GW1--01253_Well Construction - GW1_20240229

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WELL CONSTRUCF[ON RECORD FurtrlcrmltfscONCY:
'iLis farm can be oscd for single OF multiple hells'•
1.Well Contractor Information:
:IS.WATER ZONES.
Scott Hunt, Jr FROM. TO DESCRIPTION:. ,
iVc11CottitadorNattw- 17 ft.' 30 ft. sandy slit tan
4561-A. R. it I, .
NC Well ContnclurCcdiftcaliooNurrttci ;IS.OUTER CASING(for mu(tt csscd'ncils}OR LINER(if ap tticaWe)
FROM TO DIAMETER, .THICKNESS MATERIAL
SAEDACCO rL (t.. JR.
Company Name :IG.INNER'CASING OR TUBING(geolhcruiat efesed-lop). -
FROM TO• DIAMETER. 'THICKNESS MATERIAL
2.Wdt Construction I' ri it#: 50000316 0 'ft. 15 ft. 2 . 'ua SCH-40 PVC
rut t aI(ap ilicade trehpermits(ix.County;,Stan;;Writ-Jere.Irryaticn err."
R.. fl. im.
3.WeltDs.9(check welluce): I? SCRC.EN
Water Supply Well: FROM To 'DIAMETER SLOTSI?E I THICKNESS. MATERIAL
0elgliculullal. l7MunicipahPublio 15 ft. 30 ft. 2 iti' :010 SCH-40 PVC
CtGcothenual(Heating/Cooling Supply) ®Residential Water Supply(single) • fi. re• is 1
• ©hldusttial/Contnietr:ial ®Residential Water Supply(sbattd) .tq:GROUT
FROM - . 70 • MATERIAL . EMPIACESIENT MHRIOD&AMOUNT
❑hiipation . . " 0 ft. 11 ft: Portland Tremie
Nan-Water Supply Welk• .
R. "_ft.
ZMc nitoring. . DRecoyery
Injection Welly ' ' ' rt. ft: .
' El AquiferRcchargc • ®GlouridivatcrRcnicdiation L9.SANUIGRAVELPACli(if apOh:sb ' .
-FROM TO ' JIATERfL. EMPIAC.I:HF:VTMITHOD
13Ago}fcr.StoragcandRecovcty 17Salinityi]airicr 13 R;. 30 ft. Sand #2
UAgtiifciTcst C15tannitiatcr Dry rage
. ft, ft..
IDEgrcritncn iTcclmotogy DSubsidcticc Control --- .. .
20;DR!LLINt LOG(attach additional sheets if occescan'I
CGeolkeruial(Closed Loop) I7Ti cer . .FROM, to . ' DESCRIPTION Kobe:hard tied;lrnwreutane.rnsiar .dc.I
E Geotheuual(Heoting(Caoliue Return) ClOther(plain under#21 Rethinks) 0 :rt. 1 ft. gravel !
• 1 •f. 15 fL red tacky clay
4.Date Welts)Conlplered: 1-11-24 :WeU iI) MW-7R
15 :ft.." 30 ft. tan silty/clay sand
5a.Well Location: 4t.. fL•
Pet Dairy (t.. ft'
l'� f
Faciity,CicocrNamc Facility lD#(ifapplicable) ft. �-` .� EI •( G
R.3300 The Plaza, Charlotte, NC, 28205 .ft.. ft. 1-EB 2 - 20Z4
Plgsical Address;City.and Zip- '2 L REMARKS
Mecklenburg Bentonite seal from 11-13'I' )fltt)r4t E(1 rpr''iG*344,..j 113
County I!atcel Idcriliflcalior No,(PIN) I 11i�Yt3.' tX-
•
Mr:i itti(ude'anil Longitude in degreeclminutestsecnnds nr dcchual clerr vex 22.Certification:
(ifrcitfield;ovc ollongiFsofficieid) •
N �r /240elve--
1/25/2024
• • . Sigrxfa Well Contractor .Date
6.Is join)the well(y): %IPcrmanent or t7Temporsn' By signing'his JFrna;1 lrerebp certify rhardie a•d 4i)war jysrne)cr»rrinared try an»nlmrer
'with IM NCAC 0ZC.pial or I SA NCAC-02C.172D(7 Will Construction Standards and Anti a
7.Is tits a repair to an basting'went DYC,. or "inNo •reyirofMic word has bien'prowided torly:urn!owner.
If rjr(sly a repair;fill our knoirzt ouch coutrucrlan.brforrrrar(an and eaptaht the nature of dire
repair under P21 rrmark+''intros or on the bark 5f dots fornc 23.Site diagram or.additia nal well details:
You niny use the back of flits page to provide additional well site,details or tselt
S.Numb-et-of wells canstlucted: 1 constmation details. You inay also attach:additional pages if Il.^cessary-
For mulr(ple tr(lecilon.or not-'carer suppJ-.wells.ONLY ivith the same caaatrurriorr,yo i.cpn I
. sukmit'one far'r. ' . $UBMITT%L INSTUCTIONS�.
9.Totat welt:depfh below land airfare: 30 (fr.) -21a. Fnr All Wells: •Submit this'fo i'u within 30 days of completion of well
For nrnlriple'weilslist all depths(f((Wren;(ctarnplr-3=00a rut?c0 W00) Construction to the folloning:
10.Static water level below tap of casing: 17 .(.(.10( Division of Water Rc ourei ,Inforrnatign Processing Unit,
If cola level Is above easing use"+" 1617 Mail Service Center,Raleigh,NC 2 7699-1G L7
11;Borehole diameter:8.25" (b,.) 2-lb.For Infection Wells ONLY: In addition to sending the font to the address-in
.24a above.also.subunit a copy of this fonm within 30 days_of completion of well
12.Well construction inethodt HSA conSlmction to the following: i
(i.c.auger.rotary.'table,direct posh etc.) .
'Division of Water Resources,Utidergouud Injection Control Program;
FOR WATER SUPPLY WELLS ONLY: .1636Mtil Service Centcr.;Raleigb,NC 27699-1636
13a.Yield(gym) Method'of test: 21c.For-Water Supply tic Injection Welk: .
Also subtiiit one copy of this faint'Within 30;days ofcotupletionof
13h.Disinfection bile: amount well construction to the county health department of the connty.w•hero
constructed.
Fa nu GW-t North Carolina U.-pmtmenf of EmUromo:m and Natural Resources-Division of Water Rc6ci.rcz Revised August NIB