_Well Construction - GW1_20230327 (25)

y%VELL'CONSTRUCTION RECORD far[eternalUgc.ONLY:" .
.^ T1lis form can bc'uscd for tingle ar multiple wclls
I. t.Contrtetor Li ortuatiott:We .
LLMAt1R'LONES -
Stefan Smith Vtt0m• 10 DFSfntPTI ON
Wc11 Contractor Name, • 11• ft. I I
3576-A ft. ft: I •
NC Well Contractor Certification Number sIS:O[JTER_CASiNG(tor`iitiitll=easie➢:tcellsl'ORLINER'f[f.aa ritahkt- ..
FROM ' TO ' nib IETt3R THICKNESS r • \LAl'EtUAl.
SAEDACCO Inc . • . 0 f4 10 fL' 2" ' l'in. SCH-40 PVC
(:antputyWaurr. :t6 INNER CASING OR-T&.t®ING'IguoiYci-rnat£Ga ed•lonp.1 - _-.
. FROM 'TO . DIAMETER THICKNESS MATERIAL
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. • 2.Well Construetion Permit ar: ft, ft,
Lio a apyilfratile will pritarts(ix.County.S sta.t Variance.fr)re t*cia J ,
rt. ft tit.
3,•*11 Use(shed:dell use): .17:SCREEN
Water Supply Weth Faos1' 10 I nr:ts+FT1:R , SUET SITE TiIICIorsS t 'sIAtrnrar.
Agricultural [I1Gltinicipalll'ttblic 10 It. 20 It. 2" rn 010 SCH-40 PVC
0A
• t1Geothemtal(IieatingJCooliog.Supply) DResidential•Water Supply(single} fr' • fr;. r"
i t8 GROUT=..... - ... ,
Dluduslrial/Coutmereial DResideutiat N. ater,Suppl}•(shared) . FROM -.T0. MATERIAL i C IPLI.CtyiENT-31El OD ..&MOLNT
Dlrnpution .. 0. 'It.. 6 , ft. Portland Pour •
Nou-WaercrSuLthly VFell: •
. . .
h,. h,
Ithionitoripi; f7Rctimvct}• - •
Injection Welt: ft. IL:
CIAquifcr Recharge. LlGioilndir:ticrReniediatioa . ••19 SANDIGIIAVLL1ACl.iiiiiirtsueuhtsY:' •
ER01 1Y1 at,t'rnzRran. • RatNLaC.ktrl:Nr�ILrurlu'
[7Annifcr.Storagc and Rceovety'. ElSalinit}'Ranier, 8 R. 20 ft. FILTER SAND #2
❑Aquifer Test DSlorniitatern iiage fe• ft4
ClEteperimental Tcchnola,•. EISnbSidertcc Control 2n:DRILLING LOG falinriti idrtliiorial sheds:if nccessan 1
DC otltennal(Closed Loop) DTracer ,mum•. -TO D1:5CRIPTION(toWr,Intrdnkm.skatticli nnc Nadu:i+:.de.) •
ElGeothc:nnal 6Tieatinwroolhie Return) DOtlter to plain tinder.#21 Remarks) • .it. ft.
D.: 'ft..
1.Date Weti(y).Conlpleled: 3/2/23 'WellID#MW-7 .
•
. ft. ft. __^; ...y ', '` ;:.;t''
So.Well L+icatt+mt .ft. ft. {�
Former White Star Laundry . . . i4. ft, . MAR 2 7 2023
Facility,pn•ncrNarec Facility IDk{ifappliable). • ft. fh
Irkt—Alaii�n Pro: .'1 1 1.Wt
610 Lakeland St., Durham, NC, 27701 _ • +;.+• it
r4 rt. C,'..'�i�.,�:':
PttisiealAthiress,Cigy.and*ip• .2LREmARxs .
Durham Bentonite seal from 6-8'
•
County Parcel id.iilifrc;ulou No:(PIN) '
Sit,Latitude and I.ongitade in dcgrceslminutcs/scconds ui•dccintad dcgrccs: 22;CerlificaHon:
(1tncli1141d,kirksi- 104i$-5rdficieitl)
•
.
N W _• _ 3/16/2023
• Signal- of Cc...tied Well Contractor ' Daic
6.IS(:ill)the:il'eil(s): SIPCt111a11Cttt or t7Teulpor ln' by.§4inrng h'ria fciim..1 lttrebr'certify rhos the waifs)raix(vt rei cor4rrnrte4 Err;uecorrkmr_ie
with 15A.iVC4C 02C,0100 or ls,t..nrC,IC 02C.:0.00)14.11 Cr�rrarrtirifen Skarulards and rare
7.In this a repair Cu as orison,well: Dicesor ®No • eupi oftirle ratio.hruc Leon iirr rid4 to the civilrnrner,
if rhrls.JI a repair,fift enrt krtoitvi Irdl emzsaucaien hrfurvurrlon cror4,_iprrahr fire ruuare of ate
repair raider 821:remarks section or car the bark of this form.. • 23:Site diagram oradditionul well!details:
You May use the,bock of this page to:provide additionat well site details or Belt
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S.Nuatberof Wells cousttTtcted: 1 construction details;.You may also attacti additional.pages if necessary.
For rnultirge irdecrlma errracei-rrerrer twitpl)'wefts ONLY uidi rhr.ntrmec rirstrratiat.year coo
sabrnit nue form. SIII)M1i1TTAL iNSTUCTIONS -
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9.To'th%Welt depth lieto*laud sttrfaeei 20 . . ow •2 ta. Fur Att Wells: Sirhnnit this form within 30 days of.coniptetiou of welt
For irrarlrlpk ire11S list rcdl elctiths(fdifferenr(exumrpfe-3 c 2tk0 arrd2@ 100') constriction to the following:
10.Static water level helot top of casingt . . (11,) ['Wisiun of Water Rescrurees,Information Paucessing(hilt,
If mime level is Aare ciusfaag.itie"+" 1617 Mail.Ser ice center,Raleigh,NC•276c7+1-16 t7
1
IL Iturcbote diameter 4" . (in.) .2-Ib.fur IRRcti+ltl_SVSll5 ONLY: hi addition to-sending the Comm to the address in:
24a above, also submit a•copy of this fortis ivithilt 30 da}s"of completion of itrrll
12.Well eonsturetiuu method:Air Rotary constnictitnl(tithe following
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(ix.anger.rMan'.cabic,.dircc1 push etc:) I t 1
IlL Islou of Water Resources, udergroutld Injection Control PrOgrdltl.
FOR WATER SUPPLY WELLS ONLY: 1636 gait Service C'eniter.Ratcidh,SIC 27699-1636
2 4c.For Water.Supply..&Injectio II Wells:.
I3ar Yield Witt) Method of test: Also.subniit•onee copy of this faint within 30.day pf cotuplelion of
13b.Disiufcetiuu types • Amount•. _ • welt constniction to the county health department of the county whets.
constnlcted.
Farm GW-t Nonl+Carolina Depe meat of Environment cud Natural Resources-Division of Water Rmotrces •Revised August 2013 '