GW1-2022-09143_Well Construction - GW1_20220930

WELL CONS'TRUCI'ION RECORD For lntcrmalUscONLY: i
This fonn can be ascd for singk or mtrhipk+cells'
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1.Well Contractor information:
13-A ATER ZONIUS"
Scott Hunt Jr. FROM TO nF;SCa1p"o's
Wail ConKm Name A.Na
tt. ft.
h.
A.
4561-A
NC\@ellComractorCcnifrcationNumbcr ]S:OUTFRCASING for'inuhidnedrells ORLIKER(ita tkalok''
iROsl I TO VI METFit : THIMMV.S5 I MATT,RIA1,
SAEDACCO Inc 0 ft. 5 ff. 4" In. SCH-40 j PVC
CoulpanyN me 16r.1NNER CASING OR TUBING ft!eotherms!closed-loop
FROM .TO I 01,43IETER I TIIICK\ESS I MATERIAL
2.Wc1l Construction Permit fi: (I.
l.in an e),wrable µrut.prnnitf(ix.t ewity.shale.Varinrtcr,fleck rt ew.) .fl. ft.- m•
11
3.Well lisc(check Well use): 17.SCREEN
Water Supply Well: FROM TO AIANIFTPR SUOTSILf I 7111001;SS I MATERIAL
0Agrictdtutai tJMti»icipaLTllUlic 5 ft. 20 ft. 41' in, .006 SCH-40 PVC
i 43cothclntal(HcatioglCooling Supply) OResidential Rater Suµyh'(single) ft. (t. in
OindustriallConiniercial OResidential Water Supph,(shared) 1F8ROGROUT. To stATERtAL` EATP[ACEMGVTMI TIIOD R AMOUNT
oirri ation 0 ft, 3 ft. Portland Tremie
Non-Water Suppty Weil:
ft;
f�.
Oi6lonitorinG Oltcco%ety
injection Well: h: ft.
OAquiferRechargc 06rouod+iatcrRcncdiatiorl 19.5ANDIGRAVELPACKtit rlkattk
FROM. TO .AfATF.N1At. N.MPI\(1:11ENT:N47rintl
OAquiferSiongc mid Rccovci)' ❑Silinity Barrier 4 (1. 20 ft. Filter Sand #1
OAquifcr Tcst OStormimatcr M-unagc
(1. f1.
OE.fit rimcntal Tcahnolo OtilfisidctKc Control
C
20.=DRtl.LING(tAC(sit ach`additionnlsbrtts if eiccccsan)
❑Ckothert►al(Closed Loop) OTracet FROM TO DF,SCRIPTION(tvbr.hrrtlnca wilinwicope.pvifi vae.ot.
OGeothe ntai(Hcatinetooline Return) ®Other( lain under#21 RetnAs) See gho a log ft.
ft. ft.
4.Date Well(s)Completed: 8/24/22 Well1)#SVEI
5a.Well Urcatiltn:
Duke Energy ft. ft. C P g n'
Facilny)0%vrcr More Facility tDk(if aWlimblc) A. ft.
„mil
8320 NC-150, Sherrills Ford, NC, 28673 ft. A. ifli�i:fv FJ 1 : f:.n +"? ""
Physical Addmsx City-tind Zip 21 REMARKC ,
Catawba Bentonite seal from 3-4'1
C;aunn• 1'ar>:ct Id_nlific;uion No,(PiN►
Sh.i.atitude and Longitude in dc)mc%fininuteslscconds or decimal degrees: 22.Certification:
tif++'el)field,one Iattlon i8 crtflitKid)
N W __ .a• 9/18/2022,.. -�
5igtutirrc ofCenfficd Wcll Contm:tor Datc
6.Is(are)the:well(s): OPennanent or oTemporary
Kr signing•!h!s firtm„l lrrrebr'e'errift•Thor the;i•rll!s9 rsYtY{p>en'!eriruttuerert ire ae'r'orrlanrr
n•ith'!SA,VCAC 402C,01(k)Or I SA k fC 02C.02(!O Well Corrsvortkut Sralyltrrds wid ilta7 a
7.Is this a repair to an existing.well: 0Ves -or MNll e(7ltvaf'this rerrrr5'Iliarinrn p ririded rrt�lJnr a+'ll rnrn�r,
If 1his'lr a rclmlr,fill or,tknoi,e,well rnnsink-ifon brfomxtflotrwul expinhr the owrare of rhr
rela.ir tunler o2l r maikc sn jion nr rw dir&N•k of d,is firm. 23.Site diagram or additional well detaits:
You ma)'Dse lire back of this page,to provide additional well site details or well
8.Number of„'ells constructed• 1 cons(roctiondetails. You'thav also'attach additional p1bvS if necessaiy.
For mithiple in/colon to rime=+rarer supl+l+'wells OIVI,)'rr•hh the some constnrelion,+ecru e rn
submirm,e form. 911111i111UAL INSTUCTIONS
9.Total well depth below land surface: 20 (ft.) '24a. Ivor All Wells: Subuul this form within 30 days of complelion of well
Fortnriltiple wells list al/r)rluhsffdlfrr•rejo(es'em,pIN702M'mv12 I&T) constriction to di¢follolring,,
10.Static eater level below top of casing: 00 Division of Water Resources;Information Processing Unit.
lJx�rter leurl is rlbc,ve ci,iiiz;,br: "." 1617.Mail Service Center;Raleigh,NC 276"4617
11.Borehole diameter-10.62 5" (in.) 24b.For lliWion Wcllc ONhti'f In addition to sending the form to the address in
24aabove, also subntil a cop)t of this form within.gib days of completion of i,Vll.
12.Wcll construction method: HSA Construction 16lite following'
(tc.augm rotary.cable.direct push elc:)
Division of Water Resources;Underground Injection Contro fitm,
FOR WATER SUPPLY WELLS ONLV: 1636 Mail Sen1ce Center.Raleigh;NC 276994636
13a.Vidd(glorn) Method of test• 24c.For Water Suppiv&'injectio n,Wella:
Also subnih one copy of this forni within" 0 days of completion of
13U.Disinfitition f)'pc __ m Amount well consinivion to the count}' ticalUt dcpantttelrt of the cotmh.where
- - constructed.
Fonn M-1 North Cwolian Departonew of Em•iron nlc(o and Nittrral Resources-Division of AlaierliResowces Revised AuguSt 2413