GW1-2022-05485_Well Construction - GW1_20220601

WELL CONSTRUCTION RECORD Forh'Icnial Use ON1:5':_
I
This,form can lam.pscd for siugk or,niultip)c 1%'015':
1.Well Contractor information:
'114-WATEKf MNi_S
John Eisenman FROM 'to DF:SCIIIRtION
1CcllCofwtacldtKslnri ff. fc.
4439A
WCUtc11 Coal riclorCcniftcat ion Nil n•ber -115:OUTF.RCASMG:(for:64111461iir`Jaicl15)°ORLiNFR'(it.a Ile bkl ll '
FROM TO I DtA1n.TF.1• Ttll(61F.SS )1ATER►AI,
SAEDACCO Inc ff. fl:
C'oiitizi uq lrivuc �j6 INNER CAS1N( OR7.71BING'i�eotbcrmal ikjwd41ligl)
FR011• -.. TO DIAMETER. I THICKNESS I MATERIAL
2.Nell Construction.Pcrinit N: 0 A. 5 ft: 2 I)t• SCH 40 PVC
Lirr all (Le.Comity Suitt,.Variance,In`erDttl rrt,.J - �—
:ft.
3.)Nell list(chechivclI use): 17 SCRb EN
NVxtcrSupph Well: FROM I •To [I MFTER1 S1.OTSIl.► TRl(h�1SS I M:ATERIAI,
UAgricultu Hatt- UhltitiicipaVT'ltblic. 5 fi. 15 ff. 12 fo. .010 8CH 40 PVC
fl.: fl.
QGeotlicmraf(tleatiny`Cooling Sapply') QResidcntial\Voter supplj•(single). i
Qlndusaiat(Contncrcial 011 idcntial\V:ttcrSupply(sltiimd) LAKGROUT• 7
FROM 1.70 MATERLAl. F.NPL%M%lF_NT\1ETll0a I.AMOUNT
❑irrigation 0 ft. 3 ft. Portland I Pour
Ton-Water Supply W011:
n.
whionitoring 0i2ccowi). n.
Injection Well:
❑Agtnfcr RCchargc 1lCrotlndn Rcr RCntcdiation 79:SANDIGMWEL PPACK trf l dicabkl �P
❑r1 nifcrStort c aiii Rcio�c t7S51inili'Rarricf' FRONI TO 11A ,tuar. F:MPLA(:r.AuaT MF:r)loD .
9 g .ry 15 ft.. 4 ft. SAND #2
0Aojiiifer Tcst ❑Stonnivatcr brlitlagc,
n. n..
❑Experimental Tcchn(ilog), ❑Sit bsiitcaco;CenlroI
I'2o:DRiLLING t:OG(inac6'adJilioniilstirNs if tirccsuri)
❑Crwlllefo al(Clustd Loup) ❑Ttacer. I .FROM t0 MSCRIPTION ftubr.hanlnca.M4141xkK wr Ain sile.44M
013reothdinal dicatint iC0oline RelutnY 13011sef(explain under 92I ike-inaiks) 0 ff...� 15 it. SANDY CLAY
ft. ft.
4.Dite ells)Compleled: 5-18-22 Well iDONW-2 ft.,
5a.,Well Locaillo' ft. It + a
Facilii):Ouc rNaroc. FacilildiDS{ifapplk.ablc) ff.
d+ at
610 Lakeland St. Durham, NC 27701 Durham County, ft.: fl., i ►+by
Pin skal Addrsi:Cita•,and bit 2!r RE(�f.�RKS
bentonite seal from 3-4ft
Cautlh: Ravel Widilv-1ifion10,(PIN)
56:1.>►titude'aild'Ibligitude in dc(mcslmintitesl ccon�Isi r'i icciln;tlil ctrccis 221.Ccrtiticathin:
(if trCl1 f�IJ;prs 1a41ottg i siJliti.uq
5/20/2022. ..
Signlltlr•of .Dale
f /
6.Is(are)the Est ll(s):. Pennancnt or. .❑Tcuq►(irat�'" , l rG;J/il ,'. `` Ica t issrtn�re+l ae rr.<nslan«n•itliI5+tXC,%C0:C.!;, �.(;ri.:.;"2t;,02p0 Well('attsrmefinq"Cti)iulurdsiorrl.r)mrra
7.L�.thiv a mpnir ti,an'c ixting ircll 0 'ex- Or '®NO''. it)vynj'rhis rrraiil liar t »`pn%i lrltd ia'fhr:n l7 nnne:r,
If ih(s r c n rclxtlr hll[Nll.(77p1{71 weft eblwwrlk%1)l ybrowfhrAa7lil e..lphdji die-morare l f the
rqu..+r mtrlrr621 renta&6 ciion or M dhc hit k 4—tltlr faint. -23.Site d):lgraln or addiGOnR1 well detalls: . ;
Yon,1uit};.,irsc Ilk back'of.this page.to piovide addi(ion:il)veil site details o1 li'ell
8.T\irinber of wells ironstnicl (l: 1 consirn ioR delalCs: l'ou`RUTy`also attach additioriel p:rbiis if n ticssat).
Fgrin:iliJ/rfr inf<cilc>n'rrr nrurarnrrr sn�ptr tri•lh Ot'•'/,}`reirh Jhi•snrrtr cortsliurfian,}•c:ircriti -
.{aharit r.nr jatin. S p Ltt►11TTA'Cih C9'UGTIONS'
9.T(itelaT'c11 depth l►eloiv land st)rfaic. 15 (ft.). 24a. For:ill Wcllx::. Subnlil'tiiis fa'nii tiill,i 3[i At i('s.of'compleiioli of tt`r11
For aiFriblpk'well;Ustallrvp)if jdir?crew(examlih-*30209'.mvl.26PM) constmctiontolitefollaaina;'
1U.Static water Biel below top of c:)siny;: (ft.)
of)Nato Resources.-InfortnutionPrucessin,Unit.',
If water let,rl H nbvre citsiiag,.0 "=" 1617 Mail So-vice Center;R:llcigly N('276J9-1617
l L Bni•clmlc'dianlOcr:6 "(in.) 24b.Fnr hi ikrtinn Wr11c ONLY: -tit a4dition to sending thy.fort to ilie addry in
246abov, . also submit a cop)s':ofthisforul`.1►idtin.10lias•s-of:conipletioll bOv ll
12.1Vell rnnstnlctio i method:-Air conslnicdon to lice followinL
(1'c:snger._iotanic5blc dWctpuskdc.)
Division OfMater Rooiueccs;Undergrotind Injectiii)i ContnilPtr)graln,
FOR WAT.ER.SUPPLY WELLS ONLY:` 1636 biail Scrricc Center;Ri►leigli;lC 2 7699463fi'
23c..ForWiter StiplAV 4 injection VI'cllc:'
13;L Yield(gpn1) 'Methnd olf test:
Also submit on:'copy:of this forni )iid)iti oil of-..
13b DisinfeYtiongpe: - Amount well consin)clion to-ili :county hcrilih dcp;trtmcnt of the countytvlick
constmctcd•
Fonti dWe l Non)i f2wolin)Ucppnu:ut of Encironwitt mud Natural RCSdtnCCS-Dii pion of Walcr f1LrtULrtCS Revised':!tart 2c)13