GW1-2022-05487_Well Construction - GW1_20220601

WELL CONSTRUCTION RECORD orlr(cDt<11Use6NLY:
i
TM.krin can h,ascd.forsin lc or.multip)ctrclls'. \
I Will Comriietor Information: .A
- '14.WATER LONLS-
John Eisenman FROM I 'TO DF_SCRIPIION
1�'cll Gntnctcttfr Nalih:
4439A
NC Well Contractor Certification Num6ci - IS:OUTER CAStyC(fur'mutiitascd i cttsl OR LiNERlif a" Ilcahtel
FROM TOI DIAMETER. -1 T111CKNV:S MATERIAL.
SAEDACCO Inc It.
(.`.otiKt:uq`N;,uie I6:INNER CASING OR`TUR1WgVeuihcrinal ctowd4oiijo)
FROM 1.TOE^ UCAME,TER Tt11CKNESS. MATERI,\L
?,\\'ell(:rinsttvctia Pci,ni #: 0 ft. 5 ft.- 2 iit SCH 40 PVC
14sr ufl rj2plicahGwell pehaiis ler.C.an,h'..SYr1,:Wirioace,lryatiat ere.)
fl U. in._
3:Wc11.Usc(chixl:A�cll u,A'c): 17 SCRUN
Water Supply Well: FROM I TO I DIAMETF,R SLOTsvT 1'MATERU T
O 5 ft: 15 (l. 2 iii .010 I SCH 40 PVC
C1rMricultura[ L"I)ti4litiicip illl'itlilic';
i oothcm a.I tltcatingtoolios Supply)' 171kesidendal Water Supply(single)
pindustriat/Conitncrcial 011esidential Witer Supply(shared) %tB:.cROaT '
FROM fTO MAT'ERM 1 F.NIPI ACEMF_NTMCTIIOU.(.AMOl1\T
❑!rri^:)lion 0 ft.: 3 ft. Portland Pour
N,on-Water Supply Well;' i
5bMoaitoring 0Rccoyrig .
Injection Well:
❑Agmfer Rcch irgc lidronndclater Rcntediation 19.SANDIGRAVEL PACK lrf r i tlicabtvi " "
FROMIn M.\rBRLA[, EMPLACE IVAT%WT11 n)
❑Aquifcr'Storige and lkecovcq, ❑Salinin'.Ramcr'' , 15 ft:. 4 ff. SAND #2
❑Aquifer Tcst ❑Storniw iicr Driinage.
-
Ol:\p;Rincntal TcOnology [].Subsidence'Coal nil "
`2o:�DRftitaNC I:OC.(alrsetraddiliooul sheds ifrtecc3sani
OCnrothenn;tl(Closed Loop)' ❑Tracer .FROM 1.,To DFSCRiHTION ItvbY.haNnca,w4it'nict tr �din vrc.th.f
❑Geotheniul(Ilcatingt.00litfe Retain) ❑Other(ex Wit under k2l:Romani s) 0 ff.. 15 ft. SANDY CLAY
fL 11:
4.1)1ite.Wcli(v)Conry)letctl: 5-18-22 >Well iD#MW-1 rL ft.
5a.Well Lricrtina:
ft. ft.` _
Faclit}:rOnn,r Nan c,. Facility 1pk(if appli able) f1, ft.. ~ti!' r
610 Lakeland St. Durham, NC 27701 Durham County, , , ft - ft
P)tisi;td;\ddI-,Citc.and Zip xi etinL�Rts -- --(3-1-ZQ2� `
bentonite seal 4-3ft
G �±'n pm,,Fi�+hT�l URrt
Cinmly: 11.11iel Idz III il'iCSlionNo.(PIN)
5111,l;ttitude:aiil Lind;imtle in degrccs/minuteshwands or det ees: ��;Certifiicatiuii:
(ifuetl f 1d,01 Jab1{mg dlienIII)
1\ \\ l 5/20/2022 _
r
Sitmliir•
6:I.c(are)(lie well(a): .xPerniment or .oTentliorary G� �r��rl`>✓ '` f ;'�""��
b}argnor,. hu(Inv rR _ .�. t..r. 1.nnvlruefrrl iri.irienrJn,rr
141YVC,tC•D2C-'i<-.a.�:='7t a�:(,�1�:.7%IC"�:U_'0!1dt'c'it Cmtsfrerii(4n$tnryl<7rdS rriirJ rJ.4nYq
7.Is this a rcpa(r in an 6i�ting lvell: O1 es, it kNO'- 2'2�':)toJ"rh,r're"oid jmi b rri.. frh'd ire rl r t,vjl awner,
If this x rs rci�tlr f,U au knoic„t,'rtl ron,inrrri'on fn/om iriirnr nrrrl e.i;,1�Lt rli,r.rurnuc of the
itpcv mxlrrF?L r..rn«rksi,.'iiarr or im the bark of stirs foim.' 23.Site lliagrain(or additional well detaits: _
Tollinaj:itse We b:ik of.this'pa�c to Utovide additional well site details or 'we'll
8.Tuaihcr of.wells oonstruet d: 1 collsunctioli deoails: Youinay also attach additional pages if nr' esOry.
For en dijple ire ekon or me't•)ri,rcr nrpp>t w0h ONLY.wirl,'r1w snmr canrruNioir,.yoxcon
c«lmirri>„rform. :S Ll B11fITTAL'INtifljn QNS
1.Tot:tl.�Fdl de{ith lielo��~land stitiicec 15 (tf.). -2U. Fnr Ail Wells: Subtait this fern)'within-30 days of complction of well
For nuilfipfe wells'lin 01(lep,hs rl dt�t,.rcni fezramplr:'3r?00'.(11l( 2Q M') consinictionlp the folloMing;;
70:St:ttir water IeveLhelufe tali of (ft:) bicision of-Water Re!inur_6;lnf)rmvtion,F rue .it- Unit,,
IJoeu,r lrJrl i nl tie<xinia os .e., ' 1G17 Alail Sin ice Center;tLtls�1;h;NC 276994M7
I L Brarchole diameter:6 (in) 24b.Fn�j W V•I c ONLY.: in addition to sending tl:c feint to the atldre�i in
23aabrove. a6o.subntit a.copv'of;this.fonnAvifhil(.50 da)'s.of;ciinipletion of,%%'Ii
t2:'\\'clhrnnctnmtion nicthod:Air Coo to the folltiitiiig
f.e.auger.rotsn cable direct pusft.ctca
I)i)•ision of.WaterA66urces;Undcrgroulid Injection 61111-61 Program,.
FOR\\'ATER Wei Af
.SUPPLY WELLS ONLY-': ai1 Service Center:Raleigli NC27699-1636
Alctlind of test: 2 c.Tor Wafer 561,11E&inrcctiin Wells:
rllso submit ooe copy of,1116 foriii fiul>iii .t).daysof Comp letionof
I31i:UisinfeYU it tvpc a monnC 01 construction to'.ille-county hcnllh dcoannunr of il.e coi)ntt•:10icic
_ __.. �•
constmctld.
Fonn OW-l. Nonfl Cawlitn Dg4ana:in of Enc•ironnicut amt Natural Resources='Diviiion of Miler Resouix)m' Revised August IN)13