GW1--06779_Well Construction - GW1_20241114

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WELL-CONSTRUCTION RECORD .
'Fol..II*pial Ust-I5SLY: ' ,
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'1111,s fprm CP bc;.ussd ffn'sink et.nuNige..wc1! , , - •
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1.Well fnforniiitiOim-
fIll.WATER.ZONE.S.:. •' •
. Stefan Smith -- . FROM.•. 10. - .• ' RESalFtION. . . .
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3576A . 1 .L
- - NeWcil Confine-1ot CarfilkiiloilThurEci -,15.01.1TE11:.CASINGO'siliitilikigt41HWOlt•LINER tit'ip"Ileabk,:: _
.FROM-" • .TO '' ' "01,093sR,• ' THICKNItSS' • MATERTA1.
SAEDACCO
. . . 0 .:ft. 17 ' It., 1." l' .hi. SCH-4 0 . PVC •
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- - '-. • - . -• • -- '
Puulgull'Mimic , . - 16',INNER-EAS1116.4:11t.TUBING-.42,Mlie'rinal iliki1464l1f. -
-. .FROM .To. . DI.AMIETER' IIIICKNESS._ _,.. 5FATERIAL . .
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tonitrietitin..Nittlit tt.: . • ft. • •ft. . .-ftt.
_ /.4101/..o,iyilirobfr-I.M1 pohjiit*I 4r.coyn .5f0.,;-.Vor1unco.infeCtim 00.
. .- ft,
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3.'‘yell U., (elteelc,iVell uic):. .
;•17,fscitt.111;
•
Water Simply Will t: •- . . -- ' - raw' . ...TO •-- 111AMKTgra . gaT.SIZE TIOCNN) .0S 1 MATRRIAr. - .
. 4401Mi, . -. - •
EltthunicipaVPublic,. . •17 ' R. 22 ft; 1" 'in, . .010' scii-4 0 PVC
CiAg1 '
ClGeotitennal aleating/ConiingSupPly) OResideutial Water-Supply(single) . , f! 1 'ft:. • 'if4
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ClInthisttial/Conintetcbl ' -
Clitesirkntial**atefSliPP/Y(-SbairCd) 4'..IFtIROG'2,Rt a-- ' ;7:-• 711:11.-113..;111.1.L . is'..it. Lei..t...ii.NtT-;tgn TiOD&-'...4:5t1 10 'N-T
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0 ItiOatian. ' „ - - • . ' ft, • k• . . : . • .
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Ion,Water Supply Weil:. ' • .
• . ' tt,; ' ft.• . • ;', • -
- - - . 0.NIOnitering- . • ' • • •.itiltee.OYerY
•Ittkellon yiell:' -- . •
... .
ClAnuiferlieehtitge • OcioauttiltvaterRemettfiliett• ISt":SANDIGIE.,tVitti,PACktit.Lainilieitliter- ---=-=--t.r.ff .. .-,--,:::=---.--
. ... . .. .., . -..-" •. ... ., . . • 'Flora.' . :TO- .- •1.KATRatat,. . •Rmpl.„%cr.mr.4T.mimion
rlAlttifet StOMF pitfle*:et'y . , liSalinity Ilairlet- . ft, • . it.
El Aquifer test, • ESrmtvatct Utttlikage.'. . - •ft ;ft. . • , . •. .
pO rpctitnental TeelmOlogy . . OSubsideneetouttol . . .. I, ' , ' • J
. . ;:20,,,DR/LLINGIOGUifactiivddifiodoliliiiiillnecissorS-.1-:-J.'T2
riGlOknn,11.(Ciased,:toop).- . Laracer.. . Ro'.11-• - TO. T oRseRIPTION nobr.irirdret,4 gialikkkotx.rrohl-i4ti,,iir.1 ,
IDGeotitenttal tHeatingi.Cobling•Retum) . 1:10ther(e..4).laitt under#2.1.Rentatis) 0 • tt,.. 6 • ft.. f:i11;'. . • •
'6 r,4: 12 jt, Clayey sandy silt• . • • .
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4.6ate-Wieilki Ceninleteti. ..'-',jo/25/24 ',Veil ID#Apc-1°A - 12 ' fi 22 .it, sandy silt trace clay. - •
Sa,A'1:41-bt.cAtione. . . :
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. . .11,. ft, . !,.. ,
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Colonial Pipeline Company. - ' ft. . ft. • . 'Ti..-;''41 if,:ttj
Facility,thTm*ttp, "" Facility 11:4(iitappik-abie) *
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$1,- . c!: NOV 1 -/ 2E174
411 Gallimore Dairy Rd., Greensboro, NC, 27409 . . 0,. . .ft.•
P1/3- 1440i!i,SC4-404 Zip' '2-1.1iHERIARKS':'. 1 i,;,...,,,,,,::.• t. .... ,:yi..,,C:•,•Ij`i,j4,41,1
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Guilford • - Temp well for grab sample. - -
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. 174r01,10i401)
No.(PIN} .1 .
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0i,Li,iitiftto.aii(i-1,4i0tiode in degrOsiOilltit4*0.'415.0i.,ttfrxi410cOtiii .22‘Certifititiniu . . ' ' •
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c(t$01 riqtd„'m Iiivitifik.u-sianCkiti) '.'• • . - '-- - ' ,- " .' : : . •
36.070993 Is::. 79.940271 •-11.1. - . .;.......- • -. • • ' 11/1/2024 .
' 403 .of.Cc.,, R411/011Comiaddf, " 0-*/.
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6.1.4.-(Rre)the well(s):.11fertittinent or .MiTeinporary, -
By.a4rnirig driT furm,./..fiereby crigry 41a.i rhy we.*syrrs.i'irqr.;)cvrnyiniqed in urom)aqtr.
iritte/It NCAC 01,C.9I00 0.11154 NGIC:02C.:92a0:Weil Ctinstaiitioir Storio'ciriti couttaraio '
7.Is dim a iviROtn'atig4iRit well Oyes- tir !Mu- ccii2r of Mil.recruit Iiiry Ni'fl irrOiiirfell 04'111711 ilik1aret,
if.17iS.ISo eeprili.4ill ow Armilvi.wdreonsmityipahrt9rynaliati ans/m.014;0v&mire of r$n. ._ . '• . • =. •. • ,
re.p.iti rind Cr#21..i-diarkvitiaiim or on ihdimal kr .this faint, .23.Site diagram or additional iV ell details:
' NrA41 nitly-use the.back of this'page In•piOvide additional well site details:.or*ell •
.8.Numberof welli ronitructi.,41: 1 constnictioi details. You niayalsOatiach additional pagesif owessm.
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For mtrilripli 01.ENTIot or nog-I-wirer supply Ive/p.ON .LY with rl.w. orriAcoso'gritctiorr,}:orlcora
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io.froatonikriu. . " ' , , 'stint$IrriALiNgtilefidiqs i
0.11.0tatt10.1;40/itiatt1sui1ieei . 22 - --O.) 243.4tir AU Walk: Siibitiil this Lorm within 30 tlaykot--;renipieliOti ef ‘.01
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For rtratrOto lf Hit'off rliOrs if0Prerfr 0.1arrople:3@200!ailfi2e UV 1' . -01151iIICtigIbtf:i ille:011.0winX.: 1
, • -• '
ly.stot.,water level helow top of easing: - • .(ft.) Division of Water Retioureeit,InformattatiPrueesaing Unit,
If*tiler Igvel thrriroix cosfr,,,, thi..'+" ' .1617.Mail.itiv ic. C.iii k i i Raleigh;Ne1,76994617 • . ' '
I It.,Borehok diaMeter:3•25" • 241149,r tok.tion Well,ONLY: In addition to.sending AO fomt.to the.addrersin
24a•ain*e.:also Omit a:copy of this Inuit ivithin 30.•diY ;of completion Of well
12,..WcIl Oottstruction Method:DPT 'i.-ons1nici1on to the following:: ' '
(La',..wigrr...niiin....m11ft;ditx-1.pes.11L (c..) • - . . •
.1)ivkiion:of'Water 4CSOUrcg*,1Judirgtvtiiid Injection ContrOltrOgratn,
FOR WATERSUPpLYWEL45()MX:: ..1636 Mail SL4vice•Center;Raleigh Ne.2769,4636
lf.e.,For Water'Supply Ai'Inicctcon Wells: .
• 1.3a,Vttid(g1/111)' Method iif tcit; _
AlSo Stibinit'441'4:o6i1. of thiS'foinif tilthitt.30-iialt.06DnOletioti of
13.11.Diinf:Ftilon ilyper,. - Amount: , wcil.consOnclitin,tn,the county 143114*N1/01/6)i•,:/ rtil .CoUnrY where •
co.iistoicic.d, I
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!oral G W71- ,Nonh CamIhm Lkiimmens.ofTercirmunem.off Natural Hesoum.c.s-pkdilon Of Wafer ROntrm Reyiscii Angust.1413