GW1--06844_Well Construction - GW1_20241115

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WELL CONSTRUCTION RECORD. ,...._1 \ -2 -
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This form calibc•oscd for'sioglO or.Ouiltililo volli, , .. •
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1.WOLC.011IraiIdr Information: \•-..." Forlorcpal t.r.s ONLY). .
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!..:.-1:liAVATERIONES'
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Rich Lemire ' PROT TO oiciCettnioN
. . toLf4r4Iorst4aing - ft, ft. . . I ' - • .
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2593A . : .1 . . .
• .41OUTER.CASING!airifiiiiiltelliii:Ur TOZLINER,rrritif
NC Well Contractor Cerliftootbil Nil:1113'd
;FROM TO " DIAMETER, ' . THICKNESS' . MATERTAI.- i.it. . fr. An.
•.SAEDACCO I. - •.c.921mImy MAIO' 162:INNERtAS aowTUBIT4W ;ii5itiiennirdtisw-d4atiq.?Y. • •
• ' .. ,FROM TO. . DIAMETER , TIIICICUSS. MATERL4L
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.:wC.IltonstruitiOn Permit#1 - - 0 R. 3 . ' ft. 2" I, IA: scH40 : . PVC
. /..f.ge oft iikiticroi,wellpeiliii-41q,c,Cemmt.,..?;Skit;11-4rigircA;,frfectiql'41c;)
It, O. ' : .4k'•
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voutv.§g( 11.ociF:rvell use) ' ..;t7SSCRsEN.: . .
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• Water Supply ViigItt." - FROM '1•40 . i:nriatrrga 'SLOT SIZE. . THICSNrSS .".. MATERIAt. •
. 3. 'It 13- .IR 2" "i* .010. SCR4 0 PVC 1:3 AgricnIturat• C3MtniicipabrPnblic.
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. 12C3tothennakileating/CoolingS1lyty). CiResidOltial Water Supply(single)' . . - in:
01.%'ROUT_:---L.=- -'-=•-:::;-:_,,..-7.--.7,_=::---.-_-• .„,-7.--.."--T_-,--.-.- -....,-.--:::,...,--.i-..-- _
t:Ifficlustiial/Coiontereial EIRcsidential.Water:Supply(shared). -'.
MATERIAL EMPLACEMENT METHOD&ASIOUNT
• .,Clirrititition. • ' . • . 0 • . It. 2 ft. PORTLAND " POURED ..
son-Water Supply Well:. . . - • . . IL .Ucoyety . . . . . •
.. to.MQPit9ri.T.1g. . 1:1.1 .
Injeel ion Welt:•- ft • •
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El Anutfci:Recharge tic000ilwatot Hmo0iiftiori . . ,419:7:SANDZGRAVEL,PAC5 (ilalicatite)1.1T-7 7 --.----.,:::= 7::..r..- r"-
FROM TO , ." ••I.MATEIHAL. . HNIPIACEAWIT METHOD
I:/Airillike SIOR.10 aloig-q6f3. aidinity i4arrir.
. „ • ,.. ' 2.5 fte. 13 . .It' SAND " #2
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• 1:1 AgligeT•ICSI, •, 17.106rriksvatt 1)04.1Rge.- .. .
. .ft. ' ft
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1;1 .xpctimcgill Technology 1;1Subsidence CorstroI. .
s,',20,:inilliLING:t0Biiiitaell'4iddliiolial.Aiiiiiiiitestoil-- -- _:--" ---=
IDGc.otitennai Closest Loop) . CITracer. . . FROM'% • TO - 'DESCRIPTION(Won kirdn'esicsoiWock Aix:'0,311'Alen iitA
EIGWiliennlit(IleainigiCaoliD,OeiUln). Dottier(eV13iil Wider.gi.Reiriattis) 0 . "ft. 13•- ft. DARK'BRowN. SILTY SAND'
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..i.foiii.e.wid.ks)cimilikied:.10-24-2 02 4 Attell ID#MW-8 .
' ,f,l,- • ft. • V 4,,,„,Li
. ..s4..wo to,eAti".m. . • .rt. fi, '
WHITE:STAR _ft.. et,-
Faeilityittoirwr-pewe - - . Fdepity tb Ai(if,applicable) -- - --,- - ' -
NOV-1-.;;
610 Lakeland St., DURHAM, NC, 27701 . . :. -
rti f.);-:',;C:17)"11
ft; .
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. . . ' •-PlAysiail.t9droSs;,*City;and ZiO• ,,,. .R EmA1tgs4, • . . . ,. • '
DURHAM - BENTONITE FROM 2.0 TO 2.5'.'
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OMinly. _ • Pait el.16-.;:itific.:100040.(PN) .
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6..,Li.gftude'Aiild 1..I.iiigitude iii dcgcte0iliflt*IsFiiiii!1.5'dr tiCCiiii;II'dcg licsi" .22;cc/Ili-143 dui'.: •
41'401:acid;on/...itailtUig•ig s411.10cni) .. . .. . „ ..
., --• :;:74i
..--- ..1 . . c,e ,,,,o _
., . ... „, , .. ..... .4,..0.........4... 10124,2024
Siriltzieeer,Ccrtif.C1-Vicil Ceitliacte.r , „ '. . Da,O
6.Is(are)theAVet1(): %Peril-raiment :or -EITetitimrary ' •
By.Jiphig,dri.v.fiernt.1 lr ereby.et,igry rhal,rhv we/i(r)was.fwgri*criyinrckfl ill iii."4.1rtiance
. • ivirk al NOIC OZC.4)/(r or 154 kicAc 92c.:020;!'isii Cottsrnicri'n Starmtarrik asni'f'.7
7.Is this,s trOairtaatie.iii.itint well qite4- or Estio. ' cciijr.nf this reeve('/*Jac liki,11 pOijided riiitioiiriliiit'arei.
lithis ii 17 r.epali..fill!NO fir/c/Ot we1/;a5nonk.r1mbiforraarjaq.aarl oyilaia the ltipre of Mc . •
reisiiirtiirder 021 iiinarki At'egora iii-ivilhe ihk*,,tir this foilir. .23.Site.diagratir,or aitditionatli.ell 4tetait:. - . . - • - .
. . Yon may use the back of this page to.proVide,r.iddiflortatiyell site.delAik:•Or welt
8:N.umber.olwilli cottStrocred: 1 copstruCtioti'detatis:You tuay'aLso‘,attach.a•iiiiitional pagesif necessaty. '
For nuiltiplOrtfeez1oko?apa-raer iupply.tells-ONLY with rk...yrine.au/Prim/tau,Kki,ean
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icannitoni form: ',SUBMITTAL INSTUCITONS 1 . •
9..toliil welt depth het*laud orfitotii 13 „. (ft.) 2.12. Par,AU Wellio Siihniit IhiS form within 30 day .of-oatortetioti of'islet'
For 4ttilrlyge wells-Hie aUeep.thr 1/40:1!toi/(aronpf6.3@21)0'/441.2@mq •eonstniction to-the.foltoninz;. i. .
. . 19.Staticwater levet below tap of rasing: 5.2 (ft.) Dftiiion of Water ItesOu rtes.InformatiOn'Prtfresiog((nit,
If'Oiler level I's illtoevasiij,g;axe"1-', 1617Ni:tit AerviCe-Ceriter;lialeiVii NC 37659-16 i7
•If.Borehole diameters 8•25" 'On.) 24h.for titivoion Wt,ft ONLY: In addition to etitlitk..,the-romt.to tkacichiss in
24a.ahOVe.."alse.sibmit a cbby of this form within.10 dO.of completion of*II
12,Writ construction Method:AUGER •L'OliSliu;tioH to the tatIow.ing:- ! : .
(i.C:men intary,..cntAo::tlifect posk cto..) • [ -' - - • -
Dirbioitof Water Resou reek,Underground Injection control PlOgram;
FORWATER.Sb:PPLYWELliS ONLY 1636 1636 Mart Service Center,Raleigh,-NC.2760-9-1636
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- 14e:For-WateSupply&Injection Welts:
1.30.1.(041m) Method Of test: __ _
- Also sObliiit one copy of this foirq'Within.30 tlaySof eotof)letion of
1312.Llkinfeetion types .pez. . Anioun,t: AVell.-congruction to the county licalth departnnt-•at the calmly where•
. -co.hstAicto.
FOrtnIGW71. .Notilt Corollna Ds.lutasnent.of Vavirotnneut and Npnaul Resources-lkilision of Wnicaft -atrc fierhed AigusfL2OB