GW1-2021-02736_Well Construction - GW1_20210512

WELL-CONSTRUCTION RECORD For Itteno the ony:
this.fora can be need rot single or m 9titrk wetls
1.Welt Cantractor.tnformaston:
Stefan Smith 8R M To 0MV11011024
R1141cotiladvfKalttm il. ft
fL ff, i
3576A
NCWclfGommrtorCcnifecalonI3+utterS..tltTtF3t_ otimtHtfca `. Oit1+Jt�t)}R tf' 11tile
FROM I TO DtAa1CTRl1 ITHRIMi.SS MAiERrAL
SASDACCO Inc 0 ft, 10' ft. 2- lit. SCH-40 PVC
COAVMW Natae t6.1 CAS1N '+OR' : 'IltIG ft at2lnrc+lAbu is
PROM I TO DrAMETER I THWKNESS MATFJUAL
2.Well Consliwfian Permit#: tt. fl. 'g
liu a)i�epplirvi6le well permfh 1cr.Gaw�rr,S#nr,Vnrntre,lr�tng ste.l R> n.
in.
3.Well Use(Check well pxe): t?�
Rater Supply Well: PROM TO M. DIAMPYRR Ft,O7' IZ TWCICNI_SS MAT!•A' 1. J
DAglicuttund DMnnicipal/Plrblic 10' ft. 25' n, 2° 010 SCE-40 PVC
DGeothertml(Heatio ACoolingSuyply) DResiderdal WaterSuppiytsi4e) rt, f tom'
Oln this tril/Canmlcivial DResidential Water Supply fsbamd) is CitOI11'
a • <.
PROM TO ArATERNI _ LACEMMMMMODRAMOMM
OhTigtiition 0 ft. 6' n. Portland Pour
Non-Arater Supply Well:
n. A.
amonifori!% [3-fto%v
Tn)ectiff" veil h. #t
OAgWct'ltedhargga DGrottndmatcrltcmediatian t •S lGftn r.'
PRO" TO I PJAYRRIAL rxP1✓\C01I MITI M n
C1Antrifer&omgc and Rccvvc OSatinhyBarrier a (1. 25, fL Sand 20/30
❑Aquifer Tcst QStomm=r DlaiMgc
0EVrAmcntallbchnologg OSlrbsidenccCantml
21r:11Rtl�st {7>fi.00r ttatt+'�iltiitiianl3�txNstfiwcr+rssa
ClGeothe nlal(Closed Loop) ElTracer ®ROM TO D1tsMn'nOl Wor.tjrf*M ro9lrnerr n We.k*.z
13Geothemial(ReatinglCooliggg Return Clother(` ain under 421 Remarks) 0 (L 7- (t. Sand
7' n 15' (L Clay
4.Date Wel) )Completed: 4-6-21 WellTDg8MW4 15' n, 25' n, Silty 'sand to sand p
Sa.'11'eU[.tRcatk►n: R, n.
Trimble Plant Road Property n• (t; n q
Faclttty)Dg-tterNum FatrDby TD#(if Wplimble) R. n. •••.Ln
175 Yadkin Rd., Southern Pines, NC, 28387 ry, p; 5 55751 f,]. Unit
Pk-*d Addmss Ci>ti.rrttd2 ip 2t.REAfiA rt5': ,» -
Moore 2 foot bentonite seal from 6 to 8 feet.
Caatrgy Parmdt olirkallonNo,(Pt4)
ft.lAtitude and LongltudeindegrecOmimrtoNtcortor decimal degrees: 2a>Cer tionp
(if Het1 find;oaewong 4 strnielttd)
35.190679 1! 79.379691 W 4/21/2021
Si�nsl of Wdl Can�rtor D3W
6.Is(ure)the tRtll( MPmnanent or t emplRrttr} By sggginz,fia fern t hereby errrify rh u Me M*14s)ices l weer)e m roue ad in meesnrJmer
nlrh 15A NCAC 02i7-01W or.I SA NCAG MC,-020b Nretl Cnx tmrtitran StmWardx and tkat a
7.Ts this a repair tounodstingwell: C3Yes or MNn respralrhu.+rn,rth been rurlrtetm aersrHmkorrr.
ljrhla')l a rryvi9r.�tl au fiarmara xTli ea+asrnrcvfmi Enfareuirkm nowt r.�atel�nor nan+.r r�rlre
reiviramlerA21 remarlty snum or axe die lmrl rr,Cthis fismt 23.Site dla>;tram or additional well detaiLi:
You filly use the bnel:of this page to pm% die additional+ntll site details or Well
8.Number of wells constrimte'd: 1 eonsuvetion details. You no also ounh additional pages if necessary.
For mahllale IRjertkar.or nfm-imfer spit*tMij ONLY n$rh rhe;mnie eons►wfiv r.;)Dines
aa6edruarfor*r,. $Cmnnrrat.fn��lc1��N�
9.Totalrsdt.depth below land surface: 25 ln,) 24a. for All Weds: Submit this form Within 30 jars of completion of trail
Pot,nWlrlarkwetis fisr off 4*I ►,fdoremritexorApk-3@2ot7'aW20AW) Conanictionto(be folto ing:
10.Static water heel below top of casing,: (R,) Division of Water Resources,lnfnnnation Protxsing Unit.
If wuler keel is e&aur Cd"'Ag air 160 Mall'Scrtict Onto',Raleigh,NC,27699-1613
It.Borehole diameter:6.5" (in.) 24b.It faWRr3 Wide ONLY. In addition to sending the form to the addnw in
24a above. also submit a copy oft this forth within 30 dams of completion of well
I L vi'r41 coma'l etim method: Sonic eolistruction to ft follovdng:
(Le.rnW.ramiy.cable"direct push c1c.)
Dh1sion of Water Rem rem Vtsdesg ound Tojecdon Control Program,
F0R.1N'ATER Sb'PPLV WKLLS ONLY: 1636 Mail Semice Center,Ratle10,NI C 27699.1636
Jr
131L Yield(gpm) Method of test: 24c.Fur Witter SvUIX&fp'cainit Wells.
Also submit one cap}' of this foiR1R'.%vtthiw 30 days of coir4 ttion of
131t.Disinfection t31ie: Amn»ni• vmli constar,ction to the county, h�lalilr dcpaement of the county trheae
cvnsinlctod..
Faun North Camhm Dcpatl woof Emimartmtti and Manual Ri wwres-,Dtvkbn efR'ater Regftr s; RMW Atrguft 2013