GW1--06819_Well Construction - GW1_20241115

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WELL CONSTRUCTION RECORD. FcrIstatualtfsc t"./NL*:' . ' -
TIlb-fcrm can bcsscd fersia*or multi*wclb
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1.WC1kes—utriktde InfOrtuatiOu:• .
I:14,-iv-ATEMzONEs, ' •
Chris Ruf fer . FROM, 1 10 . I DESCRIPTION . . . ' . . •
Well CCr'46...etor Nam ft. ft;
.ff. I
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4223 A
!,-7:1SOUTER-CAINGICifirriiiitIgictise4174010!Olt.LINER,rit iii)Iliitbkl.. __
NC-Virlt Contactor CcifificStich Murkier
,11-FROM' ' 1 TO ' . 'DIAMETER, . THICKNESS' - STATE:MAI.
-SAEDACCO . 1 I,t ft. ! I is.
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Qualiany Namc • '- .!.16.INNER tliSINaORTUBINGAtiotbersial klisid-1600Y.',j1 •
. . :ROM f . DIAMETER THICKNESS . NIATERIAL
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2.ikelf.binstillitiMirii, CriHt fl: - , 0 - R. 8 - It; 2" t'. 'ht. SCH-40 PVC
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gm affaiViicifac l•'.0-..1tP.thttftf IL:G.0347o;Sfam;-.Viitiqnr6 Ifyiwtiro oc,-.).
• 'ft.: ft, -11'''' .
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1.'Wc413,§Clkft#41afell UFO,:• ' ' 1 37.z.SCHKEN--
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. ' FROM. l•TO ... • :DIAMETER ,'SLOT SIZE . alife8firSs 1 MATERIAL
WatEr SiippW,Well:' • •
t 8- It
.- I 18 .ft.; 2" NIL .010' ' SCH-4 0 PVC
1.14glicit1fttrai' • liMtpileipaliPtt blic.: .
ft.
1:1Geotheintal aleatingitooling Supply). . CiResidential Wait.SuPply -(single) I • - I . •
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Elfildustirtal/Conunercial Oltesidential.Water Supply(slated).
iflo-si 911Tii TO- ' : 'MATERIAL .1-EN4HACE-- S"IRN'T-.METI—-10.D.-S;A:i111 CST •
- - , : ClitriOntion. . ' • • ft, ft. i. • .
ti'otv•Watcr Supply Well: •- . . h .
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_ • . - ft, ' .
1:04:1040riPP, ' . IDIteCoycry ' ., '
Injection.Well:' . . . . ,ft.- rt. • "_ i, " - • . •. ,
. . ClettittiferReChafgO fitinatiiiilvfater Rente4iiition- -19";SANDIGRAVEIDPACIO(ifarnilieittge).',.''"'-' ''''''-..';.2,r;7 —
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'.•.. ..' •._ . . •• ... . 'PROM" . TO • ' .117ATI:ftTm. - . . PAIPIACLUENT minion
El iifCr Siprap.,e• itridiReCOyetY . . liSalinity Eitor10.- -, f, ., . . . . .
,.. ' rt.. t '' • •
ClArp*r.Test . ciStamnratet Puilitage• . " .
ft. • ft. ,
P.,..vetinicntalli7echnotozy . P.' libsi'denco0*.nl• ' • ' ' -- . _ .: :.- .. .. -. -•. . - . . :- _
f-10:-.DRILL1NaLOG filtacksthlitiodul Slirclilf accrssaril.- - _- --• ..:-' - . ' -
EldepthenuaWlosesitoop) . Cgracer: .rttost TO -08.5tattertali tcabr.hviVvvvi,initrioCk ti rye.:mail'":Eve.ite.)
• Elee,a.)titenital(11catinateobliogRetunt). : DOiher(explain_undet g2i Rentatfisli - ft. . • .ft,. .
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It. ' ft.
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• 4.ikite Well(s)Ciiniiikiedv.10-30-2024 Well jto#SDC-2 0; -
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it,. See Gem'a Notes;
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--,..,_(..,,,, — '%; ,--.•1 :
Sa.-Well Latin:'
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Catsburg Country Store ' .ft,. ' ft.-,
1 NOV 1
Facnity•Stlapgrrair •• ' • - Fieliiii liji6.f. .aiplie.hicf •
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. . . ----•-r;•':_-_-, -,-.----- -
1110 Old Oxford Rd., Durham, NC, .27-704 . ' . . :,
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PIWsil'AiNi7ifr,-'CiLY-al0Z43-.. 2•1.11EMARKS'?„ •- , ,
Durham - 1 Temporary well for grab water sample -. .
Paws). - 1)atect la-zniificapon No.(PIN) I - ' • , . • •
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Sii,Latifttiti'aiiti 1..iiiiiitude in ilegrceihnintii4/SeefittilS.O.t decimaldegrecg 22.eriur•,,,..,tu.,ft:'
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i.itiiell,field,:onettaileligig suffiCio,I) '
Chris Ruffer.. -
W 11/6/2024
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. . ' glitilitW*Of,CrItTfircliC/C11Colit1taff-- ' ' Date
6.blare)the rvell(): 13Perioanent or .20Tetitplitarty, .1.1y ytobig,Ws...fel:TN,1 Jrire0 criqfy 01(21:the irg/U9 was...(gvnq qiprTructed iir.actvidance • '
with-15A NCAC 02C.0100 or 154 Ne.30O2C MOO n11 C6istosictiair Srarlui.rls and sluis.ti
- 7,Isthi:s a repair to•an ciiitioi: l'eft. ' 0Ye's• tit Efslo. • rOyofthis ritual him.N.i'll prpiiirta)0 the in II itimer,
I f(pi sis'a rrps1r.:6/1 oar Arct?Rill WaC61.157lucieciabifprtaciion:awl kapiais ihe llyr,!,treof the . -''" - ' • , •
- repdt riirifir#2.1i-einarks:k;di:vri or ivi the brel of this feint. 23.Site ilitant.Or additional iVell*tails: . . ...
You may use the back of this to,prolide adtliiiptial-well site.cletall5:'Or liE01
Sc Dituttber-of iwellscon.itrucred: 1 - constiuctionletaiis. You tiay:alsii.attaelt adilitiottil.pagesif beceisary.
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1,:ar Utillapfellpfcalouor npn,-fliver supply irrfIrRA7.Y bith rise si'pos.pi.esSrurtIpn,youvrzu . ....
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sufsniiS our Iona: •StIRMITTAL INSTETCHONS
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9.lotal tvelillepth,befowiatul surface: _ 18 • .
• ,kft,) 24a. Par All WIN: Sablitil 4164.fonit sVithin-Mt tiyi..ot:conipictiott of ll
' For toildPle weffrlisi all sli,Prhs if illgirOis le.rtuuPT6-3e200'm0.2E010(4 constniction to sli .foltou'ing-,: l ; .'
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N.Static water level below to p•of casing: (ft.) Dii•lsiun of Water Reitottrees,'Informatitio Piticesiing Unit,
tr iedt e r level ti'ahoy einfti,oie.4.V •10171L10.i;ftTice-t enter,kaltigh, t•C. 7699-1..817
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l J.Borelnite diameter:6" • 241k-azioAutayithON.Iir In addition to senclingilka fonn.to the...addrelasin•
•24aahOre.also submit a Lops of this font' within 30 dapi,of completion of well
12,-,Well construction method: sonic Construction'to the follovAitg:: ' !
ti. :viztr.relary,plAc,;ditect.pasP,...Ctc:1 . • 1 11
. 10:shiu.'of Water*sou recs.,Thidergrotind Injection ContrOl ProgrAnt,
FOR WATERS.pPPLY WELLS ONLY: . ' :106 Mail Service'61tier,Raleigh,1VC 27609-1636
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• '24c..For WiterSnpply&Injectinri Welts:
13a,ifie10fgpm) Melltotnif test: •
Also Obi-tilt one.tiio.-y of thiS rfOrtit':U1 thin.30.tNYS 4 dotDPIEtioti of
.131).DiAnifeetion type: . Amount well.construclicin to the-county:health depanmint or the counts where-
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, Pcriu• G').V-i Nosh Csaallnu Dcpqnspentofteviranmata sral Natural Icesourcas-Ph:Sloe of Water Eltatztes• • Revised August:1613 .-