GW1--06693_Well Construction - GW1_20231024

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WELL,COISISTRUCTION-RECORD
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• '14.....WATEIZZONES
Robert Miller . WRONT: ` AO ' DESCRIPTION
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Nc:Well CortIlacior CatifigitionNiudirt qS.'411TI'ER.CASESIGOat'iiiiitti4iiiti-vitlIsf.ORLINEKtiriti-fkiabk)t ,. .
FRONT - ' •TO ' ;KANO:TER' -' IIIICRNESS ' • MATERIAL '-=•
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SAEDACCO
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' ' . FROM . ,TO DIAMETER • TMCKNESS': MATERIAL
2...Wcit.tOpiktnietfaii Pc.niiit ili • . , .
0 :ft. •25 ft. 2 ' ',IL SCH-40 PVC
/10-447406:41,71'rehpehFif.-N.(4e.Onrop..c..714ve,trariarrce,-0310.64 Cic.1
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. 0,-.6' (c1!4ioi!00)) • 17:.-SCRKEN . . . .
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w4p-8opPly Well:' • • • - nom-. . •To. •ntVatf,TER -starstm, TRICKNISS MATERIAL
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25- M 40 :M.• 2'' fii .010 SCH-40•. PVC Pre-Pack
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E1de6i6imat(Realing1600iii4&Pk): Eliesidetitiattrater.SupiilY(stogie) ' • - ft': ' If .--i'l _ . • . . ,
1:111101LqiriatiC9i1tOtalciill '1WGROIIT:-.
• PResidcutial Water,Suppik(Shated) .. '
TO. . . MATERIAL -EMPLACEMENT METHOD&AMOUNT
. • 0 kitRIRinli: . . . .. . . - • • • - ,. 0 -.1t..' 18 W.- Portland Tremie •
MOW:TM r Supply Welk, ' . • , ... . . ..
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tiaMoniftiring • , _ --dit4Vo.l.v.ty • ' , . '
hil;c1km Welt: . • • . ft.- - ft. - ' .
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- . PAintifer ItcOarge.. • •• • •: 1716tbillik'hiate.iReircdi'aliop -..,.ewSANIOIGRAVELPACKlitairj$16%ohttr • •:.- ----.. : .-. . - - ,.- • •
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. . .,__• 10''- - NI ATERIAL• - '• ,ENIM.ACIMDENT METHOR
, - Olt Andifer.StoMgc,Ond RecM'ety. EiSnliitity Bitirici, • 22. ••rt.: 40 ft. Gravel pack -• #2,
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„.,., . ..... , _. • ., '..2MtDRiLLING,LOG lattaCh mdintion itl iliCeti ifitec6s0-4 •Octeini*unal(Cloud Ltrop) . EITtacer, • .1.11031- • '10 • DESCRIPTION(color.banItitn:si.ill'mck Inw'mvihi__ .... •
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Cideotitettirai tlileatinoitoollog Retum)• . neither,(explain under:AI l-Retuaiks)
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. - 4:biith*ett(s):Cnnitileletit 19 HI-23 • ItrantwcPT-00-40. . . . . .
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• :4:•Wal 1...Datient.' 11. 4.
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OmniSource Corp. .. . IL- R. • • UCT 2 / 2023
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1426 W Mountain-St-., Kernersville, NC, 27284 . - ft... ft, 1--.t.r,:ts,,ze-,-vn
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1.11-ifikko.4*, is...s,,.Cit3',.01{1 fPIi. -321..-RERIARKS- • ' ,
Forsyth • . • Bentonite chip seal 18-22' , • - •
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Comity . Parte]Idoitineation No.(PIN) • - .5:1i,Latitude and biniiiiite in.ilegtveitrainutes!Seetinds iMtliehnnt.dOkiiici; • , ' .
r-cirtifica*'qv .
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• N NV 10/5/2023
. . „ . . .Sigintutt Of.,sf.s:::i.40 V,c1:-..,;„in-4-1-kt"--7 : • , DOg . '
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6.Is WO the-IvellOt•IpItierntaitent or LITetnporlii'.
• k;•4.0inithit•iio#,;.).hr.retreetf,i,quiri4g Jirt/0)kits(!.ver.e,,1.51,r4tmeteif ity,rtry4.irclarcr .
- ' WIN 15.4 NOW 02C•,9100o.iS4.I'1Citc.:0 i a.0200 Well Cp/rstrOctioiSra miff&did Omit it
7,4 thi..'i'ur repair'fd 44...:iimAisigvag faVIt,•• ..or PIO - , 'thit.i7pf ililf ierOrl ha Nen itro1151c4i ro 041.1trli
41 tht.s:Isp rOdli'.jilt oiJi ikrifiii4i gr;..(10.insnicplatibvimriori 6n.tizid ti.00.in rho,norare of the I .
repair reilikt#21.-rivnarks':. :iima or 6.1.the.bad:of this hint.. - :23:Siretliagrantor.additional wetil'details:
. . You tuaY•trie the back of this Page tti:PoWide"additiOnal well Site.details or Welt . •
8::$1nidieron141,s'Onstnteted: 1 • • •coosiniction details: You ina'Ado-attach additional pages if iticeisaty. •
For Jitaliii?.re IrdectiOrCtr.nipi-ittur supply.we?4 g,vix itirkrkitsain.cantstry:etioir,3iottpaa
sykatit 00.c form. - , . . ''. •• •- . SUBMITTAL INSTUCTIONS
f,..Totiii:Weit depth land stirfacei . 40 . ' . (it) :214. Far All Villsr• Submit this Thou within 30 days of,ontpictiOrt of welt
- For*dalpk.i;:iltritst op dept6 if in:Elmira-(c.mipte-3€.200'mut MI I00) ' . constnittionto!he fottowing:. i - .
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1tk t'atic Water kidtieloW top of easingt . . (it.)' Ifivisitill Of•Water RetionireeS,infornfatitinFineessirm Unit,.
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If weiier!del&itioethising:itfi?"+" 167.hfail.S.ti-vice centrs,Raletli,Nt 276594017 •
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11:Rocctiore diameter:6". • . •(in.) 146:For infest:0mi Weilki'di4LY: In addition to sending the cam to the address in
240"abeiliv;also'submit a:eopy of lig farm within 3.0 dabs of.completion of well.
12...Welt construction method:wcito7sonic cotisiniction tO.tIlifotioWing:. ''' ' •
(1.1.9tigi;t,otgy,.1n1*-riditect pcii4,etci} .. ' • . .
. iliiviSio it of Water Remoulds,U,Odefgrouriti Injection Coritt4PrOgimot,
FOR WATER SUPPLY WELLS ONLY1 .1636 hiailService Center,Raleigh,NC 27699-1636 •
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• 24C.For Water%Supply.&injection Wells:
13n,Nield(drat)- Method of wit: ' .
Also stitintit one'ciaPy of this fditM within•30:days of cOMPletiOtt of
13h.flisinfFetilan.tyjiet. Aminint: well;cOnStomtion to' the county health;department-0,f the Cointly where
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FomIGW,E Noah Carolina Depan1ment.of EtwOmucid 34 NTaturallcsourccs'-1147.1s fact aiWater Rt.clip:3 ikevicd August 2013,