GW1-2022-05486_Well Construction - GW1_20220601

WELL CONSTRUCTION RECORD For lricntalUscONLY:.
This,form can In used for sioric Or multiple)Idls
J.W'I,to"
Eractor Liforinatioit:
1Ts=WATER ZONLS-
John Eisenman MOM TO I RFS('RIPTIO\
1\'ell.cotininim Kiwi fl. ft:
4439A
r; - � -• ' i -- :,.MOUTFWCASING(/oririulIk-i"—iicllslOR LIM1FR�IR.AntilkAblel --"-' 1F NC Well PROM. TO DIAMETER- TnICh\i'SS AMATERIAI
SAEDACCO Inc
MANNER CASING OR: BING 1 eoiberival clincd-t6 i
Cougraup NanK _ -
FROM- c. .TO DLAIFIrm. THICKNESS. I MAT'CRML
2.WclLConsflvctlon Pct nut#: 0 A. 1 7 ft. 2 :in. SCH 40 PVC
Li„ir11 nJryihri,hl x e 11 P•IMIS(ix. ric:)• in.
ft. fl.
3.Well I}sc(chccl:rycll u tic); SCRVEW
I l
Water Supply Well:, PROM I TO DIAMF:TI:R sl.orstsr_ `TulcxxF�s I 311TERIM.
Clr\gticultUm[ L7Iviunicipllfi'llblib.. 5 ff. 17 -ft. 2 in. 010 SCH 40 PVC
flc' in. d
lDGcolhcmlal(ticatingX00ling Siipply) bliesideutial Water Supply'(sillow)- h. !
0IDdustriallConu»ercial !)Residential Watcr Supply(slumd). 18 GROUT
FROM 'TO AIATIIMI. I FAIPIACEAIF_\T.IICHIOD.4ANIOU,T
Dlrri_aliun 0 1.` 3 (1. Portland Pour
N,,on-Water Supply'Well:
fl: ft.
6,Wtinitoring ORcco)•crg
Injection.NYcll:'
OAqulfcrRccharge lDdr0uridlu tcrItOnc(liatioll 19.SANDIGB:AVEL1'ACKId tliliealskl
PR0 I TO NATF,ItL\l. kA1PLA(.L11 is\T Al/7flOn
DAijnlfci StorlGc antl Rciosct)' ❑S tlinit\ Rlmcr 17 ft:. 5 fl. SAND #2
❑AglnfcrT'c-, ❑Storinivilert)riinagc fl f(..
❑Fsp m ncnial Tahniilogy ❑Subsidence Ca1drol ---,
1 20 DRILLING LOG(>iuich sddltionril%IiMi if nccei rj•1'.
OGroibclnrd'(ClosedLoopi ❑Tracer, FROM TO DF5CRIPt10\fWbr.hAh101'�i.MnitM'A11'>,.^lill�T/1`.Hcd
[Ickotlieuiul(flea linet.00line Rcuun) ❑Other(explaii►th&r k21.Reularls) 0 ti... 17 ff. SANDY CLAY
ff. �. ft.
4.Date Well(%)Cornpletedt 5-18-22 wciimaMW-4
gpi
53.Well Gicatiol fl: ft
Facililplo ncrName Facililr ID'"61appliablc) fl. -
c life
610 Lakeland St. .Durham, NC 27701..Durham County, , It. ft.
Phi sisal r\ddri�Cit}.and Zip DV
2LREMARIL`i
bentonite seal from 3-5ft
(nearly,: Mitel hkielifcmlionNo.(PIN)
iti:L:initudc anihl on}�itt►tic iii degiveslntinut olm or.(ccimal ilc>ves 22.Certiticatinh.-
(ifaetl50d,Ori:I:elapug i+§iihickra)
5/20/2022
5l�mnir of r t,,M G Dale
6.Is(are)tlie'well(,): SiPertuanent ':or .17Tengwrary" r,li,,,rrr�i„tarcahlarrt
n'ir111StNC,tCOT,C-' ::` k- r:r i. i%'C:O2091VeIf Cat srriCI ion stom hmIxH Id.ft1a
7.Lcahts a retlalr tli'8R cziatiD{;N'ell:' bVes or M1 No�' a'c��y of rhis rernnI i;ac hrc,;lift:,"rl v1 ro'!hr Sit It mt'ncr,
i/lhla ar a fi t%r/r fill rnr l uilt'n well emstrrirriaw)gr rn niitm and i-ipini,r'the nariuc(of the
rtl,rir wrrlrr 8?1.n nmrk,xrrtiea ar as the hr:i•.E'fit "mi. 23.Site diagram or additional ivell delaiLc: . _,
You inay,uselhe back of.this page,to pro%�ide addilioti:il )•ell site detail or)tell
13.'Nuinber of wells.constrlletcd: 1 coil stmctio'n details: Youi ia-v also;ltiacll additiolial p.1bks if wXes6,13%
Farirur7rlplr}'nJ<cilan or aver ni:rev�{rph)r•ecells 0,�'li'NFrlr"rhi'.srmr cmrsrruclioir,,re,:rcon -
.iupniir�,ne/o,r:,. .S.L IiDtITTAL:INSTCTCTIONS
9.Total�rcll.ilcpth below land srtrfucei 17 (ft.): -2aa. For All ��'cllx: -Silbii:it This fonit tci(11m *b d its of eoniplctiori of q`ell
For iruUlinh"r•cllsli'sr.afJile,,M5Ifefl�en-1i(,�xmrpf.'3:�?fY)',a,ui2ed11Ar)) 'constinciion:todwfollouing:; '
lU:Static)rater level b'elolt'top or casing!, (ft.) Uii`islun of)Vater Ites(iurur,lnfurtnutinn Pruccrsing Unit,
lJieY7fri h•vt!)s a),nrr eiisiir{,�i,ti'"^�" 1617 211ail-Sci�•icc Ccntcr.,Ralctgiy VC'27G9')=1G17
11:Borehole(Win ctcr:6 (iR) 24b.Rn bi t �• c'ONLY: III addition to sending the font)to the addry In
24aaboVe. A,6 subiiiii a'.copy'of`.this•funn`i.thifi,S4 days of.conipletiolt of hell:
d2:`��'clfc(Instntctiion niethlid;'Air cnnsuuclioti(o the follo�l•inL:'
(i.c.:Ru�cr.Yotan•icablc direct pwil etc:)
Division of.Wiiter Rcsourics Underground Injcctloh Cuntrnl Program,
FOR WATEI2.SGPPLY RILLS OILY:: 1636 Mail Scnice Center,RAci{;lir\C 27G91=1G36
13:i S"idll'(},gim) \lcttiod of tCSt '-Jc.Fol Rater Sunnly&Tn1(rttiin licll5:
Also submit oiie'copy of thla form;�)ttllui.(i dlysof completion of
13h:UL+infaKi}m ty'lics „ -__ _ Atnuunl • Nvclt comtroclion to.lhc county licohh dcpartm;Mil of the coilith'.o-licn:
ctinstnutcd.
1'onti G1\r,l Nonli Catolimi D.Pannani of Emitournem and Nitetral Resources-D.ivision of Water Resotrtm Revised,logic!_Vi I:1