GW1--06773_Well Construction - GW1_20241114

WELL.CONSTRUCTION RECORD . For tricorn]the ONLY,: :
This Orin cast be.tord fie'single et multi*welli .
1.Wei10;iitrit'etil r lig°rillatiOttE- • :
:114.;AVATERZONES:
Stefan Smith . FROM• TO OttlettIPTION
Well-C.O.Aractot f.latee. . . ft.- ft, I'
, . 1
3576A I-
NC.WCII°miliaria;Cerfilicatieit Nitidiet . 2.1.5.011TERCASING:Eforiiiiitlkasiethirlh):ORILINER firiji Aliabk)'
-PROM TO ' inmorran. . Ituctoarss- stArctum.
SAEDACCO 0 .0, 7 IL 1" •la: SCH—40 PVC ..
"
ceiamny Name. . 16.4NNEN.VASIAIG:ORTUBING:: --eiL2iti_eriiiit ikurd-luiip)112'
,,PROM To. DEAMIETER- TRICE:NIS& NIATERIAL • .
Ioili:dq:k:Pflitl0-'. iliEiR Fein*.i; ft. ft. • -:ilt,
Mg all agi(imble 1. 1!..11,primitg fix....Coluify;Sfq.,6 Varignec..Lliallial rx.)'
ft. fl. 'in.
3;•Wr.l!.1.1,.§e ieligelc.,Woyll use): c rt SCREEN: .
•. . ' FROM' I-TO •DtAntrtf;tt SLOT Sta. IIIICKNKis I MATrroAr, _
Water Simply Wgih-
.. .. -7 ft.- 12 • ft1" ' in. .010- . SCH—40 PVC •
ClAgatplitttat• •ONIttnicipalf.Poblig.
•in;
I:16e0Eltetfitai aleatillgiCOOliDg Supply) CIResideotial Water Supply(slued . • •• ft . ,
Elitidtistital/Coluntereial
CiRCSid-CritialAVaCer SUP*(ShaNs(1) ' 141Crst- T-0- 0 A-TATERFA.I. .- ENEPLACE- M:ENTiirriloD-.S.ANI0UNT
0 litigation.
Non-Water Supply Well:. •
• h. ' ft, .
1041:911torh.lg . Itte.cOYe.1).' • .
.InjeCilon With. . „ , ..ft.: rt: - . • -0,4rptlfer!Reglatsge Elpaautiduatet Rqatectitien- itt::-SANDIGRAVEL.PACKgr agjilleahtty: -- -=--.--:..-......L.7.:._-_--.- :-....-,-.-.--...--,-'--
- 'FROST' . -TO - ' ,SI a'notTx1; fiNIPLACtwiEsT mi.:Tann.
.1:1Atj.WO SiOat-0,c ant14.*4d) fiSidinilv 110ttiCr . rt.. R." -
... . . •
0 Afer test. • CIStormwater bialitage.•
• . 'R. It: , : •
1:1gxpetiniceJOI Techt!OlOiEy .1-1,5;tobsitlenCo'COIORl •
' :' "LYRILLINVIO'G'kllacti.' htiiieriatiliiitillitecessar0 --, ' —.=. ,- -_--• '
tiescpthentaal. Closed...toop Effracer. . . %MINI' ' TO. DESCRIPTION(obbr,-InulticsivtalavikR oot.vrabl':'4re...iir,1
1:1Gcothennal(Heatin*CooliUgRetunn .. tifither(txplaitt under#21.Retuaths) 0 ft. 6 tt, Fill •
. .
6 it. 12 ft, Clayey sandy silt
4,6iiie v-44(s co,iii„kk.di.10/24/24 . ..-Wcitt ffitiRDC—6B 5a.-Well LUtationt. it: ft
li 's, L-:-.'(.,,,, .:: it
.•
Colonial Pipeline Company . - ft.FrEeflitOwter:Vattoc-. Fdeility IDN fif.ap0;ble) ' . .
ft. 'A;
. 411 Gallimore Dairy Rd., Greensboro, NC, 27409 ' - .fti. . ft.' -. ' ' iii!::.:'7.7. -7-; i7"' -.
P1.12(411. "14'(1i7. titY-lu'lZIP: 11:41iirdattit.8'.-:.
Guilford Temp well for grab sample.
Vow):• PAttel tdoitifie'etion No,(PLN!)
'
. . . '
. ,
Sli,Liftiiiitt‘ rn;te in tlegrecVmittute047,titnk.o17ifelciinaldetreCii. 22;c„tifitati„h: ,
00410 601,tilli-:.1:iiilot . 11ii4-.-zni) .
36:.070993 ,N 79.940271 :VV. " - 11/1/2024
*g., e .4:,13, .
Si*t •ar.Cc. le,ci Well Contractor . Da; .
. .
6.IS(are)the viell(s):_ElPeruiatteut or -ETethiaaraiy: • -Ity,bignOig,drisnionTri frirOy trig Oic:tt'Mx well(s)ts-its.(mignq re..Frignreted is Fx?rakrz!cy "
- lvith:1 54 NCAC 02C,0100 or 15A ArCetC 0:2C..NM,Well C6.ustiTicia,U SturicirelS dud Atm u
7.la rthi a-repair to au eiiithait iVell pYe..v- or Elio cOY.oftiliff reconi hi-AvNirv,pirl'frfes,dpfivitrIl inilSrr.
if tb.(s is 0 repair.*emr knfli://Ir.e4TeonsPafty1tla iffjOrokiii9qegh:1 exploh)iiiIti!ryrs of Ow
repariiikk,r#2:li-reinark.i.ieeiL-r,or r.in ihdbark of this forni. 23.Site.diagratii:or at1ditiouat well details:
• Yoil;day use the back of thiS.Kee to.prolide,ildElitiOniti'well site details or OR
8.Nutttberef wells eattitrticted: 1 cousaucticoidelails:You inay.illsia attach additional pages if tas:essaty.
Oiiitigrip.r5/*aim.or oruilmser supply we/A:VAIN:with ilia sualcon.s.fructlou,K,a can . • -•• ' , ,.. .. ,—: ; •
sub mit uni furra.- .$11131SIIITA 1,INS1 UCT1ONS
9.tntili well itcpth Iteloirlatidpurface: . 12 -0;4 24a. Far All Wells: Submit &IS-forte Within 30 days„elk•psupp.reaPn.of well
Fur mOT1,6:ra X:efirliJratifti.Obs ildoNitvir laumpfe-30200!dud.2@ 100). 'cOOSilliCtiOn to thc;:rOitOwit113:: i' -
1D. tiltir water level below tafrefeashig.:._ (ft.) Diiision of Water Resourtes,Infiwmation PrOecs.ing Unit,
if imiter level 6'ahoy.t..6.1*tai!"+" • - 1617'Mail.Serock:e.'4:ettierItaleigh,NC 1.7699-1617. .
11.Borehole diaMera:3•25" 'On.) ifb.perii,kcilim WI 4 ONLY: In addition to sendiug110 fowl°tlwaddressiti
24aohilvO..also submit A copy of this fano within 30'dash;of.Cpuipletion of well
1.1.Wcil.oansituction,tifethod:DPT •L-Onstniction Eo Elie tollowitig:-. 1
(ii,mgcr,riealy,..ol?le.;;diftcl.posh,. r.c....) .' •
pfvfSintrof Water licseurcCi,Undirgrotind Injection Control Piitgram,
FOR WATERspipLYWEu$ON07:• • .1636 14ail"Service.Cellnter.Raleigh,NC 27699-1636
• I 1 -.
• 24.e...ror.Watet Sun*.tic IttjectioulWells: ,
• 1.3n.Yieldigint) Medtod Of test: . . • - ,
--- Also submit one copy of this-faun Tnithitt.30.dayS.PfCotnplettort of
13.11.Disinfection Oyer.. . Artiuunt . AVM•consilinctiim to the canny licilth clepartmiinf of the eonntylitere•
conslnic.t0. 1 ' •
form GWr 1 Norlh epfollita Ek:parivent.oi'Verumninem.apd Natural Resourtes-h.i-os be or Wato7Rtaircw Revised August 200
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