GW1-2021-03312_Well Construction - GW1_20210603

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WEAL CONSTRU ON REMRD t7 ti tt ll�citrt v
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t.tWal Contractor Information:
Stefan Smith FROM 1 10 1 laMCRIP"ON
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3576A
SSG tVcll Comm orCenitf at#onNnmbca &01�.
FROM. I TO VTASTFM T7F MAWR1A1,
SAEDACCO Inc 0 fL. 15 A, 2° in. S PVC
Cetis4i,irtptiswir fin 1' t f1S (tl MA la -<
FROM I TO DWI, Tln[9CA`£SS MATVUAL
2.Went 0n..0rnv*n Pe rnnft ft. rt.
f so all tl r.0%mly,shw,.Yartramm 4alUbn rtr.) P. A.
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itersnppliwdl: FROM TO I n1AEmit it $T,O7'52Y> Trn1CtCMTSS MATE' I 1
ClA9rtitttial C3Mititieiptt111'ufTilC 15 ft. 30 R. 2° ttti I O10 SCH-40 PVC Pre-P Ck
coatatlwnwi(Heatint oling supply} msideiuiol water supply(single) ft A- in.
®fdustaConireal DRsdeidat Water l,}(Sn8d) BROfs'ItD1k9 TnT` 2ATIAA
L OD&AWSOUNr,
plmt' iloii 0 It. 10 tl Portland Pour
Non-Water Supply Well:
�NSorTilorino; t,]Rt�ot A.
o"i Rd an Welt:
OAquifer Reftry Odmiundmw Remedial on
CtAtiiutfer$tAr2�eaiTdltecot t3linittHarriet FROM
i htArRRrAT A ., ctt f^rnn n
13 ft:. 30 fr. Sand 2
DAgn%cr TW ostonmcater l)T*wgg'C fL- ft.
p>gwimental T=hnology q$nbsidC=COIST01
=;20sltYtiti�� "_' itonr3tlretsitn'.; -
E3GeOftn Wl(down Loop) Mow PROIT TO nESCIR ON ftw i,a atan°cu WkN0.
Meothetnml(HeaffigCooliMRewli.) 00dw( under#21Renl !Lm o IL 7 ri, Silt
7 ft. 30 tt. Pt9R
4.DateW0(s)C0Ujpleten' 4/29/2021 WdIIDAMW-z A.
Durham ArmX Reserve Center fl. to. —
Fecitit}J wMrNww FwiViy100(it appttcnble)
1228 Carroll St., Durham, NC, 27707 r`On
Pkr6ealAddmss Cit(.andZip 21;_ tJ1 a' .. r,
Durham 3 foot bentonite seal from 10 to 13,
C40 hAtCCt rdci�irr calion.Np.(1'tNj
%.l tudrand1,ingltnulcindcgrMs1MlFmteslsc6nd5ortl dwnaldegrees 22.Certifreatfon:
tituttt.tfokt;o*1pttlong is stdltthtB)
35.987963 N, 78.917078 w 5/14/2021
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dtaatraew Date
6.Is(are)"tine-AtIl(a): oPertnanent or Menlporat ,gy,o"�qg obis JWM f AeF&bY ak 1VY thw liar UW48?w'"t+cr'o Cinatri rrrrfi H tt�arat/arlt r
rrf*W NGAC 02C=0100 or I5A MAC s12C422)Wetl Caam dim Standards mad lhw a
7.Is this a repair to an od sting well: OVei or M N1► a m njdr f4 rrcamt l to bm�7�forMnd fo r art t miar .
tjtofx It M f ffil teat krl�+rwa uaU i^savrrxrxtrna frrjamarrtwTat�r�atndn tin+ainrxrr ot'rtm '
nwire r#21 rrttwrfxwtvtw"ta_gm t w barl of-INS farm 23.Site diagram or additional wdt details:
You bxV use h�Ila&of this page'tfl pravido:additional nr31 site details 0r well
8.N�irnh+',rof a ells e4il�trncted: 1 consuruction details. Yon ulay aLs�t uttsclY�tid"aloiiat a if son.
For*dtVeln/es4merrarat-e rr wellsOA'LYM�el�nc�sn�t�constawaJCotr .rcm
sub"lif raarfoma w4's)1 L► 7J�(.. � tCT70lV
9.Total welt depth below-land su i'aw 30 {ft) 24a ,Fhr All Weti rMi nit thrs form nit1 in 30 490,d ofimptetiort of 0*11
For mattt¢trle tttlfar all rtrpabT ljd¢$etr nt sex ?te-r 24 r n'7 tA9f construction to tk,folloning;-
1t1.Static-grater leeel below top of twiar {fY,) "'Islon of Water Resources.Infalmation,Praeessing Unit.
Itn+ttu�wkwrra3ss8r�eYcatbi, r"4« 1617 Mail Semite ofct',�lei�ty�l�29699-ibif
t 1.tiorchote'diameter 8° (fa) 24b.F it(nicet on Welts ONLY, iri addition to aettding the fofm to die addrs in
246abovv_also unit a copy of This tbrm vrithin 30 does of completion of%celt
12 131CI1 Con
4rpeilan-gWtbod:HSA consuUtdontOillsfit110wL1�
4 i c anW.tatus(;cable.dLnd PW C(e) i
Division of Water Resouraes.11ndeMmund Injection Control Program.
FOR WATER SUPPP1 Y VELLS ONLY: 1636 AtA tSer►ice Canter.Rat69M,NC 27,6"4636
13a.IkIdd(gpm) i erhvd oftest 2Se Fnr WaterSa ri do[njastGitii�clts
Also submit our coal•of this forma irlthin 10 da}sof Completion of
1313.bisinfecoton Amonrnt; well conmuction to the calm y he,gtth deps6= m,of the cal whm
construcw. I
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