GW1-2023-01954_Well Construction - GW1_20230227

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WELL CONSTRUCTION RECORD For tmcnml use bNLY:
'this form can be used rer single or multipk%vells'
1.Well Contractor Information: I '
44::WATER ZONES
Scott Hunt, Jr FROM TO Dr>_NCRIPr1ON
1%'01ComraclorNamc R. ' R. ( '
4561-A
NC Well Canim6orCcnifacationNuniier Lt GUTER AA51NG fbe:atltiPd¢iQiserlsloRIiIYERlffa'"flcable'
FROM7O DG4swrER THICKNESS MATERiAL
SAEDACCO Inc 0 ft. 1 25 fL 1" in' SCH-40 PVC
Cant/u y Nautc I6 INNER CASING'011 RING- 'eaibermll clesed-loa .
FROSI. TO DIMMETER- THICKNESS MATERIAL
2.Well Construction Permit#: R. ft, tl4
List Ir1I ajyalirable x�N p¢neits(l r.County,Shure,Variarwe.1(ftr6C4 Crr4
im•
3.Well Use(chcdcwell uscj. t7:5CRlJ N
Water Supply Well: FROM TO MAXIFTEet SLOTSIZZ THICKNI'SS 51ATRRLu•
MAglicultmal ❑&Iunicipal/Mlic 25 R. 30 R. 1" im 010 SCH-40 PVC
❑Geothermal(Heatingt`Cooling Supply) ®Residential Water Supply(single) el. M (ao,
®industriaUCamniercial ®Residential Water Supply'(shared) t8:CROtLT
-FROM TO hiATT?Rtl:L . E\[PLtCEh1EVTh1ErI1ODS'AhIOONT
❑rein ation ft. (t,
Non-Water Supply Welt:.
R. rw
MrVionitoring mCCONery
Injection Well: rt
❑Aquifer Recharge Wroundvsttcr Rcmcdialion i19:SAND1GMVE'L PACK tit a t licAhte)'
FROM TO 1INIVIRtt1. FMPI.A(1A1"TMFT1r(nn
C1AtjrtifC rStOtngCandlZttioF'Cr}' i7SatlnitVi30rilCP 23 R. 30 (t. Filter Sand #2
gAgnifcrTcst aStvmm tier IirvinaRc
R. ft
01 giC[irnCntal TcchnolaU} ❑SubsidcncC Caldiol 20:DRILL ING ILOG(attich addiiiotnei iticili it Recessan•1
17GrotUr ml(ClosedCoop) ❑Tracer Fftohl TO DESCRIPTION mbr.Imnlnen.soAlmekty 'nAm.dr.%
❑Geol1""'l(ReatinglCooling Return) ❑011ter(Mlain under 921 Remarks) 0 rt, 14 ft. gravel
14 fr. 30 rL sandy,' silt
4.Da'teWeU(s)47oulpleted: 2-8-23 WdIiD#TW-02 y"
ft. (t•
5a,Wdl Location: ft. ft. _
Speedway 7963 FEBL
Facel4)'0%vperName Fi alit IDg e1rappli abie)
R. ft. inl^r
ft �lS :S
2418 Springs Road NE, Hickory_, NC, 28601 rt. . �!:
Physical?eddicss.City-and Zip a2t:RE6IARKS
Catawba temp well for a water sample
Cnnoly Parcel itknlifcellioo No,(PIN)
5b,i atitude'and 11.6notude in deb.•ceslminuteslseconds or decimal delp ces: 22.Ccrtifec gtiten:
(lttvoil deed,Oita 101ong is in"Icicnt)
N W � 2/15/2023
Signnturc al'Ceitirwd Well Ce .tar Date
(►.IS(an)IhC Rell(s): OPertnanene 0fi 81TCmpOraC}' si nett iltir.amr,t hemb'y cerri y Mar trek Irel.s Mier(wrrel cor rrnrcred ire m'ror&lnce
d3' S & f f' ')
with l5tt NG%C 02C•0100 or 13d NCAC 0i7.0200 lVell Conshncrioa Srarxlards and otter Cr
7.Lr'tki..v a repair to un exis ILIXNvell: ❑Yes or ®No Myoffbirr reconllurshrca(uovirkd rn the urll miner,
If bens is'a repolr,fill crir krwim xelicomintettan hiforriwrim mad i,pldht the mrdre of the
relwfratrder 921 mnarkr arcrian drag the Lack of this farm. 23.Site diagram or additionut vretI details:
You may use the back of this page to provide additional%cell site details or welt
8.Number of wells constlroLYed: 1 Wtlstmction deiaiis. You ntay aiso itlacti additional pages if iwcessatp.
For nud#ple igferrl?n or am-user supply n'ells ONLY w1th the same consrrui'ttorr,}'oar Can
stdraur mm form. - C 1RMLITA .INST ITC-'PIONS
0.Togo Wf tl depth betmv land surface 30 (D.) 24a, For ALL Wells: Subndt this fiirmt within 30 days of completion of%relt
For ttrahiple ivells list alideprhs lfdoerenr(crmtaple-3@200'awl2@ I(a0g constmctian to tic fbitov%ing;
I
10 Static%cater level hela%%•top of easing: 20 ( ) Division of%tcr Resources,Information Processing Unit;
lfnnrer level t,above casing,am"+" 161711tait Set'%'im Center,Raleigh,NC 27699-I617
i
11.Borehole diamctcr:2.25" (Lu,) 24b.]ur lily n`Vrliv ONLY: in addition to sending the forru to the address in
24a above.also submit a-copy of.this form within 30 days of completion of well
12,Well uonstructiou method:DPT constmctiou to the following: 1
(Le.auger.rataq,cnblc dim a pesth ctc-)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center,Raleigh,NC.27699-1636
13a6 Yield(gpm) Method of test: 24c:For Water Supply dtcInjection Wells:
Also submit one copy of this finial,within 30 days of completion of
13b:Disinfection tope: Amount: %vcll construction to the county liicalth department of tic counter where
cownicted. i
Fen GtV-L Nonh Carollna Dcpmrmrm of EntirojmriLt aad.%n"Resources—Divi;ks of 1Valcr Reatrcn Revised August M l3