:8° 010 24a.For infection Weal§ONLY: sin addition to sending the font to the addnw fn
24aabot'e. also subtall a copy of, s fomt whbin 30 da)*s of conipledon of ttdl
12.Weil construction nnthodr ESA c mwmctton to the following:
(Lit anger.rbmry:imbit dined turd►etc:)
Dh'islon of NaterResoDreCs,� ndcrgi►ond Injttafarr Control Ptagrxau.
FOR WATER SUPPLYWELLS ONLY: 1636 Mill Service Center.Ralf,NC 27699.1636
134,vidti(gpm) Mctho t:d o€tes 24c.For Water Shire 14e;in(oc ann bells:
Also submit one copy of this form ttrithin{ A days of completion of
13b.M.Mufcction type, Amount- veli construction to the county'twkt16 dcM,dmcm of the County share
ooi,saractai.
Farm GW-t Mark Camlbm DgmMww of Esn4m=x�M and fbmral Raaurocs .Mkbn of Ulster Resdirm Rcthcd AWO 2013