GW1-2022-07808_Well Construction - GW1_20220819

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WELL CONSTRUCTION RECORD
This forty can l;c trsmi for sink or m tiplc iivtls v �o
1.
Wdt ContMetor lnformation:
John Eisenman VRON OIM'RIPti .
1A'clt Cvr�tvetor l\S�rtr: ft. n,.
4439A
NC Well Comiactor Ccnikation Niunber k11tTiR-C"AS11QG bk z
FROM TO - DtAm Tr.R TMCKNTSS` MAM-MALf,�.
SAEDACCO Inc 0 (1. 30 ft. 2" ;iin. SCH-40 PVC
C+amPcun N�rtM' =.18;1. tt11G Il 11JStAfC" m"at#li+cFd
FROM TO DIAMETER I Tni IMSS MA7"IAL
2.Well Construction Permit
Lid ediumlirvAls Drell peimito fi-e. lrnrirtwo,I/*6M e.1r,.)
fl, h io.
3:Well L)sc(chcamell pse) I7
W'ater;;n11111413?t l� FROM. 'totHA fiTTrt St T$iri TNT(y XM- I NAT JA1_
OAgr Mural 0 Mon.kipaMIb;ic 30 ft, 35 n. 2" iu .010 SCH-40 IL PVC
MmothCtny:lt(Heat{nW CoofiItg {lpp}F'I$ tt R in.
CIRQS{dl�tglA4�atCr.�llp�l�`{5LD,l�el:
I�InclustriaUGanuncrei ti Olkesidential Water$ h' SixlrM)
:. PROM TO MATEtrtAL , . ,131PlrlCf:MIM;1'tET MtFA.MOUNT. .
Oldignijon 0 ft. 25 (t. Portland Pour
Nnn-St�RtcrSnppl}Welt: ,
ON(onitor I in& O] C! xrr}.
Injection Well: n tl.
OAguiferRechrb�c []Grottndtc�tter Rctrcdilit{on: 19 SAND
OA ifer St4 h c anIdP..-O e ' 0Sahnin`earkr VROM T r*f AR RIAt; $Afitrf A �fr�y pfrrllOn
Qn 28 f1: 35 (1. Sand #2
E3Aguifct 7'cu OSto m to OM nagc
n. ft.
►Eytcrimentaf To:hnologp O,SrthsidcTlCc Gantroi tt1.�R11 tom- iithc11a6 tlaiialxi4e�s' s''
OGeodsemtal(Closed Loop) ❑Tracer FROM TO DFSCR ON 016r.Mrdn VbWr"tk n M
OC,6odteNnal(Heati Coolit Rearm) ❑thirer{ ainulnlerik3lReruatks 0 n.. 35 (L Sandy clay
.1)aic Wells)COn,pleted: 7-18-22 Weil 1Dit AS-1 k rt. ° --
Sa;\fell Location: AU
Battleground Texaco fL
Facility0parerNamc Facithi 1A4 ti[app{i bla3 4Bentonite
(t1703 Battleground. Ave., Greensboro, NC, 27,408 .Phg�sical,AMm%-s.City,aMZq,Guilford seal from 25-28'
Cout+t,° 1�cretidi4rtiftc.9inr�N4.(PL�'1
Sh.I,atitade and Lonfiltndc in degrrcarlmiteu#eslconds at dixintRl dcrct sc 2L Ca
(if well&11d,ooc LoAft it 9"fk onl)
7/31/2022
It _n xW W it8nrto-at
6.IS(Are)the N'tll{S): Pi rfllaaCnt or OreI1Tont1}' N!sJgmi rlra ft'+„ vt�!;!,fr . H'S ,art a+` ci.s ntrnrrred ur WcO tiarJAct?
with 1{A NOW 02C M-A,�;44 -0200 I I G'O.frsY+s",M StMidmds 4Uri(1401 n
7.15 this a repair to An editing*ttl g7Yes .jir ONn et"pf flair reruni har br+vi Pitn'Irtrd 10 the at ll4M*tr,
1Jtkla"ef n rrjxr#r:fill c,€tnt+i.7t iiYl!t�++rxrgrer7 a lrrjdrnanif+irrarul rifirinLa tier tkrtmee of the
repair wwerV-1 or on die bm-h ofdrir form 23.Site diniVam'or additional w ell details;
You my1 use tip wik of im page to pW ide addifiomil»'ell site details or UVII
S.l .r�wellaanstrtrtctl: 1 eosl;�tnictioadetalt�. �'eu�rori}�:al�ltitt�cl►�idd4c�nals.�n~cesst+rk.
For rite 111 t i+rjecr)mr or mai•nidrrr old!'wells ONLY with t1m,samr tronarrt AM'-.' om
submit Ow form.
9.'Total wdldepthbelow land surface. 35 {f71) 24a. For An We Submit ibis form within 30 dyes of contpietion of well
1`or iseat ote,we,11iUst oil Ow.jr s?1diffrrent f&rArryale-3@200*,iw 2@11)f1"i con4naction to the follo"ing.,
16.Static water leml below,tap ofrasin j -( ) Dh 6?nl►f Ater c(wn ,Info'm ration Proteriugk Unit,
1f x uer teti is aborr cnitnP our„ fer.Italeigfir NC 27699-1GiT
11.Borehole diameter.8.2 5^ 41n 1 24b.fir.IniectlDn Wens ONLY: bi addition to sending,the fomi to the address in
24a ab6%1*e, also submit a.c.*:of.
f this&nn'ls chin__10 da}b of completion of%V'tl
12:Well construction nrdhod EiSA umstita-t{on to Me follom ng
fi c:anger rda .cahl difrt,posit etc:l
Div Mon of WaterlResuurers,Undenrannd in]ccf{Dn Control.Progftm
FOR WATER Eli S[r'PPI?"iYEC:iS OIYI:Yi 1636 Mail Service Center.Melgh,NC 27699.1636
t3a i'ic9d{ltl►m) latcthod of test 24c.For Water Soprply&I oetion W ells.
Also subs ' otie cop}'of his fofin '%%*bin {l da}-sofcomiAet{on of
13b.Uialnfixti on h ti Ambttnt %,dl construction to the county'heslth dcpaNmcnt of t[u coinim whom
- consuuctcd.
Fann C.t\r-t A�orih Camftr GTn2rthten!of Em3romtrra and WattoO.Remufrses.-D.Wislos of I tell RCSbU'iocs Rci'ised ArigL8061.1