GW1--06432_Well Construction - GW1_20231009

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WELL.CONSTRUeTION RECORD . 5 Fig:tam-114 U4c 9NLY:. • - - • . .
111/5 form cOn- lifisiiee or truiliiple wells. '' . . .
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1:Well..Coattailot hifointatIon: -
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John Eisenman \ 1liTATER2.0NES',•. •
FROM. 10 _ DESCRIPTION ,
' "Wiltotontoot-Natot... ' • ft: R.
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4439 . ' •
NC Well Contractor ccrtilkgitlenNuarher .:AS:',OUTER7CA.SINGIfbriiiiilikiiiiiliiitt14'OR LINEK1tiiii'illtai6W.
nom • 10 •-• •DIAMETER', TIIIERNESS' MAIERIAL ..
SAEDACCO . • . .- '44- ft.'• ' . •
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- ComputillooLe. CASING OR i&Jihi!iiiiiEckikil-lOkOPLIY-."-r.,....- ---.. - • .
FROM . _., -TO _ ,_DIAMETICR IMCI•qiESS. MATERIAL
i.*F.:11Cwi5trucwrn lierilit 1,; • . , 0 -ft! •,43 .ft.- 2 : 'hi. SCR-40 PVC • '-
Lif'io 0 o"pliftr011e IFill pripii4liaS•County:A*.;Vorlausw,11Yeertigli a::l' . • .
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3;*e11.1.lt0(c1Lecli•I'L'ell use)L- ' .. • • •
-..47;SCREEN
'‘Vittr Sititilly Well ' • FROM TO DIAMETER Storsizr. ' TIIICKNISS MATERIAL
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ClAgricultinal. ritlinti Cipal/Publie. 43 • Tt! 48 ft; 2 II!, .010 SCH-40 , PVC..
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• •-EIGeoilkunal(Heating/Cooling.Stipply). • CIResidential-Watif.SopPly(single) ft; in
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CllnduStnaliContntacitil • Plicsidential Water-Supply(shared,' ,.18; R°1-1:r--•-• ' -------,---_ -----—- - ,'-- '''. -v — ."-.'• -:
MATERIAL -ENIPLACMIENT AIEIROD&AMOUNT
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Cllatatian' -. . . . . . ... . .V . -:- 0. . 'Tt. 38 1.1.• Portland Pour... .
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• -Non-Water Supply'4Vell:' - . . . _ . _. _... • . , _ ... .. . .- .
• . -ft, ft.. . 1 :- :, ' . •
' 63MORltOring . • . •ElRecovei • . _ •
Injection Welt - ' - 'ft. . - IL• ' ' •
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• .•. -r ClAnnifer13ccliatga . 1;16ibitidwatct Rcinediation n-19:SA_NDIGRAVELTACKlirup..atitabltr-----
10 . MATERIAL - ., 4111.1.A6nie-NT!Amon -
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PAiptifcr.Stotoge-and lice'dtriy . • • _ ..... •
• PStilittity Ranlet
• - ..--...•• . 41 ft., 48 ft. Sand ' #2-
1:1Annifei reit EISibtfintutee Draitingo . .
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ItiVeritneatal Toilatoloa. : 13SItbSicicacc,6introl . . . . . . . . . .
_ . ,. 20ARILLINGEOGliiiiitilflidditioiiiil 4ii,ifilltkis'i.firv't
' , • i3O0thential(-Ultise.A Loop) ;I:ITmcer • . • .F110M, TO % - DESCRIPTION 0.416r.Intralvti..stininkliihntientin sik,'(461
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.ft., 40 ft, clay/sand
111GaithenisalffleatingoolloO'Retum) ' 0011ter(explain under..021 Retnatks) 0 .
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. 40 ft.• -48 ft. PWR -1 ' .
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4:Doti10.01(s).co nipleledt 9-26,23 -Well rat/raw-9 . .
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5a;Well Location': ' .ft.- ft, , -.,-)`‘,.-. ".--t rr r i i ,f F.-
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. .A Cleaner World_#203 . . • : ...„ -• , ft.: ... • ft.
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. -Facilily/PUSerNanic •. - . . Facp4i ID#Ol-applbablei,
• 4.4 " ft:' Ori-D-1372023 .
5700 Fayetteville Rd., Durham, NC, 27713 , • - ft. ' •
in."-..,-,-.,-.4.,, 7:, • - •
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.Ploti'dal Addtiss,C,ity.-Itifil Zip•• .., . . ,.. ""' "1• '•' .".,- .-:3 ..;EN • •
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. . - . . . -21.REFilA _ . -_. • 'P.N:)."CC
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- -. . - Durham ' . • . •bentonite Seal from 38-IL41' •
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Comity• PArgel Ickailifillion No:(PIN)
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5111,4,..iltilile*Iit Lii.1*-40110 111 Ilegi.Vai'AiirlUtinqii0Als rOlttiMill&tied: ‘2z . •
amen 04141,1,4g 10104 ise_iattOeon
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. N • w- - ........,.,..:,e; ,---'1-1 ------,3.------ 9/29/2023 •
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, • • • • .Sigruattutc"..2,-71.41x4rClim_hatIO , Date
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6.Is(are)thi:itlf(s)1,XPertnaitent or ElTeospoility h.:. - '- ..14.4:. - 7-4-4qc.11-4 --:1":V.;*"7,'"
f-1 1:-..1 consitiscr4 he;ficeamtaAcr
11:ithl.4.6(Cdie OW.1.l.igP...7-1,-.77rla;f1.:1•.pf..•-..O.200 lirtql Commit rion Standayis and that d
7.Is this a nejlai.rfri an Odisiia.g well nye. or ' Ono• • -trOoftiqf ireOnl iiii;liven provides1 Pi ilre+MI Pirns4s:
if this It'd ts.'pedr.,till opt bungs vegemb-trucridia Wqrrnari;.'m drift e_tp/din nit!flown,Of riv . .
rOair Waif I#2,12irenarkv Serif=arm six boil Of this form ..,23.:4(te dlograinvradtiltioual Well dehtils: .
• ' You tiny use dies.bit&of this page td.:prosiditiddidonal well Site details or*di
8.Nuatherof Wells eoustrneted: 1 - • - • .cimisituction details..You inay alsO.attacliadditionai pages if tiedisSat2,..
For Utak,*lufee.don ornon-iivner supply reell's.if?NLY with diu.satoconstrifillost.ion ma i
.s.a4viiit tme form StIBMInT.AL INSTUCTEOST§' '. .- . • .
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9.Total Welt depth below land stirfacel: - 48 . . • -.(ft) •24a. Frit'Alt Wink Salnitit this krill Ay.ithitt.SO days of c..dittpictiOn Of*ell
For mar/Kr'i';411$list iv!'detax43 TS:efferent textunpre,3@20,9'and.2€1027) "rcO15ill1Otiol0.t0 the follouing-, V
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10.Static..ivoter ji.'0.11te10W lop of easing: • • 00 Division of Water ReitotireeS,Information Piucessing Unit,
If num,/00 ls dove easing.idle"-3." . Maii.S.kryiteJte,itier,Raleigh,NC•27659-1617 .
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. 11;borehole ilhimetert 8..25" • • -On.) 24b.For InJektiott lyciti ONLY:. i hi addition tozendiog.the form to the address in
24aabOiO,also submit 0-Coy of this fano within-SO-days of,cotopletion of Well
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.. 12.Ne11 construction'method;B8A -,, coitiOuctioit to tile folloWittg!
(Le.?iigei-tolar),cable.."-disco iitsh.etc:i• • .
• . . . , Division of Water Re,son refs.Finierground Injection ContrOtPrOgrant,
FOR WATtRSDFPLY WELLS ONLY:. ' 14536 Mali Servieerenter,BaleighiNC2j699-1636.
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.2A.4LeIO.FOE WateiS0011V&Ini•ta[0111W•
ell .
13tIied'(g• ioi) Tfthodotoit; •:„ . • spboi[one obi) of tins IfOrn Within:30 days of cOmpletiOn.of .
144 Disinfection typel Amount: r wolf,obilStruction to the county health deportment of the.cointty-whard-
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Form GW-L NoniCarelhia Dcpamend.Olboviromuclit aid Natural Itciourecs-Division ok Wale•R`mato;ce Revised August 1013 .
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