GW1--01287_Well Construction - GW1_20240229

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-WELL CONSTRUCTION RECORD Fir ItOrital Use DNLY;
This remota-it beased for its&or tnaitiple.WC114:
I.Weil C6ntritOor!itformation: . .
14:WATER ZON ES
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Stefan Smith .- . FROM- • TO - •DF.SemPTION •. - _
Welt Contractor Name. .
.ft. . ft. r .
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3576A . . . . . . _.
NC Well CoatmetorCertificationNuabei • 35.OUTER CASING(fir-staIlkisalitettsiORLINERtiriti'lleibla. '
FRO3I T6 • ' . DOMEIER- .11IICKNESS. • 'MATE'RIAL-
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SAiDACCO -0 ,fL.- 15- (1.. 2 ! hi. •SCH-4 0 PVC
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Company Nuie • ' 16:1NNER CASING 0 It-TURING;(seethe rmat einett4ocit) •
-mom .T0 DLAMETER. . TRIMNESS. . MATERIAL
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2.Well Constriction Purtnit ft; . • " It It.ft. • :,:la.
LW al aniiikage wa rPenizh`4,0,E.•t'ttunty.,,Mate;-.Vatitutee,IryCaiticti.car.,).
- !',04'
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3.Well (cheth.W01.05e): . . .
• . . 17 SCREEN_
Water Supply Wellt . - FRO141-' • TO •IMAMF.TER 5tOT SID; MITERNIVA. -I4ATMITAL' . .
' • 1.5- R. 25 'ft; 2 'irt.•' . .010 SC.11-40 PVC
.ClAgtiCultitral btltinidipal+Publia
. ft: .ft._ . -CiGeothetmal(Heating/Coating Supply) CillesidentialVaterSupply(single) • to I
• 7n.GRotir . • , ......,'. . . ..'-. . . . .
13Indastialteontitieruial • EiResiduntial Wator•Stiliply Oak]) r
• FROM- - •16. ' • '-MA-TERIAL ' RAIPLACEIMTIJETHODA AMOUNT • -
• DitIVIIIi011. . . . .. . ' • • • 0 -:ft. 1 11 ft. PorilaUd Pour
.Ntin-Witer SupptvW011:.: ' • -- • 1' . . . .
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-rt.. ft. - , .
Monitoring. , - ,.itiRecovcry
. Injection:WO:. •. . -- - . ft.' . ft. ,
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ClMitifCrtiCcharga• Eldituidiriticr Rentedtn iaiO •
, ..- .,...,. ... -19:SAAR/GRAVEL PACK(if altiotit.tde)„ - .. . „. ... . ..
. .. . • .,'most, 'To' • • 'stATRItt.41. ' "- - estri..tcour_sT METt1011 '
13 Ain:leer&pia&am!I.?.covei* " ••
1:1Salipity EitiiiJii • . 13 - ft.. 30 It Sand -. , - 2
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IZIAquifat.Test- • •
. ' 1:1SIbmnvatat liininagc• . „
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bi•Eiperinic41111:clit-ptogy . bSubsidClicar-Cautt-ol- • • - - , ... ., . . . . , •
-•"2a.,DRILLING'LOG(:Mach additional-Ora&if'necessary)
Elgeotheturd.(Closed Loop) ' , •''C.Itracet. , ' . ' . ' .PROM'-. ..T0 . 'DESCRIPTION(colsr.hardnettinlEtnek Ottt.. 1 six&dt.I .
OGOMilefillat(Heating/Cabling Return) •dOther(etplaiwunder:#21Rematlis) 0 ft.- 30 ft,. Silt
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4.Date W. CD(s)Completed7 1-17-24 .will ID#E4-.2. • . •
r-,t, ...; • •. - •
r-(...,* PI .ft—
So;Wull_Litcation: .....,
ft. '
: ::' ' ' ' '. :1'. '' ' ' .":2'1. l1.1-1. r :4. 1g41 :.1 . '
L'i lit°. -
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Thruway Shopping Center • .
Facilitykivn:i-itante . 1 • .'F'dtuity ipp()t4ppiicibte) .
296 S. -Stratford Etd.,.Wins tOnsalem, Nc,-.27103 . .
.1t.... . ft.'
. ' Dtticyq, . .-'3 UP*
• ' • • PItkkiile'0.0041:c;cilk,:ani2i.0' z2L.REttlARKS. . . . . • • °G
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Forsyth, ' . - • .2 foot bentonite seal froth' 11 to 13 feet:. •
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Coutay - • . . . Nroi 'delimitation No.MIN) 1, -
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b..11;atinide-atid'Langlinde in"Oppugn,' lituks/SecondSrirtfithind(ICtracti - 22 &riff- li HP".
(truUll 0014,1ono jzialuoil.Is"suttlacon - • • . ' • ' - ' . - - • ''' ' - 'Fa I-' • .
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. 36.093221. ' -N 80.282671 • • ' • ' 1/26/2029
• E.Ign7.7t 7 gf ce. md•Well Commetor . " - Dale
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. 6.Is(are)the%veli(*):.ItiPermanent .or .1:1Tentlioritry. . .. -4.1i.#9iiin Oa:fanrti I inerrby err*theglhe 11444$•••xix torte ettrattmeted ta.aqatrigare- '
.. Oh.15.4 NCACO2C.9109 tiri IsA Ncitcoic:0200 Well Cairiinierian Standards and that a
7:lithii a repakfo aiiriiitingwil4 piks. or 'KIND co-sikOf if*iraird has Nun iinnirkit a the*711 niFner.
Ifih(sit a rim&fill qui'kapitit walcansriardon infartnatjatt andekplaktfie.natare of flue . . .
•rereir&Tido-az!kagfok.,.:titriitincirivi the bait itf.thi.iftonc. • .23.Sitethoprant or additional well delays: . . . .
You ma use tbU.baUkbf this page to:provide additional well situ details or Well
- • S.Nitmlier of Walls caititritcted: 1 .• . • eausituationletails.1 You stay also attachidditionat page's if neCesSatty. . '
For iitaltVe Infeeila.n.ar nottyacer sitppti iqgsO.NLY with the.satne cotritruktionjoa •
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suipairimekro. SillittiffifitA fk ER INSTt.TIONS • .
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il'iliiii well depth below land surface 25 . . • . c-po 244.4.For All Wells;. Subtitit this loon v.:iilin,30--day5.ot•completion of Well
For nvilalpfewelltlistal7 dirks if cri,tiroit(esamPtc-302Dir(11420 1419) - . Constructioato the following; -
Divitinn of Water 46'0060,InfOrmation.Processitig Unit,
10.Static water level below t.op'of easing: 17 •00.
If*er kw,Odium ituifax LiSt!"-1-" . . 16/7 Mail Service icen:er.ii Raleigh,NC-27699;4417
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11.DorchoIc diaineter;8'257 . :(ia.) ' 24b.For infection WellONLY: lit addition to sending-the fang to-the gangs-in
.244 abase.also submit a.copy of thisifann within 30 dayS•of completion:Of Well
12.Well construction lnethod:HSA ' . . •constniition to the fotioOthig!' ' I i
(i.c:mtge':reim}..eat*,dime'rush.etc.),. • • ' es I . - .
tDvsiOn ofWatr Deources;Uti_ergoimd Injection 0:nil Fragrant',
VOR"WATERSUPPLY WELOVNIAtt. 1636 Mall Service,Ceittr,,Raleigh,NC 2799-1634
.. ' 24c.fOr•Water Supply&Injection Welts:
- 12W,ViCITI(glint) . : Method of test:. •
Also fUblitit One copy'of liti$ftinti-Witliitt 30,c1a5' ot Comidetion,of
1311.Disinfection type: . . Amount: . • • • , well eonstniction to the commay hUttithdetrannient of the.cant/. hi
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. constinutcd.
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FonoGW-t , • . -NonhCotolhia UgertmentiErtviroon.r...nt ocd.Naotrol itesiurees-DIvision of Water itestairo . Revised Augist201:1
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