GW1--06842_Well Construction - GW1_20241115

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WELL CONgTRUCTION.RECORD,
6\- ‘ 17clr.Lima.tis..-c ONLY.;
llhi"s fcnn co Wined Ail'sin&ci.rimlaida wolfs. \
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I.Welkitiraitir InforniaTIOD;• , !
I,•:.II:AVATEMZONE.S 1. .
Chris RUffer - mom,• , la 't DESCRIPTION '
1001c.tniEnctoe.,t4ainc ft. ft, '
ft.
' 4223 A -
•41KOTITE FT.C-ASING'(fOiTeinatkiined;viCIWORUNERiii on itienbley, -
Ne„Well'ContiacIOE Cctlifitalibii Militia
'PROS]• • TO • ' .THASIETTR. • THICKNESS• • MATERIAL
-• SAEDACCO •it.
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6INNENrAswia:Olt TFIIINGViOOlitaied•l
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.Cciapiny. •
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CKNESS. SIATERIAL
2.*-1A ..0Ilit170,.HDII 0.CPHDI#: 0 it, 8 • ft; 2" . l 411. SCH-4 0 PVC
14.0 diltmilit-Oic J.'-iVI.p.ari-iiiit*(i.. Cow!ty.Sick;Varicaur.!,Iriectiptl,ch::) : ',
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;:'Weil.USC(041T,T1011 ttSg):: 17'..fSCREEN',
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Water Supply Well: F11031:--, 410 . . - "nivivErtat sLOT SIZE THICKNESS i 1,1,41-Ealm.
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- - , • 8. ft. I 18 .ft; ..2" 'Ili .016' . SCH-40 I PVC
. . 0Agicitlutral: OtIquicipaliPOltliO.
EIGiothenital fileathigiCooling Supply)• OResidOtiat Water Supply(single) ft,- I .ti, • ii*
,-121.l-G11011ri-_-:". ''`'•:-,--..-,--.7...:-.=',.: -,.. .7',' _.....-.1-.. ..,-,':=,_- :. ' : - -_.
ElltidtisttinliCOrtunercial ClResidential.WateSupply(shared) -. .. - -,rti -
• MATERIAL I EMPLACEMLNT METHOD S:,AMOCNT
Okligatian . ft..
' 1,3011.4VITTCE 5Opply.WpIt:,:
•__. . 'ft, ft.
46141onitoting . PgITCIf.m.IY '
'InjPC1101 welt:' • -IL ; . •
1:1AqUifor.13eetij!gO. OpiotitidWater llemediiitiOn ' -151;:•SANDI.G11AVEL'•PACKlir aluati.libriit'!:--- - ------ -------....--'• -- - --------- '
'moll-- 10 . ''I.MATERIAL. •. 4 .EMPLACEMENT INEXHOD .
1:1XIiiiii 8TO ilpa0;A 1:ic.0)):.dI:Y IJSOlinity Iliitice• • . _
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17 Atpliferlest: . . EiStOmMatct lynktiagc.-, ,
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ft. , . ft: • , ,
• OF.;:xporituental Toolmoto2,y 0"Sfubsirlencotontrof . - •
Ift.--1TRYLLIN15:11:0G1Mtacti.'/Eddition'alitieililfileccssart17 .- _-
1:1Geoiltennal.(closedloop) Otracer. OM .TO DESCRIPTION feobr.11;irdneti.RAYork DIM.grain'sne.iic.1.
' - rlerioatidniial(HenEing/COblibiltelUtIO Illother(explain under.421.Rett1mks) ft: . ' ft.. I
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ft,- - • ft.
4,-baio wiiiii(gy caiiiilkjedi:10-3 0-2 02 4.-Wal 16#SDC-19 _ _ _ __._.•__.
• it,. See Ge(tV s Notes '
5a.Will ILOCiiiinn:. , . . ft.. ' ft;
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Catsburg Country Store . " . .ft: ft.. •
F,cicaity,rlaiDnpapc ' •' - fdcAkty I.D#(Wnppricable) - - , _
WerV-1 ' 024
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1110 Old Oxford Rd., Durham, NC, 27704 . -, . . Iii: A.' , ' .
Irif.:,--7-4:-'''r,-. T' ;!•-.--;
•Plplai-1.A:0"cc is.tity;ninT2i0'
7,'21AEIVIARKS'.j.
Durham Temporary well for grab'water sample
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c(*.iiint)'" PArtel.I.Miliriciitipp No,(PIN}
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Mi.:,1.4tilnde'utid-lo tigittulO in de:gree'siminutOscciiiids'011eciii,:41'41c0'Osi. 22;Cergiticagoa: •
(liiinli,Oa,-OnO IatihniiisafriCieni) . I .
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N. - - • .*. .0 hris Ruffert, . . 11/6/2024
• . . Sigaiirre-aCcifillidiCiplleCiamitni.'! . - Date,.
6.Is(are)lbemell(s):13Pernianent Or SITelitporgry, • 4:113 irfng dris.farqr..1 kireby calify Oar ih;ire:11{"srl was-„•;:,..iriq.cim.y.rnwiefl 01 Form-dcrace •
with"15A-Ne,'Ac 03C.9iao 0,,154,NPICO2C.17,209 Well ennstnictinit Ski;x4inis(old ge.riic.i
7,IS ifits o repilt to art.e.iiitikt will - 6Yoi. or No roi,of this regard'hill:lieell pi014-freri tiifilki;in,iiilivner.
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t .ds idsi7 typirk.fyi ao kinitin w e:itronsmai9ii infortmiloif evul exploMiprp hrire of the
repoiriii,der PI keinarkt:itikri2iri•iyi iheiark.iirthis form -23.S ite tlidiagram or additional well detail.; . ,.. •
You mar use ibe back of this page M.Prinide neklilionill'well•site.ilitail.5f Or Well
8:Nutt:bet-of wells cottitruited: 1 constoletioitletaiis. You may"-alkinuach.additiOnOi pagooir trzeessaly.
For ntiOptc-infeelion or ofivili'ater supply ir•pl.4:04Y with rljr4ftt.rir:c.4yis'tructlo,,t,yo:‘,can • • -.,
iarmamie,lona: SIlltMITTAL INSIITCTIOSIS
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9."Totti1 well depth beton-land mtrfacin 18 -f ) 24a. Air Alt Wain; Slibioit thlis'.fonn Within 30 days Of vOtupfetlott of'Well
For mokible v;:eils-liit all dip*ifileie-ielfr to.r‘rofrp're 3@2L10'on:12€4'MI -eonstniction to ITIOTolloninzv.
10.Static water level below top•of casing: . (ft.) Diriiion of Wu ter RC4ot:'rees,Information Prueesiimt.Unity
tj*diet le.41 th'ial:toe'oiltag;ase!!+" 1617 Muit.Service:',Cciiter,Itulciglii„NC•276994.617
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El:Borehole diamPtcr:6" .'(in.) 24b.Dtaticgtion WgIt:ONLY: In addition to sending the form:to the.acldtess in
24aaboio..also inbuilt n-,-copy of this .font: syithin,30 diY0,of completion Of well
12,•Well construction method: sonic • 'co:1st:Oct:on to the following 1, •
I ,fie:pgcr.totry;onblpIitect pot:Leto .1
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prfflon of%%ter ResourcesIinee rgrotnd Ittjeeelott Control Pro,rAm, -
17,0R•WATERS.UPPLYWELI,S ONLY - .1636 kill Seniee-'&ntr,Ruleigh NC 27699-1636
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, • .•1 Vc12-fc.For-WaterSup ply kik.laical:0i Wells:
.3o, i (1(gpM) Wtholl'Of test:
Also submit one copi or cilig.rOiA•Withitt.30.tlayi Of completion of
.1,31J.Disinft..etbin typet , • Amount:. , pall•cansitudion To.the county health dcpann*of the county where-
coiwtmetcrl. ' 1
Form GW7 1 lionh C@MIlma ik.panummi.aftwnamocm anti Mama!IlesourCcs-Dha ion of Wsici•Elmatrc • Roised Angust7013
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