GW1--00820_Well Construction - GW1_20240131

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WELL CONSTRUCTION.RECORD Fur fl anal Usc QNL\:..
This Cohn can be used Cot:single of tnultip)wells••
I.Well Cbntractar Information:
14:MATERZONES I ,
Rich.Lomita . FROM ' Tel -DESCRIPTION I '
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Well CotiraotNatre' ft.• ft.. - I 'I
it. . 11 .
NC Well Contractor CcrtiliiealionNuitties` "12° _" ° I 'Ll•7" Li (5'OUTER CASING(foemutll:eisediteils)ORUNER(ifa'Pi trcabkl:
FROM Tu : DIAMETER" i THICKNESS. .MATERIAL• .
SAEDACCO • JAIL 3 1 2024 0 R. 28. ft• 2 Ito, SCH-40 • PVC
Compaa l'iy me 16.INNERCASINGOR TUBING(gothernialclased-loop) '
' -•FROM TO . I DIAMETER - THICKNESS MATERIAL
- 2.Writ.Construction Periilit it: Inf.olrf7c ur ntPCG-C 44r:--:, Ulq, . • ft, ft: l,L'
l ru all applicable will peimita(Le.County;Stme,•VaWillAgJig iMj exc.). • ._ •
.R: • . ft. :tn
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3.Welt Usc(chalcissell rise): ta:SCRCEN
Water Supply MOM'. . TO .DIAMETER SLOT SIZE 11I1001Ss. AIATnnrAt,
Cltlgtteuitutal • DMunicipaliPub)ic 28 R. .33 R: 2 'hi 010 SCH-40 PVC
DGeotheitnat(licating,'Cooling Supply) ClRestdentiat Water Supply(single) R' ft. in.
®lndustrial/L'ontmtercial llRestdential-Water Supply(shared) . ' •.Ta:GROIFT
• • • FROH TD . •MATERIAL ' EMPLACEMENT MEn1ODBAA!MINT .
' Ofriipltion •, 0 'It. 5 ' ft. PORTLAND TREMMIE •
Min-Water Suppl*Well:. .
(t.. St. ,
{Monitoring . • . lRccovcry • .
Infection Well: ..ft, ft. .
ClAmiiferRccliarg-a' DGtoundn:[tcrRenicdiatioa `t9.'SAND!GRAVEL•PACE.(ifaliplicabls)".
.. 'Horn - TO 'AL\riatrAl. F?Atpt..t(:F:tiL,ts1tt'ut)n .
ElAtraifcr.Storagcand ltccovcg' • 1:1Salinity llamcr 26 ft.. 33 ft. SAND 6 #2
❑Aguifcr.Tcst EISto►tiramcrDrainagc • . .
R. fL i:.,l •
• IDPiiperimcnktl Tcehnolosg 13SRbsidcnce•CDntro1 • . . .. . ..-. -
3a DRILLING'LOG'(allard.additiotial',hcetsifnccessan•I
t7Geodld,inalClosed Loop) ❑Tracer . • .FROM-' TO DESCRIPUION(cobr.IIArlfiteN,wWIIntekij'ne-ertin site:dea
DGeothennal(IleatinalCaoline Return) 'C1011ter(explain under.#2t Reuiaibsl 0 .t. 8' ft.. RED SILTY%CLAY
' 8 ft., 33 (G ROCK f '
4.Date WW fl(s)Con)pleted: 1-4-2024 lilidl IDMMW-41D
•R. R...
Sa.Well Location: ft. ft
GASTON COUNTY LANDFILL - _, It. ft.
.FaclilyiewncrNamc . Facility ID#.(iFappikablc) • . R . . . ff. . . 1
3155.Philadelphia Church Rd., DALLAS, NC,..28034 .n ft
Plti3icalA4dtrss City.and Zip ,,it.REMARKS
GASTON • . • BENTONITE FROM 5' TO 26'.
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Comity Navel IdealiffGltion No,(PIN} • i '
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5b..Latitude acid Lwigitude In dcgrccsjminuteslsecnnds ordecibed dctreeg 22.catifreation:• ;
(ituell field,one lat/lotiy It stdlietarl) 1
w• `"rt tJI -.Q/r,si:-. L. 1/6/2024
..led...
sigruwir;orceni WeltContrrctor Date •
. 6.Is(are)the rseil(S): %IPerinanent .or IJTempotary . lfy.signias thin form:I hardy trrr 4 that'Mg well{sal was torn1 ea-mina-led II 1 esanicncr
- . with I NGtC OW,ploo or f SA Nate 02C.0200 Well Constrtrr(ar Standards and tivrr a
7.Cs this arepairto an,existingrt'clt; 17Yml- or KIND :c,iis:of Mir won!nr's('eon'prorde4itoilia',irllmiller,
if tills'is a iepair;Jill act knoitii,yell corutntetlon.hrfortnarlon awl explain the nature of the I
repairwrda-r2i remarks sachem ar an the bark 6f tldr fornc 23.Site diagram'or additional well details: - •
ay use
the back of this page.to preside additional well site details or.Well
8.Monitor.of stills constructed: 1 cotutmction details. You utay also.ailIacli additional pages if Decessaty.
For nrnhlpie Irk jecilnri or mini-ubrer sirppls�wits ONLY with ifn'same canatnrctfon,you eon •
submitonefora,. SUBMT'J ALINSTUCTIONS. 1
9.Total well depth below-land surface: 33 • . (R.) 24a..For Atl Wells; Submit this fonn within 30 days of completion of well
Far n dhlplc weilsrlisr aft depths ljdleereal(example-3@200•and 20 WO) construction to the foliottia8; • j'
10.Stacie water level below top of casing: 30 . MODivision of Water RearoureeS,Information Processing Unit,
If ndrer level is above c using:are"+" 1611 Ma Service Ccritcr,Ralci ,NC 276904617
IL Rorch lediamcter:8.25/4" • (In.) 24h.For fnieetion Wells ONLY: in addition to sending the font to the address,in
.24aabove.also.subnlit a copy of this'font;within 30 days of.completion of well
I2.Well cnusteuctioainethoth AUGER/AIR . . conslmetlon collie following: ,
(Le. r rotary,cnbla direct push etc:}auge 'Division of Water Resources,Yoder round Injecilon•Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center.Raleigh,NC 276994636
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fax kids!(gptn) Method test: 24e.-For'Water Supply&II✓j Icction Wells: . •
Also,submit one copy of this fonni,within 30 daysof completion of •
well consinrction to the county health'department of the.connty.wheen;
13h.buinfnKion type: Amount:
constnicted.
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Fonu GW-t 'Noah Carrilltra Departntrm.of Euyirarmrnt and Natural Resources—Opinion of WaietRentt,CM Revised August2ol3
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