GW1--06778_Well Construction - GW1_20241114

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WELL CONSTRUCTION RECORD roti..tniclail Usc ONLY: ,- • - -
'This icon can bc•atc4 resin*or:miiillp)c w.cll . • — t
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1.Weli:e41111.raifill'Informittititt:• . i . .
' E14;..WATE117.41NES.:
Stefan Smith • . . - . . l atexitt(Priox . . • • , •
. .. • *411-C.O.ArdOprOatift . •'- ft.. . rt, I . . . . • •
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3576A . ' . -1
1,15r.-11UTER:CASING4foiriii-ialkait11:')VCIIsY012-11NERfitifi ifiCab)6,
•Ne•Well ConliiMai Ccrlific.alioa Medici'
-:PROW- TO - . ViAtiiETERr ' TriinacEss.' MATERIAL
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SAEDACCO . . . 0 • IL 20 ft.. 1" 1' In. SCH-4 0 PVC •
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Coicivny Namc- . • - ;.;,;46.,,,INNE14.L.C441 TUB016:„..--;cilliimiatilu:Qii4d0 IL • •
• FROM . To • .0 imAmETER• THICKNESS. 'MATERIAL . .
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2.'wauCtinitivilititi Peiiiiit ft: ft. - . : ft: • , In; . ,
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.. • J.,L.t.f 4iii;Ippitiegge tsill prilivi40.;(;...-Coloyy4•444-;IfOr.k.orgr.10100i 0,74 .
ft.
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Well Ple( 1)ttkwcil.tis-c)i- : ._:•17I'SCREEN•,
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.,_ , • :,- • • 7' .F12(*)., -. •AO . -orANtE.TtR.. storm?", TIOCRNI;SS .1 1041144144,. • .
' - Water Supply Welt! •
• . .. . .. -- 20 'ft: 25 • fl; 1" •in! ..010' SCH-4 0 PVC
. ClAgrienitural ' - ClIonnicipaliPnblie.. •. . .
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1:10eothennal(tleatingICooling Supply) OR&deotial Water&Opt,(stogie) • f! 1 • . 11?! ir,
ClodustilaUCOmntercial
PRestdcitial-Wati3r.S°101Y(.0ilml)' -...FROM — TO 'NLI:TERIAL- '.-'EMPLACEMENT METIPOD 4.4 kiiotiNT
•.Ellttiiiation, . . ft. .. • - ft; . ••;, .
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on-Water Supply Welt:. . " , ... • •
• - BIA401.1ftOriPg . . nitccow.13:
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Injection Welt ! • . - , • . 41..., . - 11. - . , •
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0 Aquilefli0etiaNt- . OGnIttnilrre let itemediation 19-:$ANIX/GRAV.E1:.PACK6frapplkinge) -- - -.--.....,....:-...7-_-_.-..-..:. ...S..-,-_ " .
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. - FRONT' " :TO'' I' ".mpattioL41; EMPLACEMENT'Ammon . . •
-. . liAiMifet SlOp0ittii g0)1,01. Ci&ifinitv ijOrtiCi: .. . ._ . .
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1:1 ,41tifer.Test. . CISitinOwtiter Br.tilnage. • ., . .
' s• .1L• •- 0; ., . . .
- ogvc.rimcnioq!Co#ifirogy • - i:1$.nbsicteiNcr.100,1•.,
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flii.41•1111h1:1NGIOGIlitiacli,'siddifionlitiliiitilliwcksar.c11:: ' • • -----=1:-- -"-
1:1CtgpittIntlat.(Clos.441009). ' Eltracc4. • • ..6110:k I" TO. DESCRIPTION(Won lerastoi,snamek mix.grAin'..6.g,am
' • OGeotherntakfleatiniroolini•Returni. 1:10ther(explain untier.#21 Rentatis) ° ...f,.. 6 - 41. Fill i .
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. :6 ft.. 12 . ft.. Clayey ,sandy silt . '• . -
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. .4:Ddte vooki):edilipliieji..10/24/24 !veal ilpfiRDC-5A• ' ' - .
12 . fi. 25 • a4, sandy,:silt trace clay
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Colonial Pipeline Company . . ,ft, ft, . If--i-r"'t — •,.:•-•-.• .- i7,:::',7% . .
" facilityAiwacrPaitip. " ' P*014.0460qP4.7111,10)
. . ..::. ...•....... *.e.g.......6......"• • .411 Gallimore Dairy Rd., Greensboro, NC, 27409 - :. ...
. . ft. -. , • - NOV 1- i_ 2024
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!2qio.Noicii,:ciLY-40 Zip .."21.11/EMARICS..-1, . .
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Guilford . Temp well for grab sample. 111?:::,-""--,7,'',-7,-;',77w';!..;-.-4.,g!,..bl?t
(.oinily - Par ]hlotiriciii0o,No,(PIN) ' . • ,• .
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. - - $1.•:LOiiiiiicie''Aild 1400016 m flOrtieliiit0i4k0*'ir tteciiiili'dttrtC.S.;. 22Certifien Motu"' -, i. •
(ltriell.fOle:englinletis.9tflielsOl) . •. ,
36.070993 • :isT 79.940.271 ,
'v -Atl'liii--'''' - 1 ' - 11/1/2024
'Sigall:'Of .. md•W.C11 ConkotICI., ' .Dag ,
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6.Is(aia)thelfell(i):.3=1Perinanent or Vreinporary•.. . ! - • It,tignbig 4411.1a.m.,1 frirebyerdify(hal'tile-F1114)inty.froqiu).a.iny.inreted&i r.wevrirrnce•
'filth:1$4.NOW OW•.0100 or 154 d-VCAC•02C-.0209 Welf Consmiciion Stan:dards mid.!•14i,
7,Is this a moat to an.....""iistitqt wellt . pve,r,F- at .MN*. tnti of 0ri:s•ilreonl ith,i ,?irfl pl#rideri 416rityli•Oit'ifor. • ' . .
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If ailris so rOak.;t111 0,or kOltIVO IVO10/1.17Thr.;107 lirpro.Wriwi•4-04 e.r.OtoOlilieligryre of Ott.- - - - . ,- •'
- :r4,O.6-rin&•'r#21.iOwartth.S•ecrWri'bi-im iherival:rifthis foil3r. ' .23.She diagram or additional Well tletaibt: . .
you ma y use the back of thb itAgO to plioVitk adiliiiiStiaky0i sue.:161oll.0/.1 well
11,Nutitheir.of sells cOnitructed: 1 • • constmeiloif derags. You May:M§O.aitachatitlitibtO pges.if tn%.:, ary,
For muilripli orf Om or orinii.larer.pipply wo11,171MLY. Wilt the pvirtc construct/ow,.cog coo ,
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io.bofitoni'firm.-. ' • $11BNIIITTAI,INSTiTiloNS ,• - . .
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' 9,'Anil Welfileptb ItefoWlirid wreariii . 25• Vi..) -24a. kiii;All Willk.!&Anon Blis Ibmi withinwithin19 days ot:complaiion-OrV1icl. -
For rtentrible wet:Wm'rd.reorlas trVilererir 0.1'e-roll:go,3@zoo!old,2@[007 'coosirtiction to-tkroltoming:: 1 •
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to.Static wine!'level below top'of casinw . (ft): -1101sitin of Water Raotirti..s,Information PrOccsilog unit, •
if tilv.i;,er fruel LiilitoLg cps*agi: •••1-'-' .• • 1611.141.161. cmicerilicr.,.ItaIcigh,N627699-1617
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It.Borehole dim-4cm 3•25" lin.) 24h.Forbilcetitpt Wc11.10.NLY,:, !to,additiOn to seritileig the foutt,to tlie.410*-ip
• 24a4tioe....ild,submit A dopy; or:this faint Within 30'dk,.. :of completion a-trel1 •
12,Well construction Method:DPI . 'cOaSinicliniilo the following
(to:;mr.tr.4-Mary,..cal?16....rdited pesh.cto.) - . . . . • ,...., . .1,. . . .
1BilttiOn•of Water Brioureso.,lifiniergnitiiid Ittjeefion control Program,
FOR-WATER-SUPPLY WELO tonit. 4636 Mail Strvice-CeiiWr,Raleigh,NC 27694636
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. ... 14c,..ForWater•Sulyitily
1 .1.4`te10.f.t,i91) Mith011"Of tol &trtcctitin.WCI
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Also submit one copy of thig'11.irM'Within.3-t),dayef itomPletion of
14ti Di;lof,..etion type t Anitunt: Awl,.construction.to.Ilic•coanty iic4Ilk iicpaionMa-of the comity where•
consittic.tetl. •
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Femi G)Vil Nialli Coil:Inca Dcpanancni.otEmlicaima aml Nmaral Itesources-DtvitioneWaterRTotre - - gmiscd Aygust260
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