GW1--06010_Well Construction - GW1_20241011

WELL CONSTRUCTION RECORD Fat trtcntnl Use ONLY; '
This form con be used for single ar multiple wells'
1.Well Contractor Ltforniation: Y"�\
J • IL- AITERZONES
Tyler Brown • . FROM TO DESCRIPTION '
• Well Conlrsdot MIEN, ft. rt. I 1
4625 :ft. f�.
NC Well Cant[aclorCcniftoitionNw�cr FR
'=t5:OUTER CASING(forinul liklITicns)'ORLINER(ifanplIlesbte) •
O\I TO DIAMETER•I TIn1L- �
KNFS1•• 1 MATEUTAL. ,
SAEDACCO • ft,• rt. - I:iti.
(away Nam- 1C:'INNER'CASiNG OR:TUBING(keoibcrarat'cfascddonp):4.'
- - PROM TO DIINIETER. . TUICKNESS MATERIAL
•2.Well Construction Pet,�tuit 8: - 0 'ft; 10 ft. 2 'b� SCH-40 PVC
list al apillicohk Well permit:fi c.County.State;Variance.h eerier&rir.;l' • -ft. fr. :.in. '
3.Wd1.Uso(checfaycll dse): t1 SCREEN
,Water Supj►ly Well: FROM. ' TO . -DtAntETER s LOT Str,E TUICKNES$. MATRRIAt.
. ClAgacultinal ,ohlunicipal/Pttbiiic 10 ft. 30 •ft. 2 im .O10 SCH-40 PVC
®Geothermal(Heatin rCooling'Supply) ®Residential Water Supply(single) ft. _ fb. in:
,©Industria1IConuttercial IlResidennial1VaterSupply.(stated) a GROUP; .. ..:. _
Most. '. TO 'dL\TERGL. E\[pL4CEHLNT;ttEfIIODBAMOUNT
' ❑iti'iition •. 0' ' It. 6 - ft. Portland pour ' .
. Ho u n-Water Sppt).Well: . • ' • •
R " • ft i
. ftJiloniloring " - , • OReeovcty. .
•Injection:Well: tt,' fb I •
ilAgnifcr Recharge DGrot ioniser Renicdiatioti -19:'SANDJGRAVEL I ACK'(if applicable).-
•
vRosi. TO ab\TPR6\I. RAIN'.(T\IENTMutton
l�Aquifer Stontge and)tecovety'" 1 lSaht ity Rgiricr 8 R; 30 ft.. Sand ; 2
D Aquifer Tcst • D5tormwitcr ihttiiia •• .
:ft. ft. ; -
oKxpe IDCnIAI Tcchnplpgv C75nbsidcnes Contra[ 1n;DRILLiNGIAG7attach•addlliorinIAicel If.nccenarvl '
[7Geodtenuul(Closed Loop) []Tracer. • : .FROM . To . • ' DFSCRIPTioN(rotor.hu skie+,walla&nnc rr in gta(*t' . •
• OGeodtenual(IleatiigiCoolingReturn) E101iier(eNplainunder-621Retua6s) AL . ft... •
ft.. . . , ft.
. 4.Date Weil(s)Completed:. 9/9/24 ;Welt ID8m1-1 ft. tt. ;' _ a'
Sit.Well Locatbine •
ft. L f .s t. , .
•
Swartz Salvage •ft.' ft. . OCT 1 1 2024:
Factlity,'t?ivucrName Facility WP 0fappli able) • R.— `ft.
217 S. Holman St.,.Durham, "NC, 27701 ft. R,- It.:.1:.C.:'.-..7'"-"`j'e_._.1..,
. Pinsical Addles City.and Zip U t.r ::w
2 G REMARKS'.
Durham Bentonite seal from 6-8'; ' '
County Parcel IdeiditiGtUou NU;(Pill) -
•Sb.Eittitiidc acid Longttnde in dcgr eittnintitcs&sccontls or tecimal dcgt'ccs: 22.Ccrtifiudtii►n
(if well freid,cud latluttie sufflelci l)
N W• ! . . ^F.� 9/26/2024'
Signitu.:afCcnificd WellContiactor I • date
•6.Is(are)the well(s): lPenusnent, or DTemporat}'
Hp sfgnhtb this'Anvil lrereb}'ccrrlfy that the n•ell{sl>ns{wen{ttmsnurtrd in axtiwtrlmtcr
with 14A NCAC 02C.0100 or 1 SA NCACO2C,0200 Well Constreretiotr Slaha'ards and fiat a .
•7.Is this a repair to an cussing Yell: Elves- or ElNo e<7irof OUT rrcan(llas ltcn nmkidni to ter urll(eager.
If thls'Is o,rpaa iepaii.fth our knunvt well coostttrcdou T tforou,•rio n andeaploin rlic rnarure.oldie
repair rimier dr2ireoturksirciuiuorforthebailojthlsforut. ' • 23.Site diagt•amoradditional,well details: ' ' '
. • You may use the back of this page,to,pto\'ide additional well site details or.Well •
S.Number of wells constructed:.1 - construction details. You'tnay also.aliachadditionat pages if tieessaiy.
For multiple l,{ecrinn or nook-nearer iupplr wells ONLY with the setaecotrstraetlon,you con
.ubnrit one form. SUi3M TTAI,INSTUCTIONS-
9.Total well depih below land surface: 30 - •- ' , . ((l.) -24a. For AU Wells:, Submit this ifoiii within-30-da3s.pf completion of WellFormaldp1eWe sllstal leer ift"i hsIfdre'nt(cxarnpk-3@200'and2@I00) con5tinctipnto the foltosing;
10.Static water level below top of easing: •(ft.) Division iuf Water Resources,Information Ptmeessinrg Unit,.
if water level ly chore.easbay:itte'r+" 1617 Mail SCPPiee CrUter,Raleigh,NC 276994617
Il.'itotchote diameter.S,25" - '(In.) 24b.For-Infection'Welic ONLY: In addition to sendingtite form to the address in
24a adore.also.submit a copy of this fowl within 30 days-of completion of well
12.Well construction method:HSA construction to the following: I
(ic.auger.raacy,cnbh direct push.etc.) • Division of Water Resources,Underground Injection Control Prograttt:
FOR WATER SUPPLY WELLS ONLY: - • 1636 Moll Service Center,Raleigh,NC 27699-1636
13;I Yield hietitpd of test: 24c.-Fo &r Water Slum* Injection'Wells: .
Also'submit one copy-of-dill fonii Within 30 daysofcompletion,of
13b.Oisiufectiun,type, Amount •
: construction to the county health depamtnent of the.count_v.wherc
constnicted.
Foitn GW-t Noah Carolina fl porianent of Enwitannsluapd Natu al Resumes-Dtviiloo of Water tt u'e15 Revised Aug[tst211t3