GW1--06596_Well Construction - GW1_20231006

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WELL CONTRUCTION.RECORD' Fin:Put:nut tht:.c.piNLY:. !
'Tlii-formantbajtscd for.single ci multipkwilta.
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11:.Vitt.cotkattni paottiii.tivni
..1.1::WATERZONES ' . • .
Brian Ewing ' FROM: • ..-To DESCRIPtION
Will COittattotNante.- • ft; ' ft, 1 i
4240-B .. " '• 4., ' (i.. . 1 I . ' .. ' •• . . '
:•.I5.11t1TER-CASING•IfailiinItI4tikilintl-fill'OR•LINE:K(itliti-ititsibk)1.
NC Well Contractor Certification-flunitel •
non ' ' TO - • DIAMETE.IC IIIICKNESS MATERIAl. ,
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SAEDACCO . . . . . . . I
Qitpuii-Nathir,- ., . . • - • --.:141..NNER-CASING'ORTUBING-1.0a1Hitiat ckfgtil4tHilbt--' ,.. ... •
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" FROSI • TO . DIAMETER THICKNESS. - MATERIAL
"...Will too0actirin Pettlit li: 0 ii. -20 ft. 1- ' :'hi- SCE-40 - PVC •
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14-0'41titFigicabre tFeffpeimf.t.t fi,c..gurpty:1'4(41,.11eirlanre,frtiecp'04 mt. .
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. 0.,:*'..c,1015 (.0ixiiiioillii!0)i. . 17:SCREEN
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WatOSilliPtit WM:: -FROM' TO ..DTAMETER' .storm): THICKNESS I MATERtA L - •
. . 20 it! 30 ' 'IL 1 - 14.. • .010 SCH-40- PVC
• b 0,01cul(041• . . . : .b*iiiikipaii,p,04fc..: . .
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• ft; • - 11,-•
. . • tlGetititertnal aleating(CooliniStipply)- • Ciltesidentialstrater-SupOIS.(single) •. • • . • . • _
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EllucluStrialiConunercial, 1:1ResidentialWatet Supply(skated).. . "4-'0' , ")6:TER-i .-. . , . . EMPLACE11111N—TME111DD.EA.,"HOLINT. ; .
. . . El knpation •. . - ,- . . . . .. . ... . It •..: . ft, ' • ,
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- - .Nnti-Itifey Supply Vt.'011: , - - • ' : . ... . . . _ _. . .. ... - • -
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- ' • laidonitOring - . . . . •1:1Rowely • • ' - • . . .
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• Injection%Vett: ' ' ft.- . . 'ft. . • '
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• . El AttniferBeeliatgi . . • faciptiOwaterRentediation • '...19Z.SAN n/GILWELTACK'fir djuilleshleV- .=-- :,---..,-..i-,-- :-.'..' -...'. ,- ,„. '- •
:•,witotii •70 M.tTRettAt. ,ESIPLACEMENT MLTHOD .
PAintifer:SItitogapil Ree0tiety. iSallnit)Ramer • ' ••- •
. ,„..•.. • - . . • ... . • ,. .:.• . • 18. . ,ft, 30 .ft, FILTER:SAND # 2
CI Attnifel:Teit• . '17151OitilWate'ePtit- inttge•
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EIEVetitnental Tshootogy. DStthhtencO,(...0tOttil- • . .
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. ,. -. - • • . • . . -,-',2A:BRILLINGIOGilittoili:iiddllioaral ili'Milt ilteeSsiti4
betentitOutml( ftmed Loop) .- 1:21Ttocer . . -- .. '• .trnoikt.. 70 ' PKSICRAP11014.(olar hardwat.gait mtk notommi I**,tit,1. . . .
• DGeothennal(Re atingCooilttgRetutn) • ClOther.(eXplain untler.#21-Retnaths) 0 0,• .5 ft. .FILL 9I1.t AND SAND
• . '• '. -. 5 .ft,:- 10 IL SELTr SAND- - . ' •
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. 4:Dati Well(s)enninteteilt:-97147 3 'Stlitili„MP Tmw-4 .
*10 It •15 ft, WET SILTY SAND • .
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5o:Will Lticationi • - • • 15 .ft., 20 ft, -SILT/1 SAND MOIST TO WET CLAY
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Kimball Auto Glass. - ' • • -,- • 20. It.- 30 144' •CLAY PWR • . :1:-•'i-',1----'571.;
. . fictlity,',Orirc.r*Iluu r•• • - r - - Facility OtaPi3j4t4.... ' ' '.•, -,,,,'1•4.,1 1:,'---;7.-•:-Vi.'--=-1,il
p. • ft.-;.
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748 N. Main St., High Point, NC, 27262 . • . . . ft.. ft, - U C T.0-6 2021
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iillYiia9'14.415.:citi,:014 PP,. 11LREtiL1RKS'. • '' • :' ' •. . . ' . .. •
• .Guilford. BENTONITE SEAL 16 ,TO 18:' . IP.tOrir,r24tC ri I.)r.'"-7,1•4•14Pt-V 1.1'a - •
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• . (2:orgy- . - - . • - • Parcel Id-intifiCallon No;(PIN) • , • • • ' . • i 3Z.
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56,Littitntleanilitingitild0 in dcgvc&mlnutcs/sconds nt•dceItal•degt‘ceS:
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fit11117414,aite101ofit,ii•ntMetenty •- - .. ' : '. - . ' • •
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• .14r Etrtan .Ewing- 9/26/2023 .
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• - . .Sig;a3titM:itreitificd1Wil Fctitcm.ttr' ' , • ..'• Date .• - . • '. . . ..
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6;Is Orel then :OPerntonent ;or ETempfortity" - • • fly Atninvirlifinm,/Irereky.1.,Offry.qiur-014 ipelli4 tyar.0100)et.rqtrigul,f he;keariankr •
iiith".ffel,NcAC 02C.0100 or.154 Arptc:Oac 4020?mu(*pitieforrion srangareis 4nd xlms d. _• -- •
1 Is-Mks-a repair to an ekistittg*elh-' bite or No - 1. 67oft10y7i4tcliiii 104 Ear m iihmkid-al r(4*%irli vii7ier,
fith(s:ft It FAI:70./E.1149t inoiliw melt brfory i.railia sail I..t.pOlfir rkitarare of fife,
, iiiiiir arid&#21:iissdr,U sirliaiipr im thebtill:roirtithilgrar: - , . ;-23,Site.slgritattlr additional.well`tientits: • . - .• - • .
•• • . . • .'.-15u may use iike.bcii-pr this page to'.-prOlicieiddiii.Onat well site details or-Well , •
• •8.1Niontberof Wells ittftsttitested: 1 ' - • . ' . . - .- 0.usItuctfUit details YOU int,'itlierittiaeliidditionot Oases it ott.eskiry.
For-Maki&irdee.thin o'r os,i'livirir supply ONLY Milt-the:smog corrstigilitatutiiat earo , •. ,- ' .- • - -•...... '. • • •
.. sgfiviikrilie pm .
.: ". ' . '.-- • - — SUBMITTAL INSTUCTIONS .i • . ,. -
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0..Tikillitelt„depth lieloWland stirtifein • 30 - . ' " . 00. :24-11..Fiir All Willsi• Submit this Etta withiti 30.days of•complejlOtt of'Well• .-
For wilriple01-list 01 aleprizi(filiffifreirr(arn*pfer-•3@200'asii2@/479) " • constrtitttott t611111c foltotsiug; ! ' ' '
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10.StatieWoter leiv.1 below top al easlitt: - 41...) .Dhishin of-WaterReSouTafornintinaPtnicesshig link,: • .
titroire 10i,1 L'ikore eSs0.1g;.iii.e"4." ' " 1617'1Lait.S.erviee Cveianer,Raleigh,NC:2;69946 II'
IL!,Surchnin diamctim 2..28". . . .24b:.grkitileellort:Wdll ONLY: In-addition to•sending.the,form to-the address in.
- 244•abeis*.also stib.ritit a coli,y of this fona within'30 doss'of completion of welt
DEIVEN,
12,WeR must-maim,method: • constnietion to-the foiloWingt •.„ . ...
(Le.414r.c.FiNafy,.calge,•dimet pusta.ctc,} . . .. - .
. . . . . .B.iviNlp it.Of Water Resin rcesc.rintergrouittlanteetinn Ointrol,Prngraitt,
FOR WATER SUFFLVWELLS.ON1LItf' • 1636 Mall eirt-Ice Center,Raleigh,NC 27699-1636
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-2.4e.-For Water Stainlv,41-hkitaintt Wells:. • - . . , • •
f3a,'VFW-(000„ Muittutt of f,f.Sit
• Also submit one tiii)y,of this.flit&Within"30 ItlaySorcontlitiOn.of• - : -• .
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I13b.Disin . . •wetr cbastruction to the county holePth department or the connti.witOte
fection.tynet. Amitunt •, t ..,
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Farm GW-1. r ' .
Noril!-Cofalinar6,•711.Mantar EUdiOniKlitall4.Nanir,a1RePlareag,D1VIS101.1li:f Water,Fteli LD ' . Revised Atgust 2013
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