GW1-2022-09145_Well Construction - GW1_20220930

W19L"L CONSTRUCTION RECORD
For htcnil1 Use ON1;1': �
This form can be used for single or mulliplc wells
1.Well Grotractor.information:
-14 WATER ZONES- "
Scott Hunt Jr. FROM TO DFSCRIPrt(
t\'cll Ct?rAridor NTine
fl. it.
fl. f1.
4561-A
z1S:OUTER CASING forinuhhcased w'eps OR L1Nktt H a" 1kifDk
NC Well Coninctor Cen Meal ion Number FROM TO DIAMETER- THICKNESS At,
SAEDACCO inc 0 ft. 5 ft. 4" : in. SCH-40 PVC
Convinn?t,lnre n1NNERASINGOR'TUBING M(berrnatclowd-torn:' '
TO DLANIFTER THICKNESS MATERIAL
2.Well C?onstmction Permit N:Lis?«ll aprtlirnble wellprtwils(i.e.ramr-y_Viar..Varinnre,lgeaado4 elr.)3.Nell I}sc(chat:well use):Water Supply Well: 70 DIANWTER NtA,/TSt7% THICUMN-% I MATERIAL
GiAgartfhulLt OmllniciNillhiblic 5 ft. 20 If. 4^ In. .006 SCE-40 PVC
(3Geolhcmtal(Heil inglCooling Supply) DResidential Water Supply'(single) fl. R. in.
.. _.
0IItdUSltia1/CO111nieR'lal h1RCSidential Water Supph'(shared) 1A:GROUT
FROM I TO MAITRtAL E.stPL ACFMItiT Mr MOD&AMOUNT
Olin ation 0 ft. 3 tl. Portland Tremie
Non-Water Supple Well:
ft. ff.
ownitoring ORccovery
Injection WeI ft. il.
DAguiferRecharge OGroundn-llcrRcowdiation '19 SANDIGRAVELI'ACJKC if dkahk
FR()M. I I MATERIAL. F.MPLA07VIVINTMt"rnoll -
0Arluifcr Swig Ind Recolrr)' ❑Salinityl3amcr 4 A. 20 ff. Filter Sand #1
OAguifer Test 0Stornmater Dmina9c ft. ft.
0E\1xr1mcntnl Technology ❑Subsidcr►Cc Control
`20:DRtIA iNG LOG(>tlluh addiliorial s"5 If oky%sin
❑lSo6thennal(Closed Loop) OThcer FROM TO DESCRIPTION(ebbr,bardnca 1441'ntck n 4 AIt.Luce
OGeotlicinul tlfeatioelCoolitle Return) ®Other tee lain under 021 Remarks) See gbo a log go.
a.Date,W016)Completed: 8/25/22 \Vct)ID#SVE-3
ft. ft.
` a e.—
5a.Well Location: h. ft. "� '" IL
i _ WW1'
Duke Energy Tt. ft. S F P ,l
22
Facilih-,'O+vncr Ninx Facility IDR(if applimblc) R 11.
,•
8320 NC-150, Sherrilla Ford, NC, 28673 ft ft
Pltvsical Address.Citc,,and Zip 21-REMARKS-
Catawba Bentonite seal from 3-4'
Cuntil)' No.(PIN)
Sb.Latitude anil I ongltudc in dcgrxslminuteslsceondc or decimal degrees: 22.Certification:
(ifsseti field,ow latlloq is Sistllckfdl
N W 9/18/2022
Sigmiurr,of Ccnificd Well Contranor Date
6.is(art,)theNell(s): .R1Pennanent or .OTcmiporan' j/p sy iring.Ihrs foI?rr,.1 herrlrh ee�tiJv dldl,Ihr NYIIls)r+u5'{WYIr)[vihfnuticfl in fK`cOYrlfin@r
ulth 15,1 NCAC 01C.0109 nr IJA NOW 111C:n1p91tell Cowm7or nail stir yknds Anil11Kv a
7.is tbie a reliair to as existing well: ®Yee or MND rrpy of this errant lmv hews pnibidrd to J)he rarll a?per.
1f lhls is a rep(dr,fill car known well ranrinfcdor hrfoonadon dnrl ryrahr the score of she
relmirintfer021 canards.ver iorr or rvr(fir bful of thA form. 23.Site d`IaQram or additional well details:
You hiss,use the buck of.this page to'provide additional%Tell site details or well
8.Number of wells constructed: 1 consituctiondelails. You'tnac•also'attach additional pages if owessaty.
For in rldple iq{eeihm cN rrrol-warre supgv wells O/V1.1'whir the some ronsfrurllon,;rite,rim
sul-mirone form. S61IMITTAL.fKS'Pt)C'I76NC
9.Total well depth below=land surfaW 20 (fl:) 24a. For all Wells: S ubntil Ibis form within 30 days of completion of well
For❑tit iptt?cell(list all depths(f dlfl'ereru(rritrn/'ir•o7rn 200'eHu!20l(kf') canstnection to tuts.follmling-.
10.Static water level below top of easing: (t.) Division of Water Resources,Information Processing Unit,
If tswep level Is rrho?Y ceisinx We"+.^ 1617 Mail Service Center.Ralcirli,NC 27690-1617
11.Borehole diameter.10.625 (in,) 24b.For inI flifUll V j_ON Li:: In addition to sending the form to Ate address in
243 aWYe. also submit a copy of this forth within 0 days of.completion of well
12.'kVcll construction method: HSA construction to the following;
flee.super,rotary:cable,dimes push ctc:)
Division of Water Resoures,Underground Injection ControlPmpram,
FOR WATERSU'PPLY WELLS ONLY: i636 Mail Service Center,Raleigh.\C 27699-1636
i3a l�dA(gpm) a4lctltod of test 24c.For Water Supply&inlectiun:wills:
Also submit one copy of this f&ni within 3,0 daYs of completion of
13b.Disinf�titiunrpc - „_ Amount well conctntction to the countv licalih dcpnrimeni of the crnmt��.ts'hcte
constructed.
Fonn G11r-1 North Carolina De-pannxnt of Envirunn►ctlt and N:unrat Reaturecs-Division of Wales Resotrtes Revised August?o13