GW1--01538_Well Construction - GW1_20240312

WELL CONSTRUCTION RECORD .11°. Far irtsrilal Use ONLY;
This form can b:used for single or nwltipk swells
• I.Welt Cantnctor Information:
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;t1 WArERZONES
Scott Hunt, Jr . - - FROM ' TO DmieSti t1ON '
Well ConnacrorNoma 5 ft. 20 ft, ,sandy silt'
4561 • ft. ft. i
NC Well ContmelorCenificalion Nutrber -IS OUTER CASiNG(for maoil-eas:livens)DR LiNER lif an licabk),
MOT_ -To DIAMETER, . THICK'NT.SS. MATERIAL-
SAEDACCO ' ' i[ ft. ' le.,
Centrum).lvame 16.INNERCASING OR TUBING(geothermal ckod-loop);;' '
;FROM To DG.METER • THICKNESS STATERLAL
2.Wdt Construction Pcrnit It: - 0 ' ft, 10 ' ft. �2 ' 10. scH-40 PVC '
fist aB aplrlierlde rmll peindti fix.Carurty.Store,Variance,Trialicei ea)
M. ft. in
• 3.Well Uac(check well s1ce): 17:SCREEN
-__ -_ _ '—- _---_ ___ —. ___. .,"_.. - FROM. TO DIAMETER SLOT Sin. TIIICHNINS I MATERIAL
Water Supply Wrht 10 R. 20 'ft, 2 in, .010 SCH-40 I PVC
°Agricultural C1)+iunidipatiPubGc• •
DGcothelmal(HcatingllCooling•Supply) " °Residential Water Supply(single) R. ft. in,
Dlndusttial/Conuttercial • • I2Residcntial Water Supply(si ared) " o„ . . To . sr t1ERIAL DIPIACEMevT 3iemOD&AMOUNT
❑Itrii atian 0 ft. 6 ft. portland tritnmy •
Nou-Water Su tip ly Well:
rt. rt.
. mMonitoring glRcco eiy .
Injedio:1,%Nett: ft. • ft. . . -'
®Aquifer Recharge ' CJGtoundrvatcrReniediatioli [9."SANn/GRAVEL PACK(ifaitpllcalde), - - -. -
FROM • ' TO MATERIAL EMPLACEMENT M mum' '
°AquifcrStoragc and Rccovety °Salinity Barrier' 8 ft. 20 fl, sand 2
❑Aquifer Test. °StommatcrDrtiga�C fr. • fi.
❑E q;rimenIul Technology °Subsidence COMM!' : . -
20.DRILLING LOG'(allach ndditionat!Medi ifncccssanl
°Geothennal(ClosedLoop) °Tracer FROM .To DESCRIPTION(cnbr.hardness:tolLnickSi(woe('iite.OM
• °Geothermal(HeatiugtCeollue Return). .'°Otter(explain under#21 Retualks) 0 •ft. 20 fi.. sandy silt V
fr.. . ft.
4.Date Well(s)Completed: 2-20-24 Well IDyMW-1 ft. R. I.
5a.Well Location: .fr. ft. r
Greenville Utilities Commission f. ' ft. d 'I,r.-,o• Ls is V :Lr
FacitityiavnerNarnc Facility!DP..(ifappivablc) - - -
"' • MAR i •2 2024
240 Aqua Lane , Greenville, NC, 27834 ft, ft. .
Plnsical Address.City.and Zip z21-REMARKS. '-- ::, [17,Y.
Pitt Bentonite seal from 6-8'; • . �.
Conan Parcel Iticnlificihion No,(PIN) l' '
SR-Latitiiderand tlfüdcañd Longitude in deg es/minuteslsccondsnrdecimaldeglrees: 22.0 cat..
(ifneItfield,one tat/long is'stdtickil) ' ' "j��
. • N - W. /ffJJ�.J /�;l!'• — 2/26/2024
Sigromd:'~:z:Censifel'Well Contractor , Dale
• 6.Is(are)tbe.well(s):.%IPennanent .or °Temporarytl);signing Zhu unn.-i lrerd, earl that Ili!!,Tel!si was(loyal cunrnrrcred br accordance '
Wilt 111 NCAC OW A100 or 154 NCitC 02c.0200 Mir Consrmrlion Sraitdards and that a
',Isthisiarepairro ail,existing wells tJYcv or 1INI1 [eti col risk word.has No.proridMl ogre well owner.
If Ws'Is a re rk fill au knauvi well coonucrion hrfarrnnrion and(*.iplohnhe rurrtare of the •
repair rimier#21 renrarks:,ccn ra or OR Me burl of rhos form 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details-or welt
S.Numberof wells constricted: 1 - coustmctiondetails. You may also attach additional pages if necessary.
For'maple ia/ecrlon or,,w-warer snppl.i-cells ONLY with the sane costsrruetion,.yoas can .
snbmit one Pao. ' 4UBMITTALINSTUCTIONS
9.Total[sell depth helot`land surface: 20 - ((I,) 21a.-For All Wells: Submit this!form within 30 days of completion of Welt
For malripieter(Iclisr all depths ifdifferent(exarnple-31a200'and.2@100) ' • construction to Ow following: . - -
10.Static water level below top of casing: D,)5 - •( Division of Water Resources,Information Processing Unit,
• ifwarerkael is above ms(a.V.ase"+" 1617 MaiL Scrsice Center,Raleigh,NC 27699=1617
II.Borcbatc diameter 8.25" - , (ill.) 21b.For jiijecfiori Wbl)c ONLY: !In addition to sending the fore)to the address in
.2-la above.also submit a copy of this fora)within 30 days of completion of well
12.Well construction method'HSA construction to the following:"
die:auger.raw,cable.direct posit.etc.) ,
'Division of Water Resources,jUnderground Injection Control Program,
. FOR WATERSUPPLY WELLS ONLY: 1636 Mall Service Center.Raleigh;NC 27699-1636 •
13ro Yield(grim) Method of test: 2ic,for Water Supply&Injection Welts:
- - Also submit one copy of this faint Within 30 days ofeompletion,of
•
13b.Disinfection typo.: , 'Amount: well consimetion to the county'hdalih department of the count¢whcre
" - - constricted. •
Form GW-I North Carolina Department of Environment and Natural Resources-DIvislon of Water Rergdreo Revised Atgustle 13
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