GW1-2021-03306_Well Construction - GW1_20210603

WELL CONSTRUCTION-RECORD For1MvWUw NLY:
This form can be axd.for dftk ar multiple ftHs
1.Well Contractor.Tnforntatiow..
Stefan Smith FROM ORS CRrer10Y
A141 confr cw Nuance
3576A
NC Well commorCenireestionNnEtea 4iK1 UTTER, G or:7iK--Ml4ftsrdW10BR`IfaiKi�i: flrib
FtTOM. 70 VTAM TM TRICKS MATUTAr.
SAHDACCO Inc 0 rL 5.5 ft. 2" tn: SCE-40 PVC
t anPt!)^Nam .Y , R D#"'4fJBITtt;: IiCrintDtitGsd�oil
FROM7 B(A1ri.TER a'RSS 77tii7 MAMMAL
2.Well Construction Permit
LW atl.appfirriblr writ perms(Le.C'auum%Statr,Varlamre;11*64 rt etr.)'
tt, fl. in.
3.Weli Use(ch do well osc) 1 : C
Water Supply Weil. O. puMKTF:R ,rT •-M--'C NTS NATMI I,.
DAeticulMnttl 014noicipal/Pt►blic 5.5 R. 20.5 k 2" in 010 SCH-40 PVC Pre-P ck
0Cvolhe wl(Reatingr-ooling Supply) DResidential water supply is'nWa)
13MdustriallCommerciol DResidential Motet Supply(shred)
TO 2fATFRLKG P11iPtA ME7TtOO&1010uw
FROM
DIrripation 0 ft. 3 (L Portland Pour
Non-Water Supply Weil.
ZMonitorin tReCov
n1et on well: _ fi. (L
CAgitifetRccharp 0GmndwatcrRemadiutian 7, A i -
DAguft Stone and Rove y (]Salinity Sorrier FROM tnrrtRin jai i tnr Trt n
4 ft. 2 0.s ft. sans 2
❑gtMer'ITSst f3Stomm-ater.DMir49ge
(t. tt.
pEaWArncntal Tvchnotogy DSubsidencc Cottrul
'10,1)1111:is1A-CI3jt)6 reYi +tlitano'T: � ,.
DGeothrmial(Closed Loop) EAmeer MOM I TO RV—RIM07C aarbrtr�N wslrecte t�eta)
t7GeotlKmsal th 2lipp-Pentnt) 00thet jevWnulxler921Remattsl o (L 7 h. silt
7 R. 21 % PWR }�, ED
4.Date Well(%)Cbmplettd 4/30/2021 WdllD#MW-6 ft. IL ,
5a.Wei)Lrtca;ion: tt, IL h IN 3.. 20
Durham Army Reserve Center ft. (L
Facil410v6mrNa= F-lityID#(ifeppfintle)
1228 Carroll St., Durham, NC, 27707 n tr.
Phy aiml"d—City;and Zip
Durham 1 foot bentonite seal from 3 to 41.
covaly Paredidetintiaatiou No'JOIN)
4b.l.attitadc and tAingitudc in degmtW%inutestseconds+it oceimul dcgrcus: 22.Ccrlifrmtlon:
fitaelt tiC►d`Ofrt t W1oe�G f$srdfiitri)
35.988216 N 78.917661 W 5/14/2021
J0. 0d Wetl CI. Mt Dtor Date
6.is(are)the 1rell(s): SlPerminent or Effemporary 11,sorting AbArria 1 hemp rer*rhdr rle«rfi(ai*01(wrot)edawvded u-atwon(m
Writ 15A NCAC 02C,01M or 15A XCAC In2C,02M Well Caru"wdon SMnda►&and'dtet a
7.Is thbi a repair,to an existing well: E3VeS or MNo ropycf(Ur ereoni,r o bem pmrUM todr nrtl m«vw.
#Ms h o mpafr.fill owrAnfAM wit commrtrd"inforramkurMd r r*in ae nnryrr of dA"
r.prdrunder021 morarks xrrtma or an.dw tart of this form 23.site diagram or additional well demos:
You mn use the back of this page�o provide additional well site details or well
S.Numberof welh constracted: 1 emisttuttiondetails. You may also attach additiMM pages if oecessary.
Formuirlpir lr�crkur of mrar-osier s�.,q+e:u+rfls�A'LY ndrh rhr?mrneoonstrucllotr,vonrars
xy!>drrir enc form. - SURNMIMAj 1N5');Ut"'t70NS'
4.Totai srdtdepth baton land surface: 20.5 (R.1 24s. thr All Well•. Submit this.�fonn%%iibin 34 love of totVL*tion of nrti
For ma 1fip4r uvUs Hsr otl rhprha VdOervv lenwaple-30200'and 2@1W) constmcdon t0 t1w(`g[lsming;
10.Statle water leveel below top of casinr, (ft.) ilit Isiah of Water Rtwourets,Information Proceming Unit,
if%%for k ri Is&bekT cdA'r.use"4 1617 Mah Service(stow,Raleigh,NC 276➢9-J617
I I.Borehole diameter:8" {in,) 24b.Fhr inkxtian Wells ONLY: In addition to sanding the form to the address in
24a abov- also submit a copy of his form within 10 days of completion of icwil
I Well eottstrtVMM method:ESA construction to the failowine: ti
(i.e.wiXr..mtM,c•abto direct posh ere:t i
M islon of WirterRfsources.Underground Injection Control Program,
FOR WATER SUPPLY ATLLS ONLY: 1636 Malt Stnice C inter.Rat ft,NC 274"4636
13a.Vold(gpm) Method Of test tic for Water SapLrlp&tnjoaloo Wells:
.Also submit one copy of this font lvithin ill daps of completion of
t311:Dizlnftaetipn hT1e Amount:
asEl construction to the county hcidth d times t of the county where
constTucted.
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