GW1--06695_Well Construction - GW1_20231024

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• • WELL CONSTRUCTION•RECORD' Fig Imr.rnal t4c.coNi.-T.- '
This form min bcimml fig.sitigld qr multipk kik-
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1.Well.COntraktor infortitatinu:.
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, ‘1.11:.:WA.TERIONES... , .• .
Robert Miller PPECOI'. to •DESCRIPTION .
SVell CoritmOtor NW, ft; ft.
1.4 ff..
2 675-A I.
it&OUTER-CASING'(fehiftill kistillii-dfil•OR LINERAfitii'IMAM' .
NC.Well Contactor CatificaioRtfurdiet
-Mom ' 'TO •' 'DIAMETER•. TRICKNESS'••• ATATERtAt.
SAEDACCO . . . ,•. ft.•• . i, ,la "
ConlItani-lIa!l • - . • '46ANNERCASING'ORTIMINOOkaikiliiii1 elni.61.1007,'
6TtoNt •TO . DIAMETER THICKNESS. • MATERIAL • .
2..Wr:lltoristruefilin Pernik-0: - 0 :ft,, 10 - 14.- 2- : flit SCH-4 0 PVC
Pt oil opplkOb.ro;Fill poiFiri.t.,;(Lc:Onrney;•Stioo,Vorkorre.,1:10.04
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3.W..r.111350(theelell tte)si . • . . -.,11'SCREEN , •- . . • .- - • -. . ., . . .
Wafgal_BPIPIY WOIV ' -FROM-, .TO . -DIAMETER , s LOT SIM : THICK AT NESS .51EK0,
10' -ft; 25 IL- 2 ' 1.(1., .010. scii.,-40 PVC Pre-Pack
Elitgriefdiiiraf El4iIiidipalfPIitiPC. .
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. • E h loodtermal(lleatingitooling.SUpply) dResickidial,Wateir SupPlY(sitigie)
18,7.,GROUT-- .. -
ElltidnAtial/Conaitercial C:IResidential Water SupplY(shad)" '''
FROAI • -TO MATERIAL - ENIPLACEMEIT-METHOD&AIIIOUNT
• El frtimitian' . . .. , . . .. • . . O. :ft. 4 .11,• Portland . Tremie . . .. .
Noti4,4iter SupPly Well: • - • - -- • . - - • - •-
' ft. • ft.
. ' 61ViDnitOirink .1=1R4VOYCIY . .
Inkcifttn Will • , . R. . .fti -
tlAtiniferpceititgO. CidiOnndwatct Relitettlation- :.,twSANDIGRAVEL.PACICtil;nnittUAW ---= -..:7.:-.7 -. -. :- ---.'; --r-- • •
. •..•-• • • •.• . ,' . • • RONI ,TO . 51ATRIM I. •Fair LACE:06:NT Iki 1.1110 a - •
dAhttifor:StOmp-ard Reef:Of:et; 08.4104.4y.iiiairleir.• 7' . R., 25 It.. Gravel'pack #2.
El 04flii(Fi 7-6t, El$10fMatiePriii.Dpg,..:
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Elb*Np.Ttilltanial TCOD6100. • ElSttb§lkt.wC C01091. . • ' . .
..-. . i-,20:41RILLINGLOGIfiltadi4dilliikoffirdieitilfiteciisatif
ticeisdring Closed Loop). ,IIITiacer '•TROM• TO '- DESCRIFTION fok.r.Minium,kiitnick lyix:Oren siZ6.tle3
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1:1GeothennalilleatingitoollniRmum) 130ther(explain under.ni-Retuaths)
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- Fr. -ft.. .
.4,:t14fti WellO'COMpletedt'16.-3-26 'Well.ID#ePT 01-?5
... . ., 'ft. . . - ft.
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S4.WdILlIcLtttOnt r.t... . '-•
ft,. - --- ' e t.- :. ..7' r-
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OmniSource Corp.. - . . . ' . ,ft.- • ft' • Or T ,2: . .
F kO icilitygm.rNume F'dctlity tl,M kipPlk:riblA,.. _. ..
- R. ft. ' ' _ 9 2023 •
1426 W Mountain 'St., Kernersville, NC, 27284, atu• ft.,. ft . , ,
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Phkili4kftlifSs;_City,;. t Ai s2tttmAitics.:. . . , . . .--.,,,:zzoil. . • -
Forsyth 'llentonite Chips 4-7'
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Cotamr ' ' Parcel fil-aitiOallon No:(PIN
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51i li.atititrie'atid"Ctingfintlefn dcgrcei/MinutiStiirintl§tir decitnoldeglic*. .224 ce •-• •catto . . 1
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dr.weltfialit,brie Aktfloitls•suffloic'HO - ' V
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N ."W - ,!..•.. jvi. ‘ 10/2/2023
• . Sidnature ill'i:::5;i.:1,4,1;4;.e."27.i:._;,fe:,ei .-.....A.1-."-- - DMC
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6.Otto)the.'well(s)r,iiientraitent or -LITemproiy• .. . . .
fty xt.,01ing.thillerno.;-.1.hereL7 coesiXt.Oa the.11.07(5)"Ivy(1 )-0 afiyitireirif hr.,;co:ink-rice
•i Olaf 154 NCAC NC:0100 or LCA NOIC.62C:02011•1!'eil dottiMicrion irao.4ards:TM;Nu d
. 7.4 thisTa repair to an,eXiftioirwel0,' DYes .tir fitINo - 'rekkrktfrfilf•ii•Orrl hiii:14ors'plor Med rii obi!.sirlifilv!ier.
ihi.s:Lco rOyafr,..f.til oar bO-40i rich t.vognir don buformai1On will(.4411143:riortire of rile•
iipOir toidir 021.-riviuerld:seriithith,iNn i:he bale:of:66 form.. :23:80e diagrant oradditional well details . •
Yon May:0S0 the back of this p4ge.ttfinoilite-additforial Well-Site thitailS•or well •
• 8.•Ntunbetof Wells eo ustructed: 1 eonsinktion-delaili..You May allO'atlacti additional pages if ticeesSaiy.
toiiitiiirligg irdoe:r1On'ilr oini-.11.tiri'sup'ply at ONLY irlifi rfy.somq eiorsOfition,•yioit can • • . '•. • . •..-•.- :
.F4tort cri,te pm. V V V SUBMITTAI,•INSTUCTIONS
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O.ll'Otarell depth beloW.hutti stirfacei . 25 V 7, . . (If). .2.1g. For All.Willsf Sandi dus boil within.30 ii.lys of'completiOteof Welt
For ityoklpti iiTlIslist 1111•41epaki 1 fektkreiit(ostorpte-3€100!and 2101001 . "constniettoif to the following; - 1 .
id.St tie water tete]below op easingi. . dt..) .Divlsitin of Water ResoureeS,informatiOnt.oeessing Unit,
Bunter/0els//luxe Ciliittis itse"+" • V V Vlull AlLtil.Seryiee Ceittur,Raleigh NC 27891t-I6t7
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el.i3orehote dismckr:67 . • (m) 24b.For hifection Weill ONLy:1 hi-addition tosending the form to ilfe addressin
244 alidie..;.alsq'submit 4,C.Opy-.of this fault within''.0'days'of completion of Well.
12.-Vell'eonstntetion method:Reto-sonic construction to the following!:
. . (Le.eliggr;noy.calMe.ldigo.Pash.,et.:4
, . . DiviSion tif Water itilourc*,tittderprothad fttlec:tion Control,PrOgrant,
FOR WATERSGPfi.X WELLS ONLY:' 1636 Mail.8eillee Center,Raleigh,NC.276994636
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24e..For Water.Sittinlv.&Injection.wetts:. '
paili'ieldtput) .Metho.4 of test:
. Also subniit.'ono•'coPy of this'.fciitn"Within'30:days of completion of
A 131..•flisinfection type.r. Amount: •
' well:cbiltroction•tO the eaunty fralth dePartment of'the;county where
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' konti.GkV-1 North C3I011113 Lt...-panniou,pf Enkiromucia and Natural ticgources OWL loot of Water ft*trcm Rcvised August 1013
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