GW1-2021-03307_Well Construction - GW1_20210603

WELL CONSTRUCTION RECORD For it knW USc ony:
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1.Well Cnntractor:htformathon:
Stefan Smith iROM A I "ON
Well Gonlracear Name
3576A
NC C4'eJl CammaotCarlitkxtiimlVt��ea :5 t}tTl'RRT�5fNti xn+rMi4a�red: Q'Ri_ 'P,R �' .bt2`,; ,,
FRbM Tb VIAMIM TNTCKIIM MAiEPIAL
SABDACCO Inc 0 ft. 12 ft. 2" le. SCH-40 PVC
CamymT�Flamc f6: T)C` �t'iTB'1NGx"
6ROM Tb DUMi.'rTiR I TFWKM.SS I MATMAL
2.Well Construction Permit#: ft. fi. hL
Lutaft erPptitoUr wrtl prsmftr(Le.t"amty.S—,Varipare.11 01WCn er:1
fi. ti.
3.W41 Use(check well asc):
w„
Water Supply Wdl: tpRpM To atAPT M sw, tar I Ttit MAT'MIA1
OA IhITah t�MnnicipaUPubiir 12 R, 27 41. 2" la, .010 SCH-40 PVC Pre-P ck
OGeotbeitnl(fleafingtoolimg'Supply) 131tesideutial Water Supply(single)
Ohndustrial(Commcrcial ORestdermnd Water S 3t+r iiRO1TT >r, w'-
R(Shard) FRDM_ TO I 14ATEPtAL TMTK A[ENOT MUMOD S AMOWr
Olni' tion 0 A. 7 (L Portland Pour
Non-Water Supply Well:
Mmonitod OttemyTy
Itt ection well: ft. rL
DAquifcrAccharge OGroundimterRemediff"on t �`
O t*r.Slora 1114RMON OSnlin' garnet iR M MATRtt1A1 eI.A. T1TMtret D
� �` 'n' 10 ft, z7 rt. sans 2
0Agalter Test OStornimterOTMange
fL R.
OF- r`tmattal Tcchnetoa 13subsidcrcc Control
=�a: Rnsstt ; {:._fcli�iildlTfiindY�Itiezflf .
OGeotherntah(Closed Imp) O%cer YRbsr TO DFSCRtrTM oet.r bsrOM1 anwrae� etc
OGeiothennal(Heati oli Reim) c3Otlwi in wid r#21 Renwks 0 (1. 7 n. Clayey silt
7 ft. 19 tL sandy silt
4.Date WOW Oompleted; 5/4/2021 Wdll])RMN-8 19 ft. 27 f; PWR 5- VIJ
Sa.WOO UVAthtn.
Durham Army Reserve Center fL tL ` ffiA
Fscil /On=Nsw- Tacilit IN(ifapplicable) ft. FL c�
te�
1228 Carroll St., .Durham, NC, 27707 tt, R, 3,j CJP
Pk3kd AMMSS:CiQ;and Zip KC
Durham 3 foot bentonite seal from 7 to 101.
CO21W flsmd hkm lkMif a No;(PIN)
Sb.1»-ft and 1,6ugfMde in dcpm%,ni►mtcs1scc6nds or*dmal f trees: 22.t�+ettifrcaNnn:
(Iructl W4;o��e taSlla is Sidnelt(d)
35.988265 N 78.916845 W 5/14/2021
Si6rat of A%eIICanhactar, Dsk
6.is(are)the wtil(d): zFerttaneat or Memporar')• m.„g d g db Ja m,1 hereby erto rhdr:dr xrilfs)*at f mov)tm3zmmiM In arb„donm
whh.154 NCAC 03C;01M or 15A NCAC MC.020 trill CAMIreffian Srrtmdords oOdiet s
7.Is this a repair to Lou tAstiingwell: Ma or EM) pfrhk4rf11A+Y��17b`blCrJjJ7i1s'Ii�YttnJjltttYjlA�IIVIPI.
tjlhts Ixr+rrpra4r.,}dtl aerrhntritet�s�iYeoM1�Tnucrtcm(nfnmtarioriarutrxptoht.nc�nnrsre tf nc�
r4wirwWord21 rmairt:s.i ioo eras rhr Mart Of eWs farm: 23.Site diatom or additional weli detalts:
You May Use the boa,of ft page to#Mvide additional oelh site details or well
S.Number of ts•ells constructed: 1 eonStmction'details. Yau May also illach additional pages if ttbcessan1.
For matitnit of rcrkn or aan-uw*v jW#y weals OAT.#'lidrh.rhr suns onnstrrrcttorr.vaa ems
subunit mu firm. ►SUBH�M CT70NC
9.Total welt depth below land surface: 27 (lit) 24a,l"ar At Wcilm Submit Utis>fonTr uitiltn ail day%of c6uVldion of well
For arabiple urtls ho at)*p*s fjdfJ/rrrru(exmpff-J@IOn'aw 2@14w) Cbnsintction to thr,follnwins,
10.Static water level below tap of casing: (D,) Division of Water Resourtex,Infil"nailon proteW"A(Twit,
T/%Wer Wet it a6otT cr At.asr"+" 16i l Mail Smite 6af&,Raleigh,NC 276"4617
11.Borehole diameter.a" ) �ONLY-
of ln''�dition to sending the form to the address in
24b.,hoc e. also sdttni
copy
`s farm.within 30 days of completion of ma
12.Wrell CopstnMinn nMAbod:BSA C Yn5tr11i tian(0Ilte Mowing. t
lie.atom,toiM.cable.dbM posh etc.) f
Division of Water R.esoarces.}iVadergniund Nectlon Control Program,
FOR WATER Si1PPLY WELLS ONLY: 1636 Malt Service Cuter,Raleigh,NC 276"4636
13s.Yield(gpm) Method of teak
24c-For Water Supply&1nleWor cIls:
Also submit one copy of this fort within'30 da}•s of coinpletion of
13b.:Disinfat[on type Amunt: well constniction to the county he laltb&-mftnxM of the Conway Rinse
Constructed.
FunnG%1-t Re%- dAgi201-1