GW1--06780_Well Construction - GW1_20241114

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WELL CONSlitUCIION.RECORD
For'Pivotal Vac 01..t,1,16. - .
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'Bits•fann can bc:tscd for gneicw.ntulifolowelli. . .
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1.Wellt(ttittpittOr InfOritlittlitift• „
• f.1.1...INATERZONF.Sr.
• Stefan Smith . . . KIWI,. " 10 . . , OVSCRIPtION- .
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WO Otiititctorl4anic ' • - ft:. ft._ ' 1 I
-,, 'ft. ff., I
3576A , '
MIMI Conliaciar CerilfteatioiiNamtici • •;,".15:z0Ill'EFCCASINGIfiteitilitIPiii9Nfiec1Is):ORIANERIttin•!Rabid:,
• .• •;Mind' ' , TO ' DIAMETER'. ' THICKNESS' ' MATERIAL
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SAEDACCO . .. - 0 _it,. 13 - ft, 1" 1' : .in SCR-4 0 PVC
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ponspowlItono . , . • :InANNERVASITIaORIUBINCVailiciiiiitila,ced.too i.I1L..'l
• •FROM _TO _ DIAMETER THICKNESS. SIATEDIAL
;2_ 'Wilt t:91.1itr.i4.660 P.esinit-ii • • - - . . ' "ft. • -ft;
.44,furi4i(icoie t.0:11pr:Orri.7.1Ler.Couryy,i pii,r;Tar:iyirc.freectic4 ex.), . -
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3.'WC.1.!..P0( k0c/t..14101t,tiC)I. " . • '. c.11 SCREXPC
Water Smply Well. - To OtAMETRO LOT STU 11tentit I •IATIRIA
. . • '•1.3 ft.. 18. •.fh. 1" .ftt! .010' Soh-40* PVC • '
• Elkiic .
hlhtral• . •' bg•IwilcipaliPpigiQ. : . •
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• ClCvothemtal alcatingiCoOling Supply) CResidential W.atet Supply(sinew. - ft. it •
ElifotiustiiaConintemittl . ClResidcoti4.Woter Supply(shated). ...
EMPLACE NIL1T-3CETI10 0-..4 AMOUNT'
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- tltriention. ' • • . • . 4.1 • rt ; . .. ' -. •
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NonMater Supply W08: ••• .• it.: fi, . -it.M0PitOriPg 'InEtccoyety .... . • . ,
InjeCtiola Willi'- •, . . •• .•.$1...: - - ft. ' . : •
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DAtluiteritCehlyg . • OpoDtwOrratet A001;4001 f . 't9r:!'SANDIG.ItAV8t,PACKitr'ailikitttCY,:--=---- - -_..----_t..-.-z_
• ...:., . THOM' . TO'. .. ' .MATIODAI;•• EMPLACEMENT METHOD
. 12MiikkrSiOttli.0 mkt 0
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. . • . . .. . .. PSi.116nivihriir -' ' ' • ' ft. :-- • 14'.' • -. . . . • ...,• . • •
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' 1:1,4,4tii.0.1.0. • ,• : . 1?S1OronptcrOtnit*,. .
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Ir.7.4ctintents1 ToOtOttizy, . , 1:41tbsitlenC40OttOt•
111.,..DRILEINGIOGItittacti.,adttliiOtiittiliiitilf itccessartEr 1----• • - ' -"----.4 •
Oftgothetmat Oused4:40) OTracer. . . „FROM.• TO DESCRIPTION oaw.haranevi.wirtiwkont.W•tity.t•*e,ittl
LICteotitennal.(Iiii.ating/Cooling•Rotum). tlOther(explain oiler ki Renlatks) 0 ..f!". 6 , 4; Fill I . .
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• , - . - , 6 It. -12 in, Clayey sandy silt . .
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4.Date*A(s)oiiiiikidji...10/24/24 ..iikt limitpc-6A ' .. .
,,, k-. ... ... .. ... - 12' : 4,. 18. 'ip sandy, silt trace 'clay
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•54,-Well 14Cittiorit: - ---•
- . .11.. . fi. - ' • I,i,-.-;.---5 ..:.,..-.,* ,i,,,v,„.
. 2 ‘;;!.,4.,..-.%,„,1 ' 4../ ; -•'.,j ..
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Coldnial Pipeline Company - • .ft.• • • -ft. '
• Facility,th.wxr*ou --- • • EliOlitrUiM0t.m.a0C.114c/. •
ft. - NI&V"1 / 2024 • . .
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' 411 Gallimore-Dairy Rd„ Greensboro, NC, 27409 . . • . IN.. . . it.• .. ,• , : ' •
, . . ,. ....., . .. '• • 1 riff0.7rA.4:.F.,1 i.:`7:.,-:.5r,,z,,-7, lin.?.., • ,
• PIP- 1•A141i. i,.City:-•i10 410'; i2•1 REMAIIICS'.4. ,
Guilford - : Temp well.for grab sample. '
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Volms," • P-Arecttcicutirtcatton.N 0 o, 1 "7N) -•- '.. . • . ,- •
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E4iiinAtettiiiii-140gittotte iiiiiCgreegi!nikiti**COli)it'Vr.ttfiCi0.41'tIcti*Cii' , .2:L ecrtii-ta. ti„it,., ' • - r, - •
• tlf.WUll rwtc1;tweigillittigtisutilCkni) •-• -' 7 - ' - • . '. . . H./' i. • , . .
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. 36.070993 ' . ' _ . li, 79.940271 .' • •Ik. • - ; igt•-.:. -.3.- - i• " - ' 11/1/2024 -
. " • il(g, ,iccrIVellbannactal - . . • . Dale
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6.U(are)theliVell(),): Elrernittnent or _ICITeitiptiraty'.. -•
'Arakorris ihis.larand kertlyy teitify that 1hr.well4)tsur.bvq:in),cy:ely.fnrard iir actvid.rince . -
• . . .witiy15.4 riptc 02C.0100 om 154 NCE 02e,,92,aroms timstricilvir,.r.nt.,tdr.ticroirt•Fhtliti
1,Li'lliiii#i-c01.*te'*'el...! i.!*iitell1 py 46i- or 010. io j,of mil lod iiith Nen prf±l'ided rii,i0 in 11.Oilirer,
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?frhis-.6'a,ripeifr.:0/ma firii.okwerfoorrsoirerrok.ittforroariarr-mi!a-RhrOre rurrpre of rise
Ii'pYlir rirkir ni.irriraria'seo i&ri iii i-vi ihe'boa of this form ' - :23:Site din-grain:6r atIttitionat4011 iletaihn • • " -
'You'pay use the NCI'.-of this poge td:prOlick additional tell$ix .dethili-O;well -•
8.Ntenthei-of well cOnitr4ted: 1 . constntCtiotidethits:You may:ilLso attaChAiitiOnal pages-if necessary. •
eor nrirtriple htleerlon or oori-iraNr supply oveg,t0,1•:LY birh rile pm/A cor-Orurtiox yort two . ,..
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salmi/to/W/9mi.:. - - SUBMITTAL INSTUCTIONS I. . - •
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.O.Tottil Well depth hetoirlani/wrfitee: • : 00 7.2.1a. For ALL Welk.%Stibinit ilii :.170 mu%-fithitt 30 daysot:c0ippicii.0tt 9,f'W'e,t- -.
'Fo-J.imarniike werirliir oft rtePrAs IirliAterir M.I.nori,...3 eqotr tr141.2@ la91 .c9tistiiiptign to the'folloIsin.r.: 1 : '
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. . 14.'Sttitte water level below top of casing: • • AL) ' - Diiiiiott of Water le...soure'es,Information Prneesiing Buil,
//wain.1,0y1 6 reirov-4y1Sit1*11.4'."-}" .- -1617.1iLiii. erviCe.teriter.Kaleigh;NC-27699-1617
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EL Borehole dionieter:3• 5" lin.) • i4ti.-Epijklana.D.:00.0LY:l, In adlition to woding,d0 fontt.,to tlw.ati*ss•itt.
24a;00o,-,also submit A copy of'this forth Within''.0.'da5*of•Ctioipletion of well
11.2..Well construction method:DPT • • . 'i:OICSCCO;CCOO Co the,following '•
0...,micricialy;.,calkiAtti.12i.isit;*:) ' • ' • ' • ' . . •_. •,
" " ' ' • PivpiOu'of Water RrsourLcs, Undirgrtniitd Injection Control PrOgrant,
• rOR WATERsp-PPLYWELL,S ONvfre' , •i636 Mail Service.tenter,Raleigk•NC 2760-1636
'14e..iosi,•%Vtiter'SnOplY iti-Injectkin Wells: .
• 1:3#.14clit(ginn) Method Of'test:
ei;lso submit one copy-of thig'forin.1Withiti.j0'tlayorifi,....'ottipietion of
p4.Hi..inf't.,e.iian.0:Oet.. . Anititint: - --well•ConsIniction to:the county Oalth departmiinf of the.ceiniriz where•
.. . constructed. I .
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Forip,GW7.1. .Woril Catalina ficpnatentofElnfoolunctuamt Natant.Itcsowees-D.ivn Ion of Water Rcotrcwi
Revised August2Dl3.