GW1-2021-03305_Well Construction - GW1_20210603

i
WEAL CONSTRUCTION-RECORD Falm" llnroxly:
"Mis,farm can be omd for single or multiyk uas
1.Wdl Cnntmetor information:
4.'UIrllttilltt:
Stefan Smith FR M aRSGittlrrtQ!f
NN'Ctt C04Mcrot RAYM
3576A
NC-Wal9Cwamaor.Cenifi6%1ftNw*cr t .atTr it-L�1SfP nr.' Atli zedit n gitf�lNi',R{tf"" eib
FROM I TO PtAmmm Tn1CKNFM MAWRiAL
3ABDACCO Inc 0 R. 6 rt. 2n in. SCE-40 PVC
c4ftVanyttamc t6.i' Gt)R3iMIM ft2
OM TO DiAMF.TRR I 71HCKNTM I MAWJUAL
2.Well CiOnstruc!lan Permit#: it. R. hi,
list alf epplir ave wry permit,ir.r.County,Stw,Vnrfnxre,Ifteeda i r/r./ h, ft. is
3.4Wdl Ilse(ebwJc well w*. ltfr
FROM
6 _ZUM1tRTttR
Water Supply Wdl: TO a7r: Tritctc�� stArr.RIAt._
° Ilk i .010 SCH-40 PVC Pre-P Lck
OAglicultiml CiMunicipaUPnblic
C36eotiremml(FieatingGoobngSuppty) OResidential Water Sttppty(single) �' R
OindustitailCoi inxicial OResidential Water 18 a[llft)t}T: j
Supply(shared) FR M 70 MATOUAL 1MP AlT`li VIR TAfMGD RAM0MXr
Olin lion 0 IL 3 M Portland Pour
Nan-Water Supply Well: IL k
®Momtoii [J1tExoi
Injection Well: (L
ClAquiferRecharge ❑Catoundisttaftoediation '. X
PR \1 fATitR1A(, plMWA. tc?t'r Ertl a
OAgvifer.StomSc and Re try OSalinity Barrier 5 FL 21 M Sand 2
OAquifcr Icst OSton nsatcrvmimgc A. f1,
OFximimcntnl Tochnolohn° Oarbsidmc Control
2a.,nRt1:3,trCl ` c�iinikli�iieal�attttttaf;.. .
OGeoilennal(Closed Loop) Wraoer FROM TO I DTSM1rmor,a*Nr bsrin ao6Vrft c n ft,eu.
OGeotheanal(Hearin ooli Retum) 00dw `n w der421 Remaft 0 (L 7 (1. Silt
7 ft. 21 IL PWR , R"
4.Date Well(®)Conipletcd: 4/30/2021 well ID W-5
ft. tt.
Sit.'11'e11 Location: (L ry„
Durham Army Reserve Center A. (L jull IN
Faci1[tyA ncr Nanr FeWih-1DN(if oppliub1c) r flit
ati0f1 P fp�S
1228 Carroll St., Durham, NC, 27707 �, h INOZJ
Plgsiml Addms&City.and Zip 2 321 Jf KS' t.
Durham 2 foot bentonite seal from 3 to 51.
O"My Pamd (PIN)
Sh.LigiFtude and t'r ngttvdc in,ftmeslminuteslteconds or decimal degas: 2L Certiriication:
ONO t)ekt 0%boo"s is StAtitra)
35.987922 N 78.917829 W 5/14/2021
Si�mr of C .. Ridl Cei(i®ctar Date
6.Is(are)the s+ell(it): ZPermanent or OTtinporary
By#SnMp dais:jomk t hrrd,),tw t#j-rhdt Aw wel!(yl*ft tweet)eased wed IR Aft wifince
u*A 1 to NC.4C 02C.0100 or 15A NCAC 02C',020ft Well Comtmaian Standm4s and AN b
7.Is this a repair toain existing well: OYes or MNii �ftJ�ixrrtnn3ixts ptm'&lalrAttravNmio�Pr,
tfthlsisn rrpnir,/1tl ter katrrriwa ure7l rx�rtrrtuettcm ttmuefdpn mal Fspfadn itie narn+re njthr '
reyolrw der*2l remarrte..r+dw6or rm die beet qf dtrf'6mL 23.Site dlagram ur additional i+eti,detall,4:
You tray use ft barA of this page to pfoi'ide additional nvil site details or aril
S.Nnmlierof yells Constructed: 1 iaDmmttion details.'You may also s tttach a dditIanat pages if accessary.
For nwNOr injerxJw or awl-hnr"er nq,*tM15 ONU nfrh doe wme consAvrctlon,you can
sa6mit:mrfirr+a SHUNrML MISWOEW
9.Total well depth below land surface: 21 (i t.) 24n. For All Wells: Submit this ifama w'i hin 30 dgyas,of contiOetion of well
ForinWriple wrtJs ir'i r atl rl Xkx(f drffereHr constrwtion to tic foltemi iW,
10.Statle waterjm►d below top of cramp: (110 Division of Water Resourtea.Information P.rotessinR Unit,
ff wamr ttM is above eadat w,"�" 1617 Mail Sersiec Cortex,RBtc O.KC 296"4.6t7
11.Borehole dianicter:8. (in.) 24b.For inWO Wry ONLY: in addition to sending the form to rite-adiess in
24aaboi`e. also submit a copy of this form within 30 days of completion of+cell
12.N%'e11 ConStruale"miabod:HSA constsurtion I*titer tbilotiatg;
(i.e.act tows?,rabic dinxtptsstl,etc:) Alrision of Water Resonmsc,Umlergmund Injection Control Program,
FOR:IVATFR SUPPLY WELLS ONLY: 1636 Mail Service ice Center,Ralelo.NC276"-1636
13a.Vidd(Rpm) method of trsk Zia For Water'$a &&idodion tVdls:
Also submit one,copy of this fonh irithin,`30 days ofcoi Vetionof
13b.Itisinfeetionh'pt~, Amount:, wsil constriction to the county health depsiiment of the countywheTC
eeittstritctvd.
Fafm G%V-t Nonh Carotins Dqmtnx-W of Em'frDnmm t and Manual Remmom Dh+Jon of VNata R Rey lsed Ate 2013
i