GW1--05768_Well Construction - GW1_20230901

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WELL:CONTRUCTION RECORD tpr infernal ilsc!DNLY: ',
•, , - ilits-fornicai(b61uki1 for slit*ai multi*mils. -
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1.WOL.Ctinie.tetiji•Information:
--'-',t41.WATERZONES:..... • ' ..'1. , , - - ..• '
Stefan Smith Vtif)N1 TO DESCRIPTION
WenCenlotelcittiAmO,
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3576A .
NC Well conliattor 0.1flificution Nitrite: . 1S.:'13illtlit-CASINGIfig..-iiiiill IsedittritOsf OR:LINER:MIA ilitlit4Cit ,-• - . . -
FROM - '1 TO - DIAMETER THICKNESS. MATERIAL•'
SAEDACCO . . 0 it.... 10. . it.-2 I 1,*Ie. SCH-40 - -
QuitinewNatne•- ' ' • ._;,:IONNEICCASING'011--TUBINGUitnIlkiiimIckii.,e114014L-.Z......,
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FRONt TO • DIAMETER THICKNESS. MATERIAL
• . • 2.10a(etteistroethUt permit-tii 2023-20-05-MW-5-kw0 ft.. - ft,-
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'• .. Uri till ciyilieWciFellperFlOf ix-Cornty:1404t.:Variarrir,14063 017,1
•fi.- -. ft, • 1. . hi..- ,
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. . ...v.vi,:ii be(ehock.well Use).:. • -417.:
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-'Water Supply Welk . - -- - SCONE , TO • -.DIAMETER i st.OTSErit TIIICRNIZS AlATERtAt.
ClAgricultMal Elhitinielpalipublie . 10 ft,. 25 IL 2 ' 1",- , .010. SCH-40 ' PVC
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ClOotithetmat IlleatinWtooliog.Stipplyl. IDReskleiltial.Wator.SupPlY(single) r .• ft' . - 'f!...I . _ '•i!4' . . . -
OludusitialiCommerchil ClResideutiol WatetSupPlY fsluted) ;'Eno.18!GROIrr AT . ,•TO. . .MATER-IAL • ENT-PLACE- NIES-TNIE11-10D.&. A.'110014T-.—'
0 irrigation• _ . .
• . . - • . 0 ft.. 6 ft, Portland - Pour
. . Nott.Water Supply Well . . . . .. . . . ., . . T . .
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: 4 , . . • ft, ft; . • .
1914ontkning. . , dRecowly . 1
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ItAlgetion Wolk . .. ft.' . ft; ' ' '• •
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ElPluifeuRcOArge.. - ' - .110Mundwalcr.Refitediation ' . ..,.t..92SAND/GRAVELTAC.KAriimili6hti:1?',-- -- -:7:-..:T.i7:77.--.---..-:,-,.-_-.-----...-•,-'•-" ' . -
. ' •'E.jAff4.0.10.3Id.RSC6VOY. "•- - ''. -
litorty i Baktiet . ...mom. - U) • ntuRitrA I, .F.Nyt,acitmENT su..-rtmu
pSo
. .. .. . . 8 ft.• 25 .ft. gaud' '• - 2 - '•
El,V.riiiirci.Tait EISOiniiiratcePrititigic- . . . . .
IL- , • •ff. .. ! •.. r
l:14arinictilal Tc4litmkg. LISUbsittcy.cc:Cosirot , • •
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0;VRELLISQLOGIariaelladditikuiitl sheds if iteCtrifvt . . - •—- -. .
_ hgetithenual(,cldsed Limp) : CITmeer ' . FRONT- -. TO • - DINCRIPTICINIcobeihefty.w.willffikk 1)1%9min:co*.tio
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EIGmthettoal illeolitmICOollneRetwol DOtherlexpliiin under.#21 Rettoks) . 0 .ft., 12 • (I, Clayey silt
. . " - 12 ,f : 25 ft.. Silt :
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4:Date NVellcsj ..ti3nipleICdt 8-4-23 -- -:(Vett wf/WW-1R ,' . , W.,. • 1, ' N. .14.../t:i V L.. „ i•
. . . sa;Well Locationt 'ft. 1, .
SEP 4 1 2023 •
Jimmy's..Daytona . . . . . . . 11... - ft,• . . 1 1. • .
tIcility#13iyucrisituuc • ' '-. Fa4iiiyifikkOppablei. - ft, • ft, , InfOt*alitn Prcx.rAlita .
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2001 W. Vandalia,Rd., 'Greensboro; NC, 27407 . . . .. . - ft.. • •ft._ • , . . • • OW013(-Na . .
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. '. #12401.A.0*5;City.:,Ooit 4 '1.1.1RENIAR1S'
Guilford . . • . • . •Two foot bentonite seal from 6-8
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County' - . Parcel Ittisiliffiation No.(PIN) .
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• ShtLitilittleilatt li.nleitittela deOelesi!iiiitutestset(indiir-dcarialltdigOcii- -21:Certifientiour ' 1
- Or trit Q4cli QI1g.ittooi b•Sitit. ott •„.... -
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36.020772 N 79.840036 • - '147' -'v '. . '. i : .• i• - 8/10/2023
.gary:31.. of Cc*:6{4 Will Calitractar I, Daib
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6.Is(..to)the'well(o);.3OPermanent. or EiTettspOritty' 15 Algjiing Mb/0mi frerr,by terrify Oili Aw.welltil twin 010:49 arewrifeled he.Awordroicr
. . . . . . . - Iiitli f 54,N.C4C 02C.0100 or/set mcg..A2 .02139 We hi Cpusopericur Sforukrefs and Aar a
7.Is kb"!al reiratilti art e;ilStiott NVelk Diesf Or Eislo .1.4*.of this iecOurl liiikbeca providori 0:the civil rinviCr
if rin:i.l.f47 rOili',fill cot.krreiisii Watiaivalosi kfgruunion irri:(1 dpl.qIu rho norore of the
iirreir fetid&nrriNnarAiseatan swim the bast Ofllifgrm. -23:Site.ilkigrans or..adOticitutln;0(1.details: .. .
You pay.*the back of this 00,itiptoicteladditional well site details,or Well
8;.$11inberi)f wells euustrueted: 1 . coustnietiontleia4 •Ycia.iiiay althAtticluadditionulpjakes if tit.tesSaty.
For mitiple lidevidinsor aim-..hirer supply"IMIs.:ONLY MA the.satrif cosistruttialt,you cvti . , , li• •
" submit.rile firm. " .. ." • StWISIITTAL INSTETC-TIONg';'
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- 0..`176 tiil*C11,ilepfli hetoiti,land stirfuee.: . 25 (ft). • . 00-. :Nu..Far All-Wells• Sandi this''forth within SO trays of coittpletiOn of well
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Forsuohipfcio,,ellslist off depiliS if cl(fferoy iesanfpfe-3@2p0'esrui,2@l470) - "consttoctimi tolhe Motioning: . 1 /
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lt.l.Statle.ivater level below top easing: MO Divisitia of Water Resonrcio,InfOrniatitin•Fiatesiitig tirrif,,.
" :if ulaiet kUtil 1.;abbue editng..&se"+" . 1617,hlail•Servieg-tenter,Raleigh,Nt',2769!)-16l7- .
it,Rorehnte diameter:8;25". V-11.) .24b;•Ft-k 10'06cm WON ONLY. to.oddition to.sentliogilte.fomr to the address in
• 24aahoie;.also submit O.col*of this flitto within.30'daYs of.cotnpletion of Welt
. , 112..Velfpousttvetiou method:.BsA - consfiuciiou tO the fbflo‘iing,-• r , .
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(to.;4,6-rotary,calile,direct Iuit;cfc.) , - . . - -
-. . . ... . RIviklaii of Water RiNatirecii,IjliderOonittl'firjecfjon COntrOl.Program; . .
FOR WATIER SUPPLY WELLS ONLY:i . . 1636 itiall.Service center,Raleigh,,NC 27699.136
24e.Fm Water Suiplv.&faiOeffiou Wats:.
• 13u,Vield(gPto) Method of te-',5t:
• Also.submit one' 'eoPy of.thiS:fciiiin Within 7.'0:day's of completion.of• .
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13h.Disinfection typm Amount: writ e.ctil*IrtiOn.to thb county health deportment of"the.coatity where.
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Fans GW-I onit Carolina Ets:INument oradroamegaINI Natural Resoutvd-Dvf.ilba of Walerillatrm. Revised Augul,12013
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