GW1-2022-05470_Well Construction - GW1_20220601

i
WELL CONSTRUCTION RECORD For lacnual use ONLY:
This form can be used Car single ar mritipk nclls
➢.Well.Contractor Information:
:tiAVALTERZONES
Scott Hunt, Jr FROM. TO 0F.SCRIPn0%(
Well CorriradorNinuo ft. ft.
4561-A fL fL
NCWcllConnnctorCcnifw�ationNurdter 15.CUTER,CASENG(f6r®tuHi4is9 d'arc(Js)ORLINERltfO Elcahkl:
FRo,m Tp I DIAMETER TumCtiNESS NTAIEHIAL
SAEDACCO Inc 0 tL 15 IL 2.25" in, NA STEEL
Compwty Nanto id.'tNNER CASING OR TUBING' lioIYerma►closed moo
FROM I TO I DWIMElI THICKNESS , MATERML
2.Well Construction Permit#: R. rt, in
110 sell applicable well primps fee,Cmrnrp,
(t, ft. ir4
3.We11 Use(checl,well use): E7:SCR!EN
WaterSupidy Well: FROA11 TO AIANTETF,R VOTSIU. TR1CmtNT�'S'S MATMAL
OAgricuitttlal Mfuntcipal/Nblic 1:5 R. 19 ft. 1.25" 1% 004 NA STEEL
®Geothermal(1Eleating;Cooiing Supply). ®Residetuial Water Supply(single) ft. fL
®industiiaUCommcrcial ®Rcsidential Water Supply(silawd) 18'GRO[rr
FROM TO 'MATERIAL EN[PLACIMIENT AMMOD S ANEOUNT
❑1TIi ti0I1 R. tL
Non-Water Supply Welt:
QIvignitoring Mccovcry tt. fit
Injection Welt: ft. fc
C1AquifcrRcc.barge Mdrourid%:ttcrRcnlcdiation 't%SANMKAVEL-PAC1{Gr ilicAN
FROM TO AmrRittm, E NlPLA(MAIENT WIMHOn
l7Af(1lifef Storage gird)tccaNrq' []Salinity t3arrict R. fL
❑Aquifer Test mfomm-atct 1)M1nagc
R.❑Eglcrimcntal Technology 17Sltbsidcncc Control ft.
'20:'DRILLING'l:OG(attach addilionnN sheds iunemsan•1
Ott:otitetttral(Closed Loop) []Tracer ,FRONT TO DESCRf TION ooan hardnecr wt(hnck type,mrkhl-'de,dr l
13Gcndtenal(Ilea[it /Cooitu Muni) [30ther(explain under f121 Reulalbs) fL tL see Geologist's log
fL It.
4.Datc Wcll(s)Completed: 5/3/22 Well ID#Cl-C19 � ^�
ft. It. rZ F m`--, — I
.5a.Wd1 Location: f4 fL
LC Hudspeth fir. fL .-„ -
2022
FncilityXh ncrNamc Facility IDN eWapplicable) R fit, { *CDR P�� Uflh
5891 NC-90 , Lenoir, NC, 28645
R. rL r
Pipkal Addicss.City.and Zip 2r REMAR" .
Caldwell Direct push injections with drill tooling.
Coanly P�Mel Idolliriiclliun No,(PIN)
$h,I-atitude'and ILungitade in dcfirveN/minptcsJseconds or decimal degrees: 22,Certifecar6ow
(irviedl veld,Oita 1 10M Is stdllckid)
5/21/2022
SiWwmofCcitificilW.ellCall-tor Dale
6.Is(ate)the well(S)t OPermanent or MTemporary
H}•aignrng this form,l lrerebr certify rhos rhr n•rll{s•J tsar(kern)cuaxtnrcfcrl err mrorrlmrcr
tcith I�t,YCAC 02C AItIt)or IS�t 1JCriC OZC,(]200 11e:11 Cons(rxrcrfat Srarkimds mud slier a
7.Lv this a repair to an existingwell: OVes or ®No Coptsofflik recordhas becur provided tothn rrrli miner,
Iftons It a repalr,fill cm(b7t4aVr reell[atl)mrMorl brforrnadar mil ruptfahr die rurrare pjrAe
rrpairamlerA*I rernarks.srctian or an Me bmvk ofddx foam 23.Site diagram Or additional well details:
You may use the back of this op to pro%ode additional well site details,or%veil
$.Numberof wells constmaed: 19 cousintedon details. You may also attach adrlitioual pages if trec eery.
For inalroe Jq( yripn or oar-it+arer suppry ivells ONLY a irh rbe some cutrstrurtiptr,}an.am
srrfmtft aim form. SUDMITTaL INST T .TIONS
9.Total well depth below land smfaet. 1.9 (ip,) 24ir. Hbr All Wells; Subntil this form within 30 days of tonp[ction of Iv'ell
Ferroalrlpleiveffs list alldepthsIfdJ,f'ievew(erarrepfe-3@:00'arul2@100) construction to IkefoltouinF,;
10.Static water level below top of casing: Division of Water RetourcLn6 Information Processing Unit,
If it untr level Js above ca.,fag.we"+" 1617 Mail Service Center,Raleigh,XC 276994617
11.Borchotc diameter 2.25° (�) 2 tb.Fnr In( net`VeAv ONLY: in addition to sending the form to the address in
244 above,also subra t a copy of this form within 30 das's of completion of well
12.Well construction method: DPT construction[a the followitrg:
(Le.agcr.rotary,cable direct posit etc.) Division of Witter Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh,NC 27699-1636
➢3 L It cdd(gpm) Method of test: 21c.For Water Supply&Injection Wells:
Also submit one copy of this form within 30 daysof completion of
13h.Disinfeeflun typo:. Amnuut• nxll construction to the county itcgith department of the counhrwhcrc
constructcd,
Fort GW-1 North Carolina Dcpcunmcnt of Emdronnria artd Normal Remurecs-Divislon of Water.Rmotr an Revised August•2111.1