GW1-2021-03302_Well Construction - GW1_20210603

WILL CONSTRUCTION RECORD For liYcnatlt/sc(1NI.Y:
this farms can be oscd Cm 6iigk or natipk melts
1.Well Contractor Information:
td . Hl C
Stefan Smith 'FROM DF:SCRtptYllY _
W 401 Crintntctvr Naatx A. ft.
ft. it.
3576A
NC Well ComraetorCortifacsilcmMunbcs 1i` i m^i6+itiiali irre ,OR1 Ni3i. ticib
FROM PTA51ETRR THMIRA'FSS MAMIAr.
SASDACCO Inc 0 ft. 10 fL 2" M SCH-40 PVC
cart ruty=Ndnite
PROM TO DU.ETBR I TI MATERIAL
2.Well Construction Permit ft.
lrtt 41,&WHinaNe,wrdl ptinxio(ir.Cauny:Sum;Varinrs'r,trift-ti eir.)
3.Weil Use(chock well rrsc):
Water,Supply Welh FR1?N TO _ DIAMFTRR STAT M VOMMMMATPRIAL
nAgliculhrzal al4illltielpai/ia116lIC 10 ft. 20 M 1 2" in .010' SCH-40 PVC Pre-Pick
OGeothennai(Heatintooling Supply) oResidential Water Supply(singlo) R" R' fn
Obxiusir AMD1111oadal Mosidtntial Water Sopply(shared) P biFt
FROM 70 MATERML nUFLACKMINTMO11IOD&A?40I ff
Oitii -tion 0 M 5 fL Portland Pour
Non-Water Supply Will: n. �
Mmonitari1% LiRecO�r
'pjeettOD Well:
0Agttifcr lkcchort 00uoundmter iteroodiation 1 :' t
1 j&TPRtAt, RAipI �7M, 1 D
OA.gniftr Storage vWRccovciy OSelitrilyBarrier 8 in. 20 M Sand 2
OAquifer Teo OSlotrrtivatorDrn�taF,c
ft. ft.
O1r.�,cimcntalTochnola�+° OSttlisirdrnccConlmt .
30:�DR. N ," Fit(taeldi(Idii3 '"'inlirCfs�fii �-' _' ,. .
OGe (ttentml(Closed Loop) 13Trat:er :PROM TO DpscRttmo to r►r Hsror, _:rna:�rr; tie Hrl
OGeoth€tnW(Heati 1 Rearm) 001berttxpWriander#21 Retuaft 0 fL 7 h. Silt
7 it. 20 ft. PWR
3.DateVell(8)COMpletei: 4/29/2021 WdljD#MK-4
n.
Durham Army Reserve Center R, ft.
Facility/OnwrName Facility WO(i(WpH=bic)
ff.
1228 Carroll St., Durham, NC, 27707 ft. ft
ft3icd:A;ddzm City.and Zip
Durham 3 foot bentonite seal from 5 to Ovi
C4UHh, Parcet Idersifitsptipn No,(M)
Sh.'lAtimda and Lo6ngitude in depiceslmintttesisectinds ordcctmal dtgrccs: 2L Certirwation:
(I Nett I¢td-Ox1at10"slsh,dttcicrn>
35.988417 78.916675 W 5/14/2021
i;*PMtip ... Wet_Coiitautor Date
6.b(ire)tht well(s): zFernment or t Mtriponry lj�sigrtiag M for+ir.I btirehj oero rhr{t the mit(jr)woi NOW)ct+wntaed ln.a Vifth ante
wfth!:M NCAC 02C AM or 15A XCAC MOM tledd Cruutnartdan Soadards and stoma
7.Is thh;a repair to art existing wdh Oyes or M No rtFic of thu nvard has brim pmr4*4 to Ar uW1 anoarr,
if+leis k a regtdr,flit 4MI k wh WO eon navift WOMWrw mud erpkin Ow riarrMre of rttr
ng•><ti'radkr*-*I maerbA*CtiMVOrran0&barkOtrtds/nrar. 23.Site diapamttradditlonal well details:
You mom•use.tbe baa,of this page io'pmvide additional well site details or"w6il
8.A'ntt bex of si clls coasttTteted: 1 eonnswetiondet8its. You may also attach additional pages if necessary.
For nwhlple i%rrlarter saa•urrrer AWpN wells ONI,P nfi*-die angr t#jrsb'*4 rt.y"+bar
mit sad .mw farru ►SIMHM=IAC'f'iJ(.'TIONS !:
9.Total wdldepth belowJ*nd surface; 20 (R.) 24L M'er All Well e Subtidt this
'form within 30 days of Otingfietion of'nril.
1 ar uNple wells lin all idepAj jldtffe rut lerenott-3@200'ad MW) congraction to the f9tlovin5:
10.Satir-aatcr ieri below top of Minr, bt'asion ofWrter Rmi rats,lafnrmatibn Pro antUnit,
lfn,werkwlIsabetyeddaq lase"*» 1617MailSertiecC61ter.ltalei$b NC276"4617
It.Boretta a diameter:8" (in.) 24b.Fox Ell WO n ffgb 0NI LY: 1,Jn addition to sending fonii to The address in
24aabme. also submit a talky of fins fomr within 30 days of contpletion of%yell
12.Well:vonstr nction utol bod:HSA construction to the fotiowifg: {
(i.e.att2 r rotary,tzible.direct p nk eta-') !
Division of Water R.eilources,fUndergriund Injection Control Program,
FOR WATER SUPPLY A*TLtS ONLY: 16M Mail Seri ice Qnter.Raleigh,NC 27641=1636
13a.Yield(gpm) Method of test; Zia.For Wxtcr.Sv V&&tnjootkri 1'Wdh
.Also submit one�'of this lerm nithin,'30 days of completion of
13h.Disinfection hpe: Amount: well construction to the coitnly th dcµs#nxM of the couray nheic
cgnstractal.
FMMG%%t t Noah CamlinsDgxatmefriflfEnvimu=nt&WNannalRewtirm-PhisionofVVffictRl RL%-lwdAt 2til3
i