GW1--06692_Well Construction - GW1_20231024

WELL,CONsrRucnoN-RECORD'
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For tractnalt4c.GNI.Y:.
TWO-form cOoba:lled frit&thee or.mull ilik viello ' -
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11:„WOII.COnti•Attnilnirorniatioti: •
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'It:WATER ZONES. • - . . ,
Robert Miller . ' EROIII: ' TO 'DESCRIPTION
' WA totiraCIOTNatuO. • - ft: - rt.
2675-A . . . ft
• •'NC Noll Contractor Coniftcatiott Nordiet -AS:OUTER CASING ffin'itinlIkiktrtittliI'011.LINER:41tW tkable)•-z ,
FRONT - . TO - DIAMETER-- THICKNESS'*- MATERIAL
SAEDACCO .• . ..ftk, ' -.:ft. . . I, H;-in: , • ;.., ; .
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ConiputyNnic,. • ' If4..._NNERt1...24GJLt. ,........._______AS TUBING' isikintS1 els:sal-bit
-FROM -TO - DIAMETER 'FIRMNESS• MATERIAL
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2.'Weli toninyttion,lientit 4: . . . 0 .:1:4 .35 Ft.• 2' j ,....2ili, SCH-4 0 PVC; . . .
.thialtamlinditowe://penu (i4i.-611mrp;Itirte,r.:VoriatTer,lifectit4 exc..).
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•.\V OE lige(0,elp,iC 01 ti 0) , • ' • • :47:SCREEN - -
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NN1.1,1W S.UPPIY Wilb. - - -- • PROW. • TO DIAMETER 'SLOT SiTT. IIIICKNISS- •741ATRRIA 1,• _
C.JAgriculittraI • •
OIAtinidip41):PtibIiC: 35.. ft 50• ''Ili 2 • 'hi • .010 SCH-90 PVC Pre-Pack• .
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' • • 136eathemtat aleating/CoolindSnpply). CiResideidial Water SumilS1(single)
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• Cllinttratrialkotuntereinl ClEtesideutiai WaIdSnppik(SitUe'd) '1FRorUr'...-- ' • -'••'r'''''. —' ' " - .-- - -w '
TO. . MATERIAL 'ENIPIACENIENT.METHOD&AMOUNT
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. - 171rtigatian . . , . . . . . • • - • 0 'ft., 28 ft:,• Portland Tremie . •
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NOttAVitter Supnty'Welt:.. , . ,. ' j , • . • - .- .. . , . . . . .., . . ..
• • It.. . Ift. . ' - .
glidonitOring• . . . . . •Itiltecoyety - . " - . .
Injection Weit: • . . it.' lc " . -
:-MtiferleOtitgi. • - •. Lititioniiiinulet Rentediation • -, l'EWSANIWGRAVELPACK•drapillii.xtbter- - :-.. -:=•. .• -.. .. .'•.„--
. - . •-- ---. , '. :. '-- • -.FROM .TO'- 1 ALATERIAL- , EMPLACEMENT Nit:TROD ••
. 641ifei".:§(Ongic anti tteeni'eky. ):3&ilinitif3tiirlicir. . , .
, .. ,_...„..... 32 . '•ft:: 51 .ft. Gravel,pack #2
0 AnIferTe4 " • • EISIOCv.atCe PtititiaiP• - •
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CIEVeiintentol TetOinoloa. ElStibOdeoce.tontrot . • f
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,-.- . . -. DRILLING,LOGiallaelt additiohal itiOds,if itectisaitf • - -
EiCtendtOttnal0a$ed Loop " .
EITracer - - - ' Fno.Nr•- To • ' or-sentyriox frrolGr.ban:DO:x.4.561E1+Kit on.r.train**Now ,.
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. . . EGothental(ieating1CoolindRetum) Obler(etplait undet.#2 I.Retualks)
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-ft...,. fL • ; - Fil:..i....'.I: -.1'..1"- '.'. .
• . 4.1)atD‘tiat(SYCHDiillEtEdt 10-4-.?3. 'IN&M#CPT-0 P- 0
'ft:. •. ' • rt. . • ; .
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Sa: .1rt.411..neatindf .ft. ft. ' •
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Oi.-1 2 '_ uz3
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Ornn iSou rce•Corp. • _ ' . - • ft4-- . , l'C' • 1 '
; - I, x.,-•412. A..,11,17!t:,-.N ,,'•',,, ,
f*OIlity0vootit5mo . Fd00 ION edppiO 131.0., -
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1426 w, Mountain St KernersVille, NC Forsyth County, . , . rt. . . it. , .
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.Kernersvills, NC, 27284 PIO;;*Ii1-Aiidi.S..:55,,C.iti--ilil41 PP 3II REMARKS- L .
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Forsyth . • .
•Bentonite -chips to seal 8-32' ' '
emit*.• ' Parce1.1..kofifteadon No:ontl} •
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5ii...1;titifittle' ini'LtiWgiolo.iii ilegreesititinutcgisepind§.rii."cttsitintl-d041*. ; • .
ottien 641,-tmie iiillekti,•seniteto ... %.. .- . `,22:Certi. ilcatitnn • i
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.... . • ..,-..g. 4 , - 10/4/2023
.Sign:tot of,.;:.5.:i.,:::.: ,,•":-:‘,,,..t-,11.;;;,....4... Date• . - -. . -,, , .
6.1[8,(ate)thewen(1): iPerinaltent or EITemponity • 'fi>;Aigrring,grit fiiirrt,l liertig.eerlify filyzr the met t!,-Te.s.ft.4iM 0,44:soferei1 ii.e.,..rc„,...*roniv .
.iiirly iM,ArOiC 02C.9190.or.I.TA'Nat d,Os C 1#2 00 WO Ctiteitriiciton StalOards end Agra --
1 4 this a zenniitn ati4iSting w.ell Eryes- ,or No 4,(0.',9P1il'irctini kiii•Nen pi ideti:(..7)1i4.:%11.71i..inilOr.
If iNsSisli rimlif,01 eor krthirm ii'Mconinuerioii 14gioniiiit end ti.vp410 Wc mpg*of the.
it"liair wider 021:thnicirOliziaiT"a anon iho•bad:of&ix'brim. • , ' '13:4tte.dingraint.or..additional wt41.,deptits:
• • You ma ...u.§0 the back of this p;ge(0'.'groOdOitiditiottil tell sire,dithilg...or•tiOl
II.Ntintberornells eonstrtieted: 1 • . ' .consnuction derails. You limy alsO•AtiAtii idditionat pas if tieeisrary.:
For!ituir012e.Ittfecit0(er ga91.1.1tiii,r apply
4froA.13",c , . tqIIs 9NLYOirti't.. on,o c,a_s.r..
kii!siou op
1i ipra: . so . SLBNMAL INSTUCt,i,oN,§.
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9:...1Entiit*ell depth hi:Inky-land itirfatei - 51- . . •of.)....24o..Far AII.Wellsi Signitit 11114 hinit within:10 day**of:o6ittptoti9u1'of n:eIl
For Orultiple•iiyilslist ail depalis(filifjitritt(exanip(e-3@2fAtr ag(1201479) " ' "constnittiori to;thCfoIlosiiitg: . 1 ,- ' .
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18:Statie,nitter le4v.1 below lop of easing,: . (It) Divisitin of Water ReSo urea,Inforrinition.P.ioiessing Ifnit,,• .
#IttliVf let Lv boreal Y Ski,hie'-'+" 16171WaiI.Seici:,Cdttei,Raleigh.;NC-270511-f 6 t7
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111;ilorehOlc dianioten 6." 'On.) .24b;pir Infection Wetts•ONLY:.[hi addition to•seoding the fomt-to the address in
Ilifab&O,..also submit A.copy.0f tins forth within•30.'d4s:of completion of ivOIL.
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I2:-.WeII construction method:Roto-sonic . cottsinietion tollie follti*ini!: ,
(Lc.Oug0-Mtny....6a14c;direct pinIketc".} • .
Division of liVater Resources,Underground Ittfeetion Control Program
FOR WitTgR SUPPLY WELLS ONLW 1636 Midi Seridce einiter,Rnleigh.NC 2769946.34
2.1o..Far Watei Sup*&Inject kin.WtIts:.
13ait'Vfold'ktim) Mdlioil pf tc,itt
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'ex&) stiblitit nne tofty Of this'fdtin'Within'30:t1.4). 0f ctinittletiOtt.of.
131).Disinfeettotkoitet, Amonntt iced to th 'county kcIalth dcpicament of theit t couy.where „
- conittocteti.
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Fano GW-,1 North Carolina Elepanittentof Euvirotuuent and Natural ltdotuccp,Division of Water II,ecorc •Revised August.2013.
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