GW1-2021-06316_Well Construction - GW1_20210915

WELL CONSTRUCTION RECORD For trrcrmlfilsc0my:
This:fdrin can be UMd rozsiii t or MWtipls nMc8s
• 1.Vie`#�I:G�utrxctnritifolTzaatlonc 4
14. N S
Brian Ewing Iitf2l8 DFyOitllihxl'
4240-B
NC:WcllCdnraelorCoifwnti6fiNimiba tS.t![1TlFR r5�5t,9£� +�r rfFit s?oeierc "bft:E G"i R. fieaihle
FROM TO DIAMETER TFITC[cl�aa^5 AtATIRtATrn
SAEDACCO Inc 0 fL 6 fL 2" al. SCH-40 PVC
Gmv,d C aerie i6v1bT.�lE1{et'J►sIN- OIt 7Tit#IM1T "'tlurntat Tnred Id
rROM TC} DUU TER TMCKNF.SS At.9TERLkL
2.Well itenstrut'tinn permit ft, fa,
11sr a ft.7mi#iruwa wrflprerxrnfmx tr_c:Cnuxrrp;SNP,traria wo,Tr*6cn evr j
3.Well,,F Esc tther c well tasc
777,,
Water Supply Well, FROM eta aiAnrRri a $t01re1rF; rarzt'acjqe$s MATRWAL
MA ltitral ❑I�fflriie Pali bl 6 fr 16 A. 2" in U10 SCH-40 PVC
® pthenmi(Henting,�Coo i Supplyl bResidential Water Supply fsira�tel ft. fL
�
13lvc lstiial(C'om*mial ❑Residential WstcuSuppty(sltattcd)
ONN TO MATERIAL nUnACENINTblETHODS MIOUNT
Oldigatian 0 ft. 3 fL PORTLAND POURED
Non-'Wakr Supply Well:
®hhoaiilcann pR+�ts}� ' ft, tt�
InjeeilobWeelk ft, ft;
DAgniferltcGharg (g0crittm terl cwttedialt4n t§ShlNiit{, L A 'f3
(7 lifer(` Slor7 FRA
Irnit} 8gca> i 13c0 ` 0o e+zAtanrs #zi z ACTsrrV T tiiiTNtair
4 ru 16 fa, FILTER SAND # 2
❑Aquir(CrIest l]i�inreF
❑Experimcntal Tmlinralogy osubsidcmd Coitrol
2{t:,If�IT.�.,1l+wCr`]AG`faiiacb atlrTl��ifa°f alic���riecie+csirr�k
❑Geoitherraztel{Closed Loop} 01'mce r cenoar TO AmW-
❑G utlieriiaal(Fleatir poti.rie Return)} ❑Odier Lt&ain under#21 Remarks)- ' 0 f.. 5 It. FILL SILTY SAND
5 ft. 10 fL MOIST SILTY SAND
4.Date Wsll(s),i' tppleted: 7-29-21 *dI]D#MW-101 10 rt. 16 (L WET SILTY SAND
•a
$a.Well Locathiu fL
Exyxon/Walgreens fL, fi. y
F (IStt"ewrlGr Naar TSr r71to'TDP SAf appi7G86t6')
3701 W. Gate City Blvd., Greensboro, NC, 27407 ft, r�E rC•
F10rssl Aalz9cs Git.and Zip .2T:lt'Efyf Xis. ti;
Guilford BENTONITE SEAL 3 TO 4'
eaitaki, (PrN)
5h: tttitrrt#c and T�irrirlc ira tlel!r�emimilscen�rtls rr eirrrtal ttse : Iectifttirin:
ifvi�s)tltl,'rIittleftsS�Strmt6 'rrl? `
11' W S—ria 1,p�1.E�i�Vo l'g 8/8/2021
5ia�irir:•ofC.cattfacd RteII CAntra^ina Date
6.Is(mil the w;ell(s)n mPennarneeit or i7Temporairy er min i&Lr rr 1 lwreGu Verlify Plaasr,rhe,wr14,a Kv+y ti4tre)ema inrefrd iru tmx`auitYncr
it*Ah)5A NCAC 02C,01M r r ISA WCAC.02C:02M WWI C.`ramys i,41a r Srand'ams areal daui a
7.Is t116 A xiiair to an ciiNttn ovllz £7Yc�( tar ENo coy,6fthk record Jails brera iargnirti d r arE r irrdP{nv,ra r.
}fete#R l a xe{aa{r, #1 nrtr ttaNfrty s Pd caraarr�rev#ran r(arr sttik+r arrarl:rlrPaiar the morNre 0f the
repair to der,f2l remnrdfs.serlitna ar ran the hraff•raft#ds fnrui. 23.Site il.iilt;ram,or additional well detai k:
You rltia}',use ilk bac6 of Ws pares 6{roAde addiflor it skv1l site details of lie It
S.Number of wells constructed: 1 constiuctioii details. You46ay also attach addiliavalpages if uecessatY:
For matW&lrefeerAmw 0rr#i-,"Wer apply wells ONLY W(A rAr,.srtrtic camsirurtZnir,S c ai.aTer+ �TltlllCl T'A ,TAT�7 TIONC
AuNi t me fOmt. _
9.Total well.dep1h`below landsuyface: 16 {fl,) 141L For It Wells. Sirhniit this t4irn within aft dne's of compteti0n of mil
Formaldplr tc►'titcfoltomng,.
10.Static water level below tarp of crasinW. (TO
of Water Rejau reel,InformationPrutetis3ep Unit
If iluter kvei dr fibme r,aLlgl "+ 16 i7 lk'1mit Service fi fter,R aleit h,NYC 27G 014617
il,Rarebole dian etm.8.25" ) 24h.Eff mice m WeTIs ONLY., In addition to sending the.form to dke address in
24e above, also stib0i t a pupa of this 1bmii twitbin 30 dayg of etc mpletinn of well
12.Well canttsimetion metbod, BORED construction to the follmving..
(i.c.sii-er.nxagltabte.diaod pusk cic j
IT hlonr of Water Rem, rcei,t nderground Injecilon control Program,
FOR WATER SUPPLY WELLS ONLY-' j636 hfitit Ser►'ice Getilm R aleo,N C.274"4436
l3a l find'(ftlrnrl ctland of tc t 2Ar-For Watcr Su 1-�4ti in'c"im IWOW
Alai su�riiit o 'or t[nis Mmi, Mt4ft,3 1,days of-comple Lion of
13b.Disinfection etrl e. Aruinuat° well construmon to the counh,lic:alili dcpcartmeazt of the crnhity:rr'hexa
�canstztictal. � '
Fa ire Gar-1 Nord Caerlinr Dpwtoxvi if Envirmrtriieia and N:iriiral Rmurccs-Divisibn,ofWalerftesoLrom Rciimil August201:1