GW1--06781_Well Construction - GW1_20241114

WELL CONSTRUCTION RECORD. Fai,kcru�tiicotNLv;.
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This form aun be uscd for slogle or ntuIllila nxlls, • . .
. I.Well[oirtrsictor Lifornlntion:: '
tii WATCR'ZONES' ' ';
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Stefan Smith B'It014 10, . ' nFSCRIPt1ON .
• lyc.liCorirrctortatnc, • • ft:' ft.
• 3576A ft. ft. ! '
NC.ltdlConitactorGctiiftatioitTwdiei • ,I OUTER:CA fNG'tfor`e'aoitnitik,thi,cthYOR;t INERaiiiitic-abich - •
.•-FROM TO " ' 'DIAMETER-. • Trr;Cti:VESS' MATERtAL
.SAEDACCO 0 ft.• 10 (. 1" I :Au; SCH-40 . PVC
6191.79We►S111 :OR TUB9iG 'eolierinat t8a�ed Iliti "+.
' tictt,r(t,7>ty,ttianti:: �._.. --' IL' '
• .FROM TO: .r DIAMETER IMICKVCSS MATERIAL
'1.'Wctl'Ceinstyllkiou Permit#,t -- `tt; ft: �,
l iu anti•viicr fc Ki 1prrnrirs ti iff,Coory;Stahl;347rigrccr.Ark ti arc:)' . •
. fr. 9. • . •1n;
. 3:�Vc1l:I3te(cticcic:wcll tisc)): to SCRCEN: •
!F'aterSuhplti Well:: F1W 1:. ,...10DtAI1ET6a s LOT SIZE : 1n1CKNESs 1 NAT1tRiat,
• . DAgncultttrai . D2yitunicipal/Pttblic. 10, ft: 15 ft;. 1" •;a ' 010 scs-40 • PVC
• DGenthetmal(Heath Cootin •St l • DResidentiai Water Supply1i: ft. • in:
►!�• � g1 :)P� (single)�le)
' �ITidustiialJComnfercial • ©Resldential.Watel:SuPPt'(sliatril} ` :t ::GROUT::_4=- - <: :-- _- .- ? ; _ -
FRO\I TO ?]ATERFAL {EMPLACEMEVTM£TItODSAStOti\T
131ttigatian. (t. it. .
l'an Water Supply Well:,
ft;' ft: '
1M4;1fforinN- - • InIteeoyerl. .
Injgcliun Welt _ ft. : .
.• OPigis fer Rechacga Dc3ndundlrltcr Remedi anon- GIs:•SANDIGRAVCL•I A(Klif atijiMat tleV.'_ .u 7.= _-. -
•F orf,s1 • 'TO' rttemt'r;rti:- htti.i4c..i.4,s\T 4 irniOD
1743qutlerStoro 0.1ltccowtj.• E'JSaliniiv H• •
rrticr it,: fG
13AqurfcrTest, • i3Sthrm ptcrtil(Wtvgc;. ft; (f;
Cl trmeetal Tochrioiot ' pSnbsictcacc Control •
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. Itti:ORTIAANGE G7attacti addifivnat skrels lottaa nrcl:`-'•" -
• mC;a:i1tl1Crutal.(CIos t oa11} - DTracer. moll' .TO RDStRIP1t0.tulb st1• riinui,nntiwkhtlrmon'3rair.1
DGeolftennat(FIcatinriCaoliue.Rctum). : D011tzr(sru
plaiunder•0ZIRetttatis) ° • i It
. 6 : , Fill j'
'6 ft:. 12 ft. Clayey,sandy silt
#:DateWell(s)Cosijilc,ed;:10/25/24 ...W6ilimi-IRDC-10B ' : •. - 12 ' (4. 15 it, sandy silt trace clay
Sa:Well Lncathlnl .- ft.. fi, 1 - •
Colonial Pipeline.Company tG• ns F''‘..',.•,!C..J tl._;., 'V 1—Le .
Faattii}', w6cr?smr r Facility IN iifappbaiblc}' . ' R f. p N O V 1 / 2024
. 411 Gallimore Dairy Rd., Greensboro, NC, 27409 . , - . ((4 ft.. ' ' '
Plnsiitl:Mdrescat) unitZi0•. 'gt`REMARKS:?) Iri::;:F . _ :.,-,1;%-f::.
Guilford Temp well for grab sample. - I)ftt r'fi...3�i
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. .(0nty Pr 3ldintiC.11ion No,(P1 ) . - ' • .
III.X.anmU.dcuiili-L,oiigtttttoIiiitegttc's/minutes/sccont 9.1...f)Ccintal'dcgrits 2'2:C�eUtiorit:
• If;i�aU.rwrry, nolvpo,ig.is3ulllof<:nl) : . .
36.070993 • . . 79.940271 'W 4 y 11/1/2024 .
. . '5igmi .ofc rwd Well Caiaiactwr.; • vase
6.T9(nre tin.t'il(s):•13Pennunenl or SITemporflrg`.: • By biping drfs. rm 1 heripy carte ihaf.lhn-n'e ts)tras.(Krill.[Yir rnrererl is rxtrir}rmce ' -
with'1$4 NebC 9:C.1110i or.1S41 A'C4G a2C 1400{tall Colrsrrricrfar Swrktarii3 ai+ut rkor u
• • 7,kthts if repair tit'an.e.tisting wcll% OYa - or' li7No 411'offhrs nd'nni lii.7' iro pr}i'ilia rif,&I i11 e.O•irner, '
(fthisuorepair,fillccekrrclnvtntilrcru1nrrrloaisfomurr'oseeiNti lila)nibr,iartirc,ofdue ' ' • . I - - •
reprrrurl r3'2Lirmarkr'sisitau oira}Gdbrei•of Mei forur. - 23:Sitediltaranit:or ailditionallf•eli 0-aii3:
Yitat ttiac use Die back of lliis 04 io prbilde adtlii0tial'welt rile detail:or bell.
S:Numberof wells construtred: 1 - • constiuctioti'delails iron nma}Also atlavh.tdditlonat pages:if n ressaty
- -For muldpk 1,k/.t ion of rir11-H0t r•supply"IYL`uu ONL :01rh r1C rasr/e CR1istrrrctksr,you can • I.
srabuilr onr form.. ' ' ' ' ' . : - ' '' 'ClutiISIITTA I.INSTUCTIONS '
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9.P'ottil welt`depth 6etmw1and wtl ice . 15. - 04 21a. lrnr All «r611 z--Snbitiit.lidsTOM!within 39 . .day�spt'compfciiou-of'we11
Foir r,tah)pJe i+ellr list all rlay.0s lit ,fl'e`it'tit ii.itn piV,t@ 200!<ud 2�'WO eonstnrction to i1ie:ifoitorsi l :: i' •
DU.Static water five]below top'of easiu - (NI Dii'ismn'of Water Rc ou rces,Infirrmation Ptn eyiimg Unit,
If'Why kit tit ilhotc,uih ;rue i'+" •l617'Afuil• .St1Sviec.Ccnter�Raleigh;`C-27699-16 t7T
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It.Borehole tliurrietct:3.25" l l 24b, c t te9 EMIIONLY: In addition to sending the forlrt:to ilirr.addtess-.in.
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2da ab0o.:also stivliiil.a:copy of this form within Sil-dn. ,`01 coaipletioD Orwell
• . 12,•Weir consttpetioir Method DPT cons11riCtion to the following . '
(i a:,aug;,r._eaaq cabla:dinri pis)i..etc:} yy ' - •
. Dir,91611'ofWflterRso curpt,. nder'gruttitdTetjecikanControlPrognun,
FOR WATERSGPPLY WELLS ONLY: • 1636 Mail Serf ice•i eriler,Raleigh;NC 27699-1636'
• •• ifs., or Water Sappy&tnicettoni Welts_k3p• ,(dm) • AclQ of tot': •
Also subtilit one,cgly'of ttus Sorui.'wit in.3i)daysofcompletionof
•1Ib Diiiinfettinn.taps. Amount:. ncil•consimetion to the county.1i hh dcpartur nt of the comity isisere-
FensGW-L .NnithcymllnaEacpanmentseEucsannx-ntandyaturaJRcsowncs•-.DivitIonofWaier€t atrm- RevisedAugust:MO. .•