GW1-2021-03019_Well Construction - GW1_20210527

t VYELL CONSTRUMON RECORD
rwItnaruu tr5e ONLY:
.
Vft Tore,can be lased for sitk'or mottiph was
1.Wdi Contractor iitforalation:
3i,::�A3T3at'ZO.
Dylan Fierst irR l+t o tptl(1V
ltC41 Conftttn.ctarnr 27 R. 35 11. PWR '
4507-A
NC Well ContrMtorCanifkation Nur ber 15.00TM-. .GA oriirailtl�bWd: t/R7 .' -R'Ata`, S.
PROM I TO VIA REM
TMCWFSS I MATERIAi.
SAEDACCO Inc 0 ft. 25 it, 1° An, SCH-40 PVC
Cansptr,p:Name '6' CASiN�R' 22� 4ofn
FROM TO Plot r?THR TtnCkNM I MATKRIAL
2.W41 Construction Permit R.
lru att rr Gratxfr urll prmeitx 0 r.Cb nM—8w•1lariamrr 1*n*R tir.,y
ti. 4.
3,Wdl Use(ehcciiwcll ruse): 19"
Water Supply Welh PRO." To _ y J awifftZR I stofsom I -mic-c -J. AmiAi,
ClAglicuttund DMunicipal/ilublic 25 (t '35 0. 1. is .010 SCH-40 PVC
OGN tenwt(HeatiniO Cooling Supply) OResidentid Water Supply(single) �` R' i
QlndusttiaVC'otnmcaial OResidential Water St -'ORdi11 a',ppl`(slrrted) PROM TO MATrJt1A'4 Vhnq.ACEMP.W3 M0D&AMOM
❑im tion fl. /l
Non Water Supply Well:
fL, ft.
Mm nitorin ❑!aLv `
Injection Weft; • M
t]A,quMcr Rc0h;rge 00mun dmitcr Reovdiation Ats S 11.
- -PR M TO PIAP,11M, .tPAT Y.7`Not1
DAquiler&ott -and.Itcona y Q�%lingBorder 23 M 35 ft FILTER' SAND #2
Mquifer Test OStotnmater Dminr ge lt. tG
OEwrimentpl TMlinotog} OStAwdercc Contort
OGeuiher wl(Closed Loop) ❑Trace PRO ir11d I TO^ OFC'RIMON(IIMUr amen WRNMn n e+De.eru)
OGoodienwl MeadtWOonflng Retuno 00ther in under 021 Retuatw) n• e
d.DateWeITO)Completed: 5/5/2021 Well lD#GP-5
tL (L r
SM Well ultatlim: ft. M
EPES Transport System ti» ft. } ?rnCgSSt
l`hcilityfGwrcr Na= FIRC114 MR(irappiko1c) R tt
1511 Pleasant Ridge Road, Greensboro, NC, 27409 ft. R.
Ph)sieal AiMmss City.aM Zip 1r« LARKS
Guilford Temporary well
Caatgy Pimd Mentirlwooft NO,(PIN)
5b,l wtttbdc and Lgn>;itude in dcgnxclmlmLtesls +finds or decimal aleRtvcs; 21 Ca7ilioation:
cif C11110KAMIC la O1V is 91iftkid)
36.125296 N -79.961075 W 5/4/2021
Si6mtinc ofCeatificd WcS Cowaetar Doe
6.Is(are)the n cll(s): OPerntanent or oTemporary Nv sfB�X hi fipm,
f hereby that Aw m ffs)uxu f"rrl&.wn r ed to rtianAmee
Qth 1k4 NCAC 02COM ar.f3A ACAC 02C,02do weil ConstrrtMon 5mr4ards and tiara a
7.Is dribs a repair to an ti tiog well: Mies or MNt► t�J�hdr rarnrdhnFbrew Pr+r+�rn tl r nrlt m�vitr.
1f 1hPs 1xe re�cifr.�l uvrRrrai<n ucll eaasrnrctfa+o fi�rimaretkin miry r_epfoFn tk¢rmrHre njrhe
reMir nnder0_11 rewurlrs xr ftm or an the bad of thlp f 23.She diagram or additional well details:
You BW use the barl;of this pale to ptoOdeaftdonal vvvfl site details of well
8.Numberef ftlis constructed: 1 construction details. You tm�alsoaUracbaftti*nalpaguifeecessasy.
For AtaiMple,lgkMmi or am-vwr mr#y wrflr OAU vtM rite wore omsrrmfion.you sim
ir6ndt.aae fora SUBMUTAL NSTUC140N3
9.TotattrettdeptN belotr land aurfae 35 {R,) 24s..Fhr At1 Willy. SirhtWt this fonn wi hin 30 dtns of ooinptetion of+vets
For Mftwr laths 14r all dep hs 1fdorrem to ft"O"ing;
10.Statle.water level below top of aaslnr. (ft) [Nriston of Water nesoirrtta.Information Proctsing Unit,
tf"dlrr lruu l hOboar edltaF.asr"+« 1617.111itz't Service-Linter,Raleigh.ETC 276"-1617
1'i.Bortitnlc dtutmetcr 2.25^ Qn.) 24b.&Z EbIWI4it_WelR ONLY: ;ln addition to sending the font to the address in
24a above. also sttbntit a copy of This fmtn'Within 30 4%of completion of wall
MAW eonsttuvftn inethod: DPT construction to tbe13tuwkirtg:
(fie:anW.miny,2eblcdoegpashe4c.) Dhisionof Water Rem tret,lTtidergroundinjectionControlProgratu,
FOR WA MR SUPPLY WELLS ONLY: 1636 Mail San ioe Clatter.RatelO,NC 274"-1 636
13a.Yitld 24c,for Water SvWX&injom4i m Wells.
(gpm) Method of x Also submit ane m of this forth idthtrt 1.0 days of compiet"ron of
tab.Disinfe+cdon Amount: %vcll construction to the c6unLy he htt depnitmau of the count),t hor
cottstmcted.
rann Gw-1 Abnh.Camlins D.•pmtnt n1of En%*wnnnd and Namusi PAwwoes-DividomeMster Resoom Revised Aigust 201.1