GW1--06821_Well Construction - GW1_20241115

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WELL CONSTRUCTION.RECO.RD • For.igopal i*.1)1ILY.;. '
This-farm can bcltscd fafsingla cf.ntuttittle..welfa. • ' I
'1.Well IntottnatiOn:• • '
,....1BrATE/C.ZONES.• . .- .. .... - .
Rich Leiaire FROM' TO . I DESCRIPTION
W411.C.ne4tiC0r Nanic ft;-. ft,
. .R. ff. -
2593A
-;15:011TER.CASING VoiriiitittgeankifiVitWOZILINEKT(it lin'Alenbkly
NC-.11,c11Connadcit CcrilftdatinilNutrbei .
FROM' TO '" DIAMETER' ' Totaiter..ss HATEEttAl. •
ft. ., ft.
SAEDACCO . .
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•? 6'...4NNERI&sING7OFCTUBING 'rioiReiniii ibiLcid4.30. .-,.1' -•
C511141.1-n.).Vont'
• NROM TO • DIAMETER TiliCKNISS- MATERIAL
2.:We1l'COnstruititin OM'Olit#: 0 11. 2,. - ft: 2" ; In, SCH4 0 . PVC
proft.47iticnbie tri)1,06-nruz li.:Cr.ontnt3,,,,,'Stine,Variauc.,...., '
' ft. • .ft. ' :. ':4)., •
X'Wel.I11.ie-(0itelt..welltniejt -•;17YSQREEN,
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Water Smittl Wie.11:• . - • VOW-V. - ,..TO • ,ntfoor.Tgft storm*: . TORTMS$ I•7,1aTiintAt, . • -
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• -. • 2•• ft.- 12 ft; 2" im .010' SCH4 0 PVC
Cl4gT1c.itIturat„ . liMonicipal/Thablie,. .
R. 'in' • ,
. ' EiCtothemtal tlienting/CoOling&pity) . I:Residential Valet SutiplY(single) . 0! ,
( OUT - .:-..,--,. .-7.'..7,.:-.?--=- -•,....--.,":":-._.::,-_...,,---:,._-..:-. -..,-•_
1:3111dustfialiCotitufercial DResidential Waretsopb.(shared) TT,R0,57 MATERIAL ' EMPIACENIENT NIETHOD A/AMOUNT
• 0 frritintion. . • . 0. ft.- 1 ft;• PORTLAND POURED
Nola-Water Supply Well:: .
- ft. " 'ft, ' • '
1111,N10nitoting . • .•Ort-C.COWY . 1 . .
InleetiOn Well:* . • ft. .
• 0 AquifirlIeekarge: '. .ItiGnauridivalet RentedititiOU- 119zSANDIGRIVE1::.P.ACte(if aivOliCAblu)Y-- --,- --.:-.;....7.7:_:...L-..7.- -.7Z..:.7.-•
'PROM' ' , TO • ' 'I.AI ATP:MAL , totil...termENT larrtiOn.-
nAiitilf.ci 56*arkl.0.*0r .
Yd ,' 1:7Salioity Ramer . ' 1.5 ft., '12' 11.' SAND 1 #2 ' .
• . ... .
1:1;1416,0-.Test, . ' tIMommatcr I)Mitingc- - . •
hi- - ft:
00periptcrtial Teel:m.09U_ 0hsidctice.Couirctr.
10'.:4311B.LINGIOGIMtactifadditionlit itilitiiinceessarit : _ -.:.-. ---
CICteothenual.(ClOsed.l.con) . ElTracer. - . . . :FROM' ' TO. DESCRIPTION Nolan ImitIncii,staMtch IMI.h.'ArAin''Ste,'at.)
13Geolitential aleatineCoOlinglietunt). Mather(explain under.al Rentarks) O ' ft, 12 ft. DARK'BROWN SILTY SAND
. (4. - -ft.
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4.Date Wei-KO exitiiiided:.10,•24-2024 Well ID#mw-9
5a.-Well LOcation:. . • ft, fr.-
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• WHITE STAR . - ' ,ft.• It; .
Facvtgrypic • . - • Fdeility MN(2icappiieablc), ' • _ t\11 V-1-1,-210'24
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R.. fl;
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610 Lakeland St., DURHAM, NC, 27701 '
- ftiL ' • ft.' . ' Inf.:,-.:7,-.-z-.272:, P7,-,nr•,.''- °t •
PhYsi4111.130es;•Cir)....010 70.. :7111.41EM.ARKSQ, .
• . . :)14,',.1..,--.•..i
DURHAM ' BENTONITE FROM 1.0 TO 1.15'.- •
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(29 wily ' PArte]1( liftcatinnNn.(Pnt1), - . 1: . ' .
,511„-Littitiftdoatid 1.-Miiitude itdcgreesintinutr4/SeCilitls'Or decininl'degreeSi 22:Certifitationt •
(11;ttelf COW.,ottO hitiongis saftleloa) _-- -
,...,-7-- '. , . •• Ct>
'1V— * ...'..rt2i CX9- 4",0-.^.1!f-f• 10/24/2024
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' - •Sigtisotit o(Cent.,.._i.Well Coinntefeit.,' Date
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6.Is(are)the itch(s): KiPenitanent or LITetitborary.. .8.r..ti$tibig Mir-form-I lrireby erilify that./4 lid/(s)wax.(Krill)cy,,vrucipci in nivqiikinc:e
• War'/51..KCAC 03C,OI(t eo!/51.404C Q2C..Q209 Wilf Cintsmiction Skonfont ond gm n
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7,Is,tfifS n.rep*to an giititing well . OW*" or KIND 4-4;yof this)4vorti hirkl.4.;;Ni proiiidoc,6 dn,iirli inrirCr.
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jyrkis:is n repor.:,0)nr kinwn 114.4.01151/Iftichg brfninnninq taut g,',Vph2ht thrownre of rut,
*lnk.tali.).#2.1 Moods"i•eiltinl or on thdint.a.Of this;nem .23.Site diagram:or additional it CII details: • ,
- . . Yin)may use lime back of this-page to.protide additional welt site details of Well '
.8:Nntitherof-welb constructed: I. . consttuctient derails: You otay:alsa.allachadtliiional pages if neettisaiy.
Far nuitiOn15.1,rokakm,of non-Icarcr svplx wcIppNix wini rfle.enc.twitruction,vat can
suini i tone-fynn.. .STIBMITTAL INSTITCETOSS
9.tottil trelfilepth below land swine& . 12 (ft.) 24a.. For AU Waist..•Sitbinit this Allrill A;i1hiti 10 OA.of:cOltipictiOn-or*$ .it•
For Pilik.gk WrItrliSrrell AVMs if ilif)ivent(OxempFc-3@200!and 2@ 10,9T ' conslitictiQR tO Clr9.110Nsillg..: 1: ,
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10.StAtic water lad-below top'of casing: 5.2 .(ft.) DA•iiiciii of Witter Rtiourees,Information Ptticcsiing Unit, '
1:i tiia)ile kvei Li atripe t.Osfy$,WV'+" 1617' Mail§ervic...c.Center,Italcigh,NC.27699-1.617
11.Borehole tiliamerr,8•28" "(in.) 241,f;rny feilvap Welk ONLY:.In addition to sending the fomt.to the.addtess In
24a:itii0e.:also submit a cop y of this folio within.30`daYS of cOnipletiOn Of-well
12,-Well construction.method:-AUGER 'CODSIDictIOn to-tItO following:: I'.
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(i.e',ttuer.ro*.ccalileAliect put....ctc.:} ' I • • , •
pivkilan:of Water-Resources,Underground IttjeOlon COntriil Program,
F.oR WATER SUPPLY WELLS ONLY f 1636 Mail Scrtice.Center,Raleigh,NC 27699-1636
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. 7,4c.For•Water.Sttoolv&Ittieetilini Wells:-
- I3a,Ifieldfglim) kthiotl tif test: . . i . dontidetn.
AlSo Sialt one copy of this form Wihn30 daSOf io of
-..1.3.h.biiinfeetion.typer , .. Amount: . well-eonsttoction to.the county health den:inn:int of the county whom-
F constotetett.
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Form ow-1 North Cntoltna De.ptirunest.ort twatintsetu and:gerund licsomees-1)N ii Ion OF Woier Reoaroim Bolted Attgust2o13
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