GW1-2021-03311_Well Construction - GW1_20210603

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WELL CONSTRUMON RECORD for lrlcmiilVaONLY.
This tatimcan be awd for slgkora W10c vmgs
t.Well Contractor firforniatton:
tavi�altzD
Stefan Smith FROMM To ORS .I"
To1V
Well CoNrmvr Name ft. A.
k ft.
3576A
15.011TER C i elriit itti�e3if d C tiR i i7t`lf i b. ;,
NCCVeIIComracrorccnd&miionNnmba FROM TO 01"TA;TRR T"TCKNM MAIMAi.
'
SABDACCO Incmp 0 h 8 h; 2° 1e. SCE-40 PVC
CoMYWart i6,:11 1t G.OR�lIBIIi .'._ ibersdid�,. ;
FROM TO DFANUTM TMCkNFM MAIrJUAL
2.'4 Wt twonstr acith►n Permit
L j;t ir11 eRprit n51r roefl pmnlra ti r.County.Start.Variruere Irs[do7j rtr:J
tL fl. isti
3.Well Use'f0i well asol: ��."S 1�N #, ,
Water Suplttlr Rrdl: FRO" TO _91ARPTM g—TS17y, Tier MATK1ii i`.._'..
lAgttcliftn3al C9MnnisipnllPnblic 8 it. 23 fL 2" tR .010 SCB-40 PVC Pre-Pick
DGeothennol(Heatin0ooling SttppV) iflResidential A%%ter Supply(singia) iL IL F
13 tndasniallcominciciol DResidentii tl WOU'Supply(shared) 48,0110 ;x
PROM TO MATRRtAL 7?.1tPLlICEBIF_�7 3�tEiiIOD fi AMOIIRr
Otrri loon 0 ft. 3 fL Portland Pour
Non:Water Supply Well:
mMomtori pRaa. e.
it- (L
in eet oa clt: ,
l�ii►cpriferitcchirgc DCtot�ndtrntctRetnediation
FROM_ lMATa Rr't. R7ittrl A�i?itr\ N n..
CAoaiter St mgc find Recovery' []Salinity Ranier 6 IL 23 ft. Sand 2
17AgW"7csl ostommaterl hinge R.
17>vcdmcnnd Tcshnotagf OSnbsiderre CQ*Ml
30.`QRII;iJNti1<iOGf: tl'icli5itf$iftant
17Geofltemial(Cloud Loop) []Tracer 'FROM I TO nt eTtrnitO,r wtsi lierletla�xi�rBeR nc na s
❑Geothertni " ati 2 Return) OOther in under.#21Remart) 0 M 7 (L Clayey silt
7 $ 19 (L Bulk silty sand
4.Date WOO)Completed: 5/3/2021 WdlJD#MW-7 19 R. 23 fL Pt1R t� �
So.We"Ligation: (L n, �
Durham Army Reserve Center A. tL 2
Factlitymu'li Name Faollit)1Dk(irappbublc)
fL it.
1228 Carroll St., Durham, NC, 27707 ft. R. PEd>j
ft#%iWAddxss,Ciq•.aMZip 2ti2A111
Durham 3 foot bentonite seal from 3 to V.
CAM* PWW tdetdffkatton Na,(M)
Sh.i40tadc and l tingitnde in degmestminntedlece6nds or decimtal 4eg"cW1 2L Certification:
(ituctttkld;miGW*ngissakic(d)
35.968617 1• 78.916834 y SiA� 6ni �iww_-R
5/14/2021
Signs omraetor :Date
6.is(arc)the wtil(s): e2i ereianent or Memporary
By sig8ins Bois faairr.I Arrrb)•eeitgfj t)rdr the e+r14x1 firb l wore)[Yaritthrcrert to rxrsprtitnracr
with.15A NVCAC 02C A100 or 1JA NCAC 02C.t M WWI CaaurYtws vn Srtaiada►da and Awl A
7.Is this are'airtoanwdstingwell: Oyes or MNo ropy afthar.eVn„rr has brim pimtrkatorhr,ivrrni
MW it andff r�l iM&rb xectmn er rw. rk�hbl m o+ed r.rpltrirt rkC�arri:re of dtr 23.SitedhWam of additional well
�' dctattr:
You ray use the back of this pegs to pnA ide additionat nitil site details or well
8.Number of hells ronstrttcted: 1 construction details. You also nttackt add riorlal pogta if cessan.
For—Nple 7Ow-or ONLY uirh-flan shrove carrsTryrcftarr.�ai rwn 117"f
subtaftoneform SU,BD�LIN5 T.UMONS'
9.Total ftdl depth below land surface: 23 (i7.1 2Aa. For All Willy; Sutin it thislfonn uithin 30 days of compkt an of ntill
Forowf0pleityft hiralldep0a 1fd*renttero"le-3@20'md2k'JW) construction to the following
10.Static water level below tap of eacinz: (R,) Division of Water R soprets.Information Processing Unit,
T/ntirter kW u shame rdt)rik W e"'t^ 16171V a Service Center,Ralciph,NC 276D 417
I I.Borehole diameter-a (in.) 24b.:Fnr i0h3go0 Wells ONLY: In addition to sending the form to"tlte.-ddress in
24a above.also S*mit a copy Of ills lotto`wiihin 10 days of completion of *�11
12.Well eonslrnction method:BSA cmirtiction to the tonowbw
(Le.xiw.notary:crble.diym posh etc:) I
Divislon of WaterResoorces.Underground Injection Control Program.
FOR WATER SUPPLY 1VELLS ONLY: 1636 gAll St toe Ct nttr.Raleigh.NC 276"4636
13a.'Vitdd(gpm) Method of tesk 24c.For Water Sap&&'tnjontHatiWells:
Also submit one coin'of this fortis within 30 da)•s of completion of
13L.Disinfection type Amount Ni-cil eonstniction to the county he lth dep tment of the county tvhese
comorucW.
I
Farm G%V-1 Nonh Camtim t quivio t of Emiionmd and Nanusl.Ri ww=s-Ih-hioa of Water R6aim Revised ALVA 2013