GW1-2021-05685_Well Construction - GW1_20210727

WELL CONSTRUCTION RECORD ''ForlltLrmnlllseONLY:
This ferm cea be md.WsiVk or mW iptc nos
1.Well Gonttmctor information:
:2i-. cif .-y w
Brian Ewing `" To 01%0,110110'V
V6,01 c l*alC Nam R. [t;
9240-8 � tG f _
t�[111t1E _� RCilt`tIR1FR N:.; bii'1= y'
NeG4c19CbmsscWrCL-rtiCr tGaiaNwoliaVIUM To 9RVVVY1W TDRIC'MMS MAITURL t
SAEDACCO Inc 0 11. 30 IL 2" hL SCH-40 PVC
Can"14filk
FROM IM t)tAMITER TRtCr+ ffi z. M&URIiL
Uss all aaamlimble U-Wr mrIWIT 1e V.caurng%Sww,t adamr„ltokdol Or.
3.Well Use(ch"k well Qaep. xar
Water Snppl4di: trNOAt TO t►1A?►t Y st ctr TirntYt ATSttinr..
IJApriculltntni t�IMnt�utipalfPblir 30 tt: 40 Ft 2^ to .010 SCH-40 PVC
[3t'�e otitannal(Heatingrootirg&Wly) [JResideatial Water StlpA (sin*) I (L rj' �
13hW►stft1fCot Wo;ial 0fk*Wtltial Water S-w1 (sbamd1
L N
S ROIq TO MA3L UPLACT-MINTµ,.. N.'MEMOD&,h
C31 itatl 0 ft. 26 tt, PORTLAND TREMI
NOR-Water ratty Well:
QCAlgrtiiorin C.lRt fin °
7n
04 tt.:
OAqu*r R-ccbsrp Rcowdki ion V `Y
'x,
pAolCcr:ilQrete, al+d Raxetcn I1alinftyatticr ra. a ati «H > .rat
28 ft. 40 ft. FILTER SAND # 2
QAgitifcr TCM C1 .;4.vv er 13r, Rogu
tt. ft,
MEWOMCMI To hnotogy i7Sia'h� dn=COMM
V41❑Geothen nal(Clad Loop) Maser pxa Mt DEWRt�rflos Wo ,UrdnauAO777d tW.
OGWthequal tllcwh Coo . Rettts»i ❑Other - under#21 Reingt 0 (L 20 IL FILL SILTY SAND
20 (L 30 ft, SILTY SAND CLAY MOIST TO WET
4.Date WeR(s)Onipleted: 6-24-21 WegjD IMW-03S 30 rL 40 ri. SILTY1 SAND MOIST TO WET
5a41Ycii lrtre tn• (L tL
Old Battleground Storage tt. (L
Fscit aYJiraaca haste Foamy 1D#(ifappltablc)
3700 Old Battleground Road, Greensboro, NC, 27410
PIV,iCU1t1d3W L y..aattZlp it iRTt77
Guilford BENTONITE SEAL 26 TO 28'
C' m.• Parfet kkidiftt anon No.(PINT
W 7,.V tt do said Lougho le is degreWinjouicalscctntdh or dcd-mal dcgrem 22.Certitleatfon:
EiSa,ett teetsf= hlt?lot�is aiende
7/7/2021
; omWcuc, IM Owe
6.Is(altil the WA(iP xftterntanent or UTetnporary By x'ymntl;'hit,liertat,1 Arrok aY+rfo.fbaf I&ivefi{S)iron(wwwj crandfneeie d iir s"tardmdce
r 1 A l A NCAG 02C.i 1fW or 1A NCAC 02C W.700 Zeff f"attsfmcdlart;poiddeves errtd ffiff a
7.is d&a repair to an cAviing well: uOVes ov &Ni► rogr at thil rrtwrd has&M lrrarVi*4 to OW still owner.
ifthis'ts'a t ctdernu nw—iton.ir�lnrr.:r m-n mid cxpluht tl r mrare OrAr
retprrir tuder r«3 rrmar&ar xmika a or rm I&had n/'1.6is forft 23.Site dbq"m or additional 4 oM det il4:
Yost may ttse ibe,bul,of fibs page to provide additional w1l site detail.,or yell
8.number of wells constructed: You r a is o adach 6 s if tmessa*'-
Frrr aifatlalltte it�i7k?ltrrr sav=te�,l8r r.�rzplr wrllt Ghti'41'tidrk rkt�arrrtte crtxsfrarticor,trorar arias
sak"sril&M fond. SUBMt'1TAlL VNIKUDRS
9.Total wet]depth(below land Surface: 40 ft1.i 24& Fnr Aft�"Wiellz: Skibmh this fbint within 30 4ags of coaTalenon of well
f,5r Mat#tilr7r+t Ps lisra?ti rgixlsr lfs$(mrrna to crrranl x#@�'S i°crnrt m @dl7di b ccm5tttttat in tta tlz :fR►thrvrin :
10.Static water Itit-A below bap of rating: (ft.l lttir-islon orwatter Rrirtun ti...Information Pn ee ng Unit„
if nalr&%Vj lx ab&r crftln4' -4" 1617!41'afl Savis a+Cfiater,ltslltt a,iYC 216994617
11.Dorcholt 414tucter..8.251, (fw) 24b.For[0ft OXLJL: In addition to wending the form to the addim,in
24a above. also subta t a copy cif this.fomt within 30 dWs of completion of trill
13.Well VOMInKtion tt hod;BORED consaur;tion to the t`atlawipgw
(i e.att r.(wiser,cable,diaact marls.ctc.t
Division of Water Resources.Vudet%ronnd tojecdo Control Program,
FOR WATER SMPLY WELLS ONLY: 1636 Afel1 Seniti1,Ceinter.Raleigh,NC 27699-1636
i3a Yid 1 NOW 9f tests For WAtcr So 1:_ octJon W AI:
Alsta stth0til one
3 ate'of this(aria %tithifi 3tf dtstaicoMpleli tQf
♦vcll coustn action to the aauraty b�,slth dep ani m.of the cm arty w e m
13b.13txlnfaxxtata t0 gala►atini:..�,..�,.....�.�,__...�.�,.......z,�.. - }
ei►itfrtttcted. �
Fanu GW-L No ah vWOUt'1.#SkTttuirtMt o8£rati-Itutt MM and 3dmund Rmwe"-.Dti*W%eat WQ ttW4Ur= fk-viscd AtgW M.1
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