HomeMy WebLinkAboutGW1-2023-01576_Well Construction - GW1_20230209 LVELL.CONSTRUCTION RECORD' �
Fax ieirnralllsc ONLY:
'fili.i fonncan kusc6 fit'r.singic er mtiltipla I IIS.
Il:lYaq.Cgnttattor IttVorntation:
34::�ti.lTtttt2aNFs
Stefan Smith FROIN . Tit DF$CRIPTUrV
asllcotitrattlirN:,nic R: rt. � ' .
3576A ft. ft.
NClVcl1CoidmdarCcnitimt1onNuwhcr 'tSJ®[ITER•ChSi G(fopmhfliriscdercl1s10RLANER'/if.a' [!sable
FRONT I TO UrAND-IM' Tnam-N.S5 SIATERiAI,
SAEDACCO Inc 0 h.. 5 ft, 21, im sCH-40 PVC
i,
(m,gilu,yNauk•. [6:INNERCASiNaOR-TrtBtNG.(eailrer,natrG,sc�tou' '
FROST To DIAIiWUER TMCKNFSS SIATERiAL
2.well boosttnicfiiiu 0cl7iit R: R. R:
1.4i irll amil'ale isrjl primits Ox Cawo.S?+na,yariarwe,146c;iC4
ft. ft. in;
3.!Veld iFse(checl:�ti�e11 asc); �17:SCtsti.RN '
Water suppkv 1%at41: FRO'[- TO MANIFTFU Sr,OTSrsx TnrCtcrr�s -atatanril,
bAgdcultural CJIiltnliCl[1GtU1�ItbIiC 5 ft. 20 ft. 2^ i° .010 scH-4o PVC
[Mob iietttal(Iieadq/Cooiin SYg)ply'l ®R tiat csiden Water Supplk(single) tt• tL in, p
®ludustriaVConmmcial ®Residential WatcuSupplg(shated) `18:GROUT'..
FRONT To. mATERL%L. E�mLACE.r[ENT!UMOn cANtoUNr
Ellni tion 0 fL 3 f4. Portland Pour
Nnti�VttterSuC►D.�}�VcEI: ft. (L
§dMonitpnrig, 17rtecmrry
Injection weft: h. (C
t3A.q*wficrRcchargc CJCioulidsalcrRc6ndi;Uiou tv:SANDIGR VEL,PaCr{rru,rticlnrzt-'
FROM TO 1 NtAF11M. 'MtPI Act MEET HLTnon
17AgU[fcr.Storaga atxi ReCai'C�' I]Saliitiry l3 iiriee 4 R: 20 ft. sand 2
❑Ai)nife�'Ccst DSiymiiiatcrl]raipaac
ft. ft.
❑ESperimcnlal Tcchnafo ❑5ribsidcncc,C'odml
20.iIR1LF:%NGiL0G7a0;kh addltionul stxel�"iLaeoessarvt
aG:wtiien»al(ClasedLoop) L 7Tra(er FRONT, I To DrSCRtPitO\lcabr.hmtrgcsV.ar.Rrnck nss±,�tiet
DGeothennal'(Ileath ootindRetuut} 1301her(esplain na&r,#21 Retua&) 1 0 tL e ti silt;
8 -ft.: 20 tL Moist silt
Date IVeR(s)Cnuiplefed. 1-23-2023 -dye[[®IfMW-3 ,
?i: h• `+art 3 .�j.
3a:Uldl I•(rcatinio ft. tL
Circle X 3476 ft.- f(
Facilityi0isixrNarac FactlitJ tDk(iCappiimblc),
infor-m :;-ort �r 3v El t{3 Ui r
3302 S. Holden Rd., Greensboro, NC, 27407
Of i icnf Addres&Citr•:and Zip '2t.It1 M1tAI
Guilford 1 foot bentonite, seal from 3 to'4 feet.
Contuy Parcci W111jrC.,lliornN(I.(slu)
SIi:i;;ttitudt:,�tndl:tingrttcd�lndc�icc•�lmi¢odes/stcrindsnrdt.•cinoatcfcgtiGc3: 22:C•crtificatiern:>
(itiiell fictd;ork 1410ug A'Sidl",Ci_,d)
36.019491 1v 79.846016 W q � 1/23/2023
Si� cYificd NcIl Cantiaetar Dais
b.is(tii)lheii'ell(s}: MPerrlirne,t UC DTetttp4tvi7r }+Gniir lku .rm„ihrrrh iertiJ�hatrhrurlJ�Jxxls r,rre ttM,IrirL'ledGrLtt'drY([n,[Y
t6dOY M A1C4C 03C,01(lta or IJA NCAC 02C.tJ200{{ell CultsHaicrlwl SrarxiRrds allcl tisnta
7.iv this a repaic-fu an¢xistigg Nval:, ®Nvw ni• ENts rdp;roflhds ieeonl lies been pmv*d&Vila U rll 4,iPr
lJakls:dt a lnli m,filOur kw Iva ti ed evewaucalmi hVgrinrrka mid ey(ahi rbc lamrre of r1je
rei,ciimulcr&21.iernrce[5`:sirtran aron the Lark-ofthis jarnc 23:Site diagram or_adilldonnl%yell detaits:
You alai'use Uie,back 4 this Ppge(a.proi'idc"addiliotial well site,detit*,,-or ici:ll
S.NutuberoBveliseonsfru►ted: 1 eoustiiictioriileiaits; Yoilitr>fitlsiiattac[iaddiliolwtpa es iftucess�ry.
FOrlltallJple h(ecfiU1t-Rr a61-im. rs.lpplyivu,IIs ONLY ii•Jr/lfhebQRlC f4ttSrll/CflO/f,yea ncea�
suGn,li'o»cjom,: SCiBbit7"iAC.iNS'PCT�7`r®N�,:
#J' tid.ivelE ftflt helo*-laud stirfacu 20 (fc•} 14m.Fdr All Urdl Sitbinit this fan,tvillid 30(b of'e6mpietiou'of well
For mahiplc icrlir Jisrald diphs Jfdeereitr(ercua ple-3@200'cred.2@ MT) Construction to tl,c folfoniag:
i
i.U.Statfe water letd fielusi,tap of eaAkW 8 (D,i Ilia LAU'a of Water Eli, Urce+,IafurDtation.Piucessing Unit,.
01werdei'edisdhaveearattal;•Uw•'t" Etit7AfailSenieei~cdfru,11a1ci C2769916t7
tt1.Borehole diameter.8.25^. (ia) 24U:Eat DMAIgy ONLY`: ;in addition to sending the form to ibe address in
2 a oboes also submit a i opy of[Iris forth widdn 30 ft 'of catnpletiou of ttr ll
12:.lYelicouce etion,method.HSA eoitstr»ctiotitodlii following:-
(i.c.a uo r,iota{}..cable_bireci pasb etc_}
1Riv1810a d!Miter[tesourcca,Underground fttjecfion ControlProgtaur,
FOR WATtR SUPPLY IVELIS ONLY: TbSb ALtiE Sera lcc arenfer,l2alcigti,•lC 27b99-163<
f3a,Vicki(ggm} tfetliod of test: 2'r.For!!ratcr.;Uppli;-&[Sic".I'm',!!'ells:
Also slibaiit otie'eopy of this fora tsithin 30:dassof conipletidwof
13b.Disififcctian i. Atnonnb well conMnivian to the county heahh dgmrt=nt oC the cojw4,tek
Ali constnictcd.
RnaMA honlicomanaEK-putmemofEavimiownt and MatualResoumes-Nvh Ion 4VInt f 11-Mumi5s Rci'isedAU9wA1013