GW1-2021-05686_Well Construction - GW1_20210727

WELL CONSTRUCTION RECORD For tfftnid Use ONLY:
'ni's rMM can W B.wd r"siraie or Multivic mils
is Wdi contractor Information,
Rich Lemire AKtMM TO R '(grPttr)V
�$cLtCQra�rxtart+tar+rt f#, f6
2593A
NC Well Covmw4orCariifmionNuffber OM TQ 4 VMMFIMR TJtftt+ £BS MATFRfAI.
l 0 tL 30 h, 2" It. SCH-40 PVC
SAEDACCO Inc
.
C00601y Namt FROM TD DI3titB FIsYt TrtiCKAESS 1URLAL
2 Wdi Canatrvrction.t'ermit#: tf. k bL
M a,rll rlpallr-raW wrll pernrit fr F.Craurarv,r�r r,t�rardarcca,7r�acOrxa cri.) t3. tt.
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VaterSupply Well: - FROM I TO f DtAMMOt 'SrsMU I ?CftG°K„t�g AfATfdRiAt.
30 fL 40 R. 2 i .010 SCH-40 PVC
I�Alricttttxfnl Cl2�4tcuasciptG'E'nblic
aGeotheml(iieatingfCouting Supply} OResiddentbi Water Su & rL im
Sup*isio�ei• _
'j&4A0U1r =
P7Intll+sttialff?on tercial DResideWbi Water 5tippf}'(slitrel) aRo to f17avF�RdI
$.4gu T atM T &AMOUNT.
p lyp0 0 ft, 26 tt. PORTLAND aTREMt4IE
]Vt WMIater Supply Wen:
Mmoni#orin ❑Rdxavrn' a
ifa� tiff YV'�:
�a Agttifcr llechat Cit;roufrd3er Refftedliaitigr± •Rol liN. . t a .Mu: m .
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QAgtifer&vMpAndRcf;p"..`r�' ASahnity Hanicr 26 ft. 40 ft. SAND #2
QAgn6fer'l'cs4 1384orunrater Dminipc ff.
nE.vetimenini TO-.t"Wl0& [7Stt9rsi ice Ctuarxil
if Cf:taaiye*A `
❑C,eodterrfatl(Closed Loop) ❑Tracer TROM TO oE4C14irTfOS'C rt,F'edhc sot#rnck ireNt;'t
Cif dtettnai(id€atit lCoc�liu MUM) t7Qttrer , ain un:a#2 t ittoyat[ssl 0 ff. 40 tt. RED SILT/SAPERLITE
ff. M
4.hate Weff(s)Completed. 6-16-2021 Wdl @#Mw-02s ft. la
Sa.Weal ta"tion:
BATTLEGROUND STORAGE +�
Faci t -OA,wrMirm Faclfty WN(ifapplrablci — fi~ ff. •�
3700 Old Battleground Road, GREENSBORO, NC, 27410 ft, (L J V
P1n-3ical.4d MM cin.andZip .
GUILFORD BENTONITE FROM 26' TO 20' .1n1Cr 3ti4:n o (:On
fm�•
PXWWrit+ieC,9lip119NO,(f=frir
5b,iatilu4c and t4rigitude in degrges/Minateaf:WConda or&0-19#1 dcgrcm 2L+>~crtikatinn:
1
Wes€ 6/20/202
5rgaAum Of C ,4cll Can Inc
6.Ls(at*)the wallf}: ZiPerrnantut at 'OTeamorati frr argning 1W.Aaarnr.l Arreby crrtr/s rhraf thr nwflW lux(Wrnj xrrarr"Wred sm trar�rdtmer
otitlr f.,t iYG>4f•0?C.r7lt>n rrr 1 A AICriG p C.ado lt'rfl f'aa. rrtRs¢tc+aa.Srraavicrr�'r a d,#Kr"
7.1s flits$repairman etis#it tFeU: s'7 cm or KtNo awjr.of th s renal hrb br^µmpi*d rn the uvtl rrrr nrr.
l frr#ia t n re am Ftl rrar Rtrrn+�a rvrlL ecarasaran�iPrea z r/ormurrf6rf caul rtyaPain rhr tuerare c?J rhr
rem=.rund rS23 remsrtamer&m ur rm rg5e be l nttrdx jaran. 23,Site diHt?l' m or additional wfill dcL-dK-
You m*use the back of flsis page to ptfnide.additiowd well site deWls or W-di
S.Number of.wells rongrurrted• 1 csu=tioa details. You may aW allach addit ondflp3gM if ttdxM21 .
ferarivi'rtivfe 0*fi'c m ew son-immr.Qpph w6—ONLY 4401 rlae$aM Vwsbwlimr.Kati+c'm ` IB�113"TAi�1NC7'i fC3j0B$-
9.Totaivt'etl.depdf Mint land aurf4ce~ 40 {l1.1 24a. For H.Wei Submit this font v ilhin 30 days of Compiliion of well
For alwhipir welh 040 afideprh,il`ewemlif conaiffc-on to the fOlin ing:
10.Static water ievei below trap of-ea�atng 3i ft1t.M Division of Water Re$01a mom,Information Priacess+n,-1;nH,
lj �a r le J Zv ed+ewe r°srar.�;�f�r 1617 Nj4 Set'tiieo CtnMr,Raiao,NC 276"4617
t L liarcfinle diatnetr r:8.25" (Cal dab.I{I1 lgb%t g VljM ONMY, in addition to&NWinS the fo t©file address is
246above. also submit a oopy of this fom within 30 days of completion of WWI
12,Wfill eowt�ctlou mobod:AUGERS constmcdou to a follatviug:
(ic.
'Cr.
ram.�l ie,ttiier ash a tc.1 Division of Water Rcmumcs.Undergmnnd{Ojectlon COMM PrOgrAM.
FOR WATER SUPPLY WELLS ONLY: 1636 Niffil Service Center.Raleigh,WC 27699-1636
2#e.For Water Supply&tnjM091t 1VciLrs
t3a,V idd(gpaf) 6'c*od of test Also stfbmit one cM of this fain within 30 days of completion of
13b.Disinfeet€oll big Amount: rNT11 c0uatnrLtion as the County beolthi departm m of the r+rounty*hens
corWuctcs'L i
fintRtG�tr-t t rrattC�rtatinaU SrtmcsaxofEt+�9rt�tta nL f3t+tn�t�z�st+at�es-Zfittsioaaf aleiftreunu lmmdAtMot2013