GW1--06696_Well Construction - GW1_20231024

, WELL:CONSTR[UC'TION'RECORD'• For fennel ttsc.ONLY:.
'no form can be user(fair.siegfeer multipk wsUs-
1.Wdl.Cout tctorinfortuation: • • -
41:.SI ATERZONES7 ' .
Robert Miller FROM '10 DESCRIPTION
WeIlCoiitadorNanrg, R, ft.
2675-A fr. ff.
NC_WcllComtactorartift®ttonNturbcr • •jI5:OUTER:CASING(firmttti-civod`rieflsl''ORLiNER'(lfan peabk)'a ._
FROM ' TO - ' TDi1METER, - IICKNEFS-• •_ MATERIAL
SAEDACCO • . . . f4. . ft. •. i i'ln
(loin i}-Napm, • • • %tG;i NERCASING'ORTUBING(iiatheriunf'eluiedaoo' ;,='
qru
FROM TO DIAMETER .T[RCNNE5S• ••' MATERIAL •
•
2:Wdll ConstItietian.Pe'nit 1r; 0 'ft., •35 -ft.. 2 I 'b. SCH-40 PVC
Litt till npplfcpbfc sf 41 pis i 1Ji.(Lr,:Gountv.'Srtr:c,%Jelinxr.Irlra-tki rri;.,l'
.ft.,- . • ft. I -in.
3:Well:IFsa(cheek well psej .17:SC1tEEN -
•
Water supply WeIL•, FnaM' -' TO DIAMETER SLOT Sin 1IIICKNr~vs 1 MAMMA'. •
(Jtlgncultttte! 35 ft: 50 'ft.: 2 ' in. .010 SCH-40 PVC 'Pre-P ck
13t4ltinicip lfpnbiiC;: i•
®Geotltennat(HeatingiCooling.5ltppt}) .ClResidential Water Supply'(single) tt: : rt.. .. '.in,
©IudltstrialfConlntercial ClResideniiat WVaterSuppl}'(shared).. '�O ROUT`,To. ,, ._ ..RIAI. EVPE ACEhIEST hiL'riiOD&AMOUNT =
•
Olttipation •.. . . .. . . . 0 ;ft.i 28 • 'fL. Portland Tremie - .
Nati Waiter SOIlik'.ell:
• ldMotiilorini r1Rceotr13 (t._ . ... - . fl . .
Injection Welt: - • ft. ft;
. .' OAqutfcrRechargc flGroundititticr Rentediatian tsaAND1GRAVELPACK•(ii a Il liciabtu" - - -: ..- .- ... _
'6+R1)111 . -.TO' - MATP.RtAI. RMP ACEAOF-NTMETHHOD
i]AgnrfLr:Storageatd Reeei'eiy []Salinity Harriet • 32 •R.. 51 ft. Gravel pack #2
IJArtniferTis;. l7Stoniiw-atci`[)r.,tipaac ' - " .
• It.- ti.
• bE41.7nntcnial TrOolotoga GSIrbsi[tci c toii1r t
a.DRILLINGt:OG'(auaeli addilioniil t(s trneccssnttil:
DQothennat-(Clo edLoup) OT eer' FROM ' -To DESCRIPTION cc br.bxtdncn,anitntcttltii a griQr.ciGl •
i7Geotheanal(FleatiiigICaolhtg Return)• ClOtiter( llaiit uttder:#2I-Retuad s) ' ;.r ' 44 .
. 4-I.,', • fL
. . 4:Dater'stiaks)Couipletetlt'10-3-23 WeliII WFCPT-120 • �F
tee_ L P, ;+, l;• '",
5a:iiVcdIld ocat€nn: • . •([. t4 i i �d'9...
OmniSource-Corp. •. . - .ft,- ' ft; tli, j �:,. 207 .
FieRity,Onr•ncrNamc_ Facditj trig('itappiicablc)•. - - -
•1426 W Mountain St., Kernersville, NC, 27284 ff.; fk, 4••",,a ..,.Y4 J
. . (3'r.QaCI(:e
.016*0 dddiass:.City_arid Zip ILL REI RALRMS .
•
Forsyth - Bentonite Chips.28-32' & 51-53'
Coney' . - ' ' - Iareel.Mentiftctnian t o.(PIL.n
•
' • S6.Lit titad eandton gtadeia dcgtteslrninueslsccundsatdccintri dcgtxcs:' .22,Cf ern •entioi(f teiiaid;ont ltt it b.$ icCd)11• �V 10/3/2023
Sigtniutcdf.:c�t+:.4 ;^ci ?_<`;...e' t" Dais
6..Is are. .)lhC:\ti'@Il�y}: �F1'4t11AnCRt •'Or t7Tentporiii}' its sJr;oing grit faun 1 hereby Lver v thci ing ii•144 mu(wit)0!iiyitigterl tO;Ocv..OrYIanCY
ndrh 154 ArCAC 02C 9(07 oral xt.NCAC t72C.J.3OOItd!Cxncsr cicrio n Swndants and rLvn a
7:4_this-areliirlc:toan'cri5tingp'ell:• ®Yci. Or 121N10 e-rirofthfrrtconihesGrespmtitfrdro?ir well rnthirr, • •
if th(s.Li a 10414 fill u,in4riiwj vat i,ansrrur tlort hrjornuulon lid r.ipinln rile rtarare of MeI -
re,lafr glider i2l remarkcsrriwn ori.vi ilio baik of this fornc. . .23:Site illagrain or:atlditional Welt detalils7 •
YOU play.use the back of•this page to provide'additional hell site;details:or welt-
S:Number of wells eousftiteted: 1 - cousttuction details. You sits}:tiro attacli additional lite&if nrcissaiy-
• For mnfilple.lrtfecilOni}r nisi-aster sulrplp&Hells,OhLY a Irk rho.some coirstriwiiorr,-*po i
'oficrtuo»e!Ono. StIBMl7TAL iNSTIICTION3 I
9.Totalwell ilepth hetoi.r Iimd,stirface.£ 53 ((t.) Ito. Far All.%Vella:' Siibntit this knit within 50 days of eamptetioti''of Well
Forigtihlpfcireitsllsialldtprhslfd(fr+i'rent(exiwptr-3@2P0' id20,109) - - cons(tiielionto the foltasiug: . '
16.Staticwater level tieluty top of easing:, • (i) f tivesiun of`Water Re.Stiur`c ;Inftirmutiern Pittiessing Unit,.
if wateri'ef k it above edifn.lice"+" • I417:Maii.Service Center,Raleigh,NC 27499-IG 17 - '
Ill.SorehOle diameter,6" •(in.) .14h.>:nr Itifeetion Wells ONLY:I Ili-addition to•seading the fonts to.The address in
24daboi;'e:also submit.a.copy:of I this'Anil within SO'dal's'of completion.of welt
12...Well construction.media d:-Roto-sonic • . constiuctian to the followine:: t ,
(i.e.anger salary,cable;ditch posit cte:) • .
i#ivislou of I.Vater.R_i'sources.IIndeigroutid Ciijeitlon Control,Ptngratn,
FOR WATER SUPPLY WELLS ONLY: 1636-Malt Service eenier,Raleigh;NC:27689.1636
131I,Yicld'(g6+gij Mctiroif.of test: 24c.For Water Su'p ily.11c injection.Wells:• •
,
Also Split/tit one'COO}' of this''fiuui,within"sit:da};sofcotuple(iott.of
13b.Disinfcetiun,type: Amount:.. well:constniction.to the-county health department of Ike-Coiinly where . .
constttreted,
Fenn OW-1 NNnli Civalina 1A-paninciriarEseitorumiit and Natural Resources-Dntsbnof Walcr Reorra s Rcsised August1013,
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