GW1--04531_Well Construction - GW1_20230713

WELL CONSTRUCTION RECORD• ,
Far Itgerml Usc ONLY;
This•farm con be mod for singtc or muitipk welts
' I.Wclt.CantrateNr'Information: , .
'It..TI'ATERZONFS ' •
John Eisenman FROM TO DFyCntPTION
Well CortractorNl m ft. fit.
4439 fit. fC
NC Well Contractor Certification Neither `IS::OUTER CASING tfu''initliheised octhfOR LINER'rli'.apbticablcl-
FnoNt To ' DIA IETER THICKNESS StATERTAL i-
SAEDACCO Inc r4 IL' 1n
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CmrrpanrName I&INNER.CASING OR'TUBING•piineheiMill eloScd-lotiji'l ' _ . . .
FROM To DIAMETER THICKNESS. MATERIAL
2.Well('onstrtrctirin Permit#: WM0501555 0 R. 10 ft, 2 SCH-40 'PVC
!Sri ill apapliedhle e-Ipenxus.tcr..County.Starr,1'rrriarxr,frya'Cn etc.J' fit. ft, to.
3.Well iIse(citedc.w ell use): .17.SCREEN . .
Water Supply Well: FROMTO UI%MFTER SLOT sin: TiII( I mS 1 MATERIAL
IJAgtfcu{IUCdf • 1JhlllilicipaUPublrc 10 it. 20 ft. 2 iR. .010 SCH-40 l PVC
©Geochemral(Flcating1CoolinsSuppIy} DResideittial-Water Supply(single) e. • IL in,
®TuduslrialfConmtcrcial ©Residential Water Supply(Aired) -'t6'GROUT . '- -'-
FROM. •TO. MATERIAL I EMPLACESIENT MEiHOD 5.AMCKINT
El Irrigation . .. • 0 'ft. 7 ft. Portland Pour
Non-Water Supply Well fit. fit. •.
% Monimring • DRrcovery� • - _. -
Injection Weil: ft. ' ft. .
. DA_quiferRecharge OGroundttalcrRciilcdiation -ISAANDIGR,a'ELPACKtir'wgrueantct:- - - - -- .
FROM TO - M&rEer.•u. RS1PIatermkn1•HETROD
❑Agaifcr Storrge aid Recatrty C1Saliiuty Harrier 9 R. 20 D. sand' #2
❑ArinifcrTest- ❑Stvini atcrihairtnge• fit. (t.
❑1 erimcnt.d Technology ❑Subsidencc.Conirol .
;•20.ORIL LING'LOG(attach additional sheets if ireeecsant- '
OGeothentrll(Cldsed Loop) DTracer FROM - TO DaSCRFPT10 (Toler.honlocn,somow,ri Ivo.fawn un:.(Ie.t
• ❑Cr otltelunit tfleatiiseiCooliue Return) ❑Odlec(explaitt under421 Retuarks) 0 .rt. 20 ft. Silt/sand/clay
ft, ft.
1.Date Weil(s)CAndetcd: 6-27-23 Weil IEIWMW-15
..a.Weil Location: .ft. ft. Ca a`� ''nm-: �/ ,l
Former Catsburg Country Store fit. ft, I'J� Z�t3
Facility.t lwnerNanuc Facility lok(ifappli abic) J
R. ft. ,
1110 Old Oxford Rd. Durham, NC, 27704 ' t. ift>i.,l.a.-t,i :�t r r. =r• . l;f'rfi
Plnsr ry dddrass City:and Zip :p G RE l%lAtDiS .
Durham . , bentonite seal from 7-9' '
CoauIv lead hienlifueatton No,(P1N)
5h4.mutude and l ingttuilc in dcgrees/minutcslsceonds ni decimal degrees: 22:Certification:
(ifs,elr 1•,ctd;Qa lairtoiig is-sultlek_rn) ,
r
N. �W y��r --��. _-_ 6/27/2023
.Sigamire fw'=;.,,: -a-E.c i�; ` - - Date
Date
6.is tare)the wells: 8:Permanent or ❑Tern rarti =" y -?
(-) Nr!i not^whir elhii.7.i •,°.•;1.,�;i ,f:3;;Krz • .
S r. f rho ti;:.., t :cq.:F.cJ ixrrirrrtcterl mum pxeonlrrnin•
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iiith'FM A'CAC 03C Ir-'- �-1. `rT..t.'..,.. ,0299 Well GTrtsrir+ctuon Srcu,dmafs erndrdurrcr
7.IS this a n.p.ur to an.ciisting well:. O 'c, or EINe rrr,•u-of dims rem-tmi lutes turn iui:ritdrd i•?:be%Mi.oirnc•r,
-If this.11:n ii'palr.jiff emit kry.irol uudf cvruttrrctieri hrforoarrl«n otid cgth hrr rfrr nartare i>f rime•
rrpuirraider 021-Lanark,.sn:arun or tar ncm b.:..(of this form 23.Site.dliagram or additional well details:
You pray use the back of this pmige•to provide atdditional well site details.or Well
8.Number of Wells Constructed: 1 - coustiuction details. You May also attach additional pages if necessary.
For airahlpe.lrtkerlon mu runt-manner iirpp)y wefts ONLY urirh rfiu.srree'ourstrurtion,yea c on
safrmirnrie form. SUBMITTAL iNSTITCTIONS
9.Total Well depth helots•hind surface: 20 (tt.) 24a..For All Wells: Submit this fonn within 30 days of completion`of well
For math/pe icrlff list oft depths ifdlfi•rrau(rrrsrnpte-3@200'ara12 3 Rio) conointction to the Caressing:
1t1.Staticwater level below top of casing: 11 (Ill.) Ilivlsiun of Water kc nurrees,Information Processing Unit,
. ff woiur lever is itborr casing.is r"t" • 1617 Mail.Servicc'Center,ILalciglr,NC 27099-1617-
, 11.Borehole diameter.67 Oa.) 2-tb.Far(}dmtloi.Wells ON[.Y: in addition to-sending the font to the address in
24:above. also submit a copy of this flout within 30(1ays'of completion of it`ll.
12.Well construction method:Air cotlstinetiou to time following: '
{i.c.auger_roman.criblc:direct push.etc.) •
Division of Water Resources,Underground ftejet(lon Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Rzlleigli,NC 27699-1636
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13at Yield-Wm) �Ictltad of test: 14e.For Water Supply.&Injection Wells:.
Also submit one'copy of this folio Within'30.days of completion of
Il311.Disinfection type: Amount: .well consimction to the county he.Ith department of'the coirnly�wheie-
constnucted.
Form OW-t t ouli Carolina Depan.mem.of Each-omens and Natural Resources-Division of Water Raotrm. Revised August:0I:1