GW1--06597_Well Construction - GW1_20231006

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WELL,CONSTRUCTION RECORD Fat/ erestusepNLy:.
, • "This-form can b'uscil fir siagic at lnultipk wells'
1.Wclt.Co ntrnetur_Information:
'I&WATBRZONES
Brian Ewing FROM. TO , DESCRIPTION
• Weil Coale-Mot NSrne• ft: it. .
4240-B ft. ft I
NC Well ComlactorCenife�uioRNumber 15'OtiTER•CASiNG(rdi'inuftl ediscOsl''ORLiNER'([fap 'cable]
-FROM -i ID • DIAMETER ' ?nlCKNESS" MATERIAL
SAEDACCO . ' .. .. . 44 • el. 'ln.
Conyp;uq•NMIIC. t6 1NNlER.CA'SiNG'OR:TIIBING:Iij ulherineeknetWoiiW.."-
FROM TO - DIAMETER , THICKNESS. MATERIAL ,
2.Well Constt'uetion pent*#t 0 R. 20 ft, 1 i .la. SCH-40 PVC
. I.irfidlapplitafee wimpy:910..0x.Cpunry;shrte,Variatre,lieettki3 r,.t`• •rt. f4 'Cif
• 3.'WcII Live(chiddI use)•: 17:Sf:REEN _
R'aterSuppl),Win: FROM •TO DIAMETER. Sf,OTSIM THICKNESS t M %I ATERt ,
CDAgticulttttal Olgiilueipal/Fub)ie 20 ft. 30 ''ff. 1 in 010 SCH-40 PVC
DGeotkkermal�'Ieating�Caoliog Silppb') 13Res'idential•\'rater Suppl}'(single) fi; 'rt.. ''ill'
• . ®iudustriaUColnmercial_ 11Resideotial Hater-suppl}'(slated) ' 'GROUT. _-_ :°
FROM TO. MATERIAL EMPr.ACEMLiT mEniim S AMOUNT
lJlrrigntion" . . . _ rt., ft,
Non-Wa r Supply Weil: . . . R. ft,
• itMon tOrin.g 1:I1 csnticl}• - ,
InjecttonWell:.... R. ft. '
CIA.:OilerRccharge • DGioandtrtictRentediatjou -ct9:SAND/GRA ELPACKtff_1q,pi(eahtet _- -
_ PROM- 'TO . ' , MATERIAL • •tisrPIACEAIF.NT MI:TROn'
• ElPd ilfef-S101agcandItceovel}', DS;ilinll)'tjaioc 18 R.• 30 _ ft. FILTER SAND # 2
❑Aquifer Test ❑SlornwiterDrtlrtage ;fG fL
CtEyrerir i ntaI Tcehnotose OSitbsidencc,(atdrat '
'20:DRII.LiNGLOG7nilaeh additional iheelslf-'ncecssari•-
DGeiMh (Closed
eniwl(GlnseLoup) 4Tracer .a7tOM-• Ttr DESCRIPTIONRoobr.Furdncsi.aoltnle4htx:;tsx Ori.Nek lSl •
C1GNDtllennl•a (HealinL/CooW]aReturn} D r
Othe (explainunder,#21Rewatls) 0 f4. 5 ft, FILL SILT AND SAND
5 . ft: 10 ft. SILTY SAND .
4.Dato Wett(9)•Compleleth-9-14-23 WellW#TMW-5 10 rt. 15 f4 WET SILTY SAND
54;Well I:rleatlon: 15 • :.ft. 20 ft, SILTY'SAND MOIST TO WET CLAY
Kimball Auto Glass 20 f4 30 it. CLAY.PWR R.r- ,,,r L.,,i
Facility,+ChxnerNnnic. Facility.Wk•i1spp)icabie)... . , p. - 202
748 N.;Main St., .High Point, NC, 27262 VC�
ft;• f4
PI(yy'3rcalAddra5s.City.an49 . <It.REMMAr1KS , �••�.-,-!'.-i,-,-1 pf.-,.::. ...:.-Jt.-1,.:
BENTONITE SEAL 16 TO 18• ,.C:ii:'i.a
Guilford. I Gz-v..s ,� •
Crossly- . Panel Id_iitifleationNc:(MN) . - i
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56:.1.atitudrand'l4ngftude in de(n'ceslrainutcs&scsands air dochtial.degreck . rr t ti22:Cectii(radi retd�one 1010 itsdricktd)
A "N.Y. Brian E. .� 9/26/2023
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.SigmtumofCettillcd•WclCantlaator Date
6.Is(.ire)the"Weli(s)i JPennaitent or .SiTemporar)' �'St u ilri tm,l hereby certify tlr'r tK uellls_l was( srni oirylrcted i,atoltiancr.
frith"IS;t rYC,tG 02G AIOP or Ili NGAG 0 C.U.PO Well Crrtstrir0'tut Srara tards,rrid:!is it
7.4 this-arepair.takui3Onctinj teeth' Dies .or No • • a riof'rOOirorcoixdr,risbccapa»iukd'ro7?.irdioietier.
eth(s:lt a rejiaalr.faltcarFhnfriww1 n'elit50aaila viari btf©roiasIUai Rid exp(aI,i to IN7tare of the •
igfiair ruiner 021 irruarJ:r ceari n or ivt Te builOf thisfarm.. 23:Site diujrani ormdtlitionnl well details:
You ma}..use the;back of this page to:ptovide.dtIftonal:tell sue;details:or*it
8.11untherof Wells constructed; 1 ' . - - eottstluction details..You!nay itlse:ivacti additional pages if ttec..ssety.
For nrulrlplalideex!on urorii-leaner supply•iidts ONLY with rlie.saioecturstrurtktr,y+oketio '•.
sa(rm&anrfcrin. • - SIIBMITTAf.INSTIJCTIONS- i
. 9:Tatulwill depth befon-land surface: 30 . ' (ft.) •24a. Far All Wilk Subndt ibis form tvithiti 30 days of-eontptelioti of Well .
For anahlplci�vilsllsri-61,leptsifiS/fi•reo(cxgRipte-3@2.0o'mul.2@117l. - .con5tructtoritothCfottoning; ' - -
. 10.Stage water kit!below top of casing: ((t,) Diyi_sinn of Water"R6ourres,Informittiun Pnieessing Unit,,
!livelier 1614 is dboro cidsle,;.osi'"+" 1617 Mail.Seri:icc Ci tr r,Raleigh,NC-27649-1617 -
11.Borehole diameter:2..25"_ . 'On.) 2'lb:For des I on Wetlq ONLY: ip- ddition to•sendir g the form to the address in
24a aboee..also submit a•copy of this'hail within 30•days'of completion of welt
12.Well construction method: DRIVEN -
collstiuctioli trithe follomhig•
. (Le.auger,tatasy',cable_-direct push:etc:} - I_ ..
Dlviyion of Water Resat'rces,Under0ouud fniceilan Control.Ptogranl,
FOR WATER SUPPLY WELLS ONLY; 1636 Mal[Service Center,Raleigh,NC 27699-1636
• 24e.For Water Supply.&Injection Wells:
13a,Yield•(gjim) Method'of tat: •
Also snbniit.one'cbpy of this'Ain't':t-thin 30:iia}sof cotupletion.of•
13b.Disinfectionpypc: - .Amauuh Ivcll-cot sftnction to the colony health!depautnent•oftltc count'where ,
constnictett.
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Fens GW-1 North Catalina(7rpans.ent,otErivitttnmeni and lslatural Resotuccs-Division of Water EtIatico4 Revised August 1013