GW1--02223_Well Construction - GW1_20240409

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WELL CONSTRUCTION RECORD 0FurtutermluseONt:Y;
Thiafann can be used far single or multiple wells
I.'Weil.Oiiitr i for Information: \A
Scott Hunt, Jr FROM -TO .: . . DESCRIPTION I ••
Well Conti-alai ban'c 25 ft,_ 15 ft, sandy clay tan
4561—A . ft. f6 .
'NC Well Contractor CcniftcatioliMu & •IS'OtITER CASING(for'etullkisedwclls►ORLINERalai) Ileable).
FROM I-bet DIAMETER, • 'nnrt.cEss' MATERIAL
' SAEDACCO (L (L 'iir.'
• Coommt.Nowt. t6 INNER CASING OR TUBING(geatbermal efusxd-loop} , '
. 'FROM TO DLAMETER.. TRIMNESS MATERIAL _
2.Wellonstructinn Pei tail n; 0 R. 10 ft. 2" +in SCR-40 •PVC
I.ur pII abgrlinatde m llpenruh(L..CpnnN;SO O.:..tiariapYC,1nl ectica etc.)
It, I . i in."
3.Well Gsc(chcckwddi use) t7:SCREEN-
WaterSupplc Well: - _ '.... FROt1• • TO DIAMETER !SLOT MO: 1IIICKSISS I MATERIAL
❑Agticultutal C]Mun[cipaltPttblic 10 tt: 25 ft. 2" • a .of SCH-40 PVC
CIGeotllemtal(tieafng,Caoling Supply), ®Residential Water Supply(single) rt. It. is
•
Cihidustrial!Conmiercial ®Residential Water Supply(shared) 14'1;ROOl
FROM' - '10 _ • MATERLtt:' - ' EMPL.CEEMENTMETROD&AMOUNT
' ❑frttpation 0 ft. 6 ft. portland- tremie
.Ikon-WIDIceSullplgW91t:,
• QGARonits rng C7ltpco cry R.. fL
InjectionWeil: rt..' ft.
lAgtrifer Recharge • l7Gcuandwatcr Renicdiation `19:SA.ND1t:RAVEL•lACK'(if utrpticabtoP .
FROM ' TO' ttLartatAL' 1 n]IPLA(FMMI'(t mmuon
f3A(ptifcrStorageand Rccov'ety flSalinity Bairicr 8 R. 25 ft. sand i ' 2
❑AtluifcrTcst. CStounwatcrf]rtinage' -
❑Eivrinculal Technology 11Subsidcrtec Cotd}ul • . . . . •
• 20:DRU U IG LOG'(atta&additional ntietls if nccecsant - ' •
DQeodiennat(Closed Loop) •❑Tracer. • ' . •iwn• TO DFSCttir'TIOh(wtsr:iradncas.wnraicktrnt.Otiasirc:ert .
• ❑Comtlieun t(Heatioe/Cooling Return) . UOther(e piaiitunderld21•Rettlerks) .0 :rt. 10 rt.. red clay with brick, •etc
10 ft. 15 It red brown silty clay ,
4.Date Wef.l(s)Completed:•3-11-24 .Well IDI,IMW—lit 15
ft. 25 t4 tan sandy clay
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5a.WdI Locations: , R. . ft.. I. .
Forward High Point f. tt, 7.-_, `�',:''�
Facilit}•,OivocrNante, Facility lay(if ft, 4,c „-- r9 g'q' '
720 N. Main St.,-High Point; NC, .27262 R ft �R '
Plgsi al Address.Cits'.and Zip. - , , 9 2024
Guilford Bentonite seal from 6-8' 1 itlfi,;r;,;.;' n Pr.,-.— .
. ...'sac,;=a0 L'?X
• County 1?arec1Id iitieltlonNo,(PLN) `i vc.✓13
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5li.iLittitiidc acid I..ongitude intfcg xc-ss/miautcslxconds or decibel ddeetrccs: 22 C ca u.•
(if cell field,sere lavloug is$ufrkic l) • . .
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• 1\ • W • & ,,1v1 3/16/2024
Sigint tr>*rCcn.ri.• W-IlCanrractor Dale •
• 6.IS(aril the w'ell(s):.m1*evinanent: .or ❑TeDlporai}' 11y'signin'his farm,'1 hereby cerr;(p t ai ilre veli(s)was(isrrei cn.yinreferl hr nxtinnlmrce•
with 15et AYCAC MC.01G9 or I SA NCAC 02C.n0.00 Mil Consrrrct(orr StoOdards and Ali a
7,Is;this a repair toanceistingWell! _ DYes or I1No e.'pyof MIT record has NEW provided.kJ'ii.c lrftarter.
If n'r(s'is a repair:fall err s`nvnw u'dl consouclon_hrforrrurd at awl uphill rho Ihirare of etc 1
repairwrdrrd'2l icmarksSrerioo or on the Lead:afdo..fornc 23.Site diagram or additional well details:
You may use the back of this page.tor.preside additional Well site details or Well
• 8.Number of Wells constructed: 1 . cOtlsttuctian.detilits, Warmly Ago atlacaadditional.pages if necessary.. •
Foe frinild*Irtfecilon iir non-leater iv*'veils ONLY with rite setae construitIon,pi!.can ' '
sabmit'tow Prin. ' SUBMITTAL INSTFJCTIONS.
9.Total well depth below land surface: 25 • (ft.) '2-00. Fur all Wells; Submit this Ilion within-39-days of completion of nen •
For rnahipla'wells Use alldcprhsIfdifcroii(rvarr,ptc 3e20f'and.2@WO) - tonstmction.tothcfollowin3; -
10.Static water Level below top of casing:'15 (}p,) Division of Water Resaurcew,Information Processing Unit,
If wwrir level is abava casing:use•'+'• 1617 Mail Service Center;Raleigh,NC 27699-1617
11.Borehole diametcr:8,25" (in,) 211b.For hiketiort WON ONLY: II• I addition to sending the faint to the addles in
24a aboNe.also.submit a copy of this fans within 30 days'of completion of well •
12.Well coustntction'method:NSA construction to the following: I '
•(Le.auger.rotary,cable d sr t pnsi,etc.} I
'Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: • 1636 Atilt Service Cettccr,Raleigh,NC 27699-1636
{ •
4e.Fo
13a.Yield(Rpm.) • Method of test: r'-«'atcr Supply;Sr.Injection Welts:
Also submit one copy of this forum ttvithin 30_days of completion.of
136.Uilinfcetiun rye: Amount: well construction to the county health department of the.coiinl wh re
constructed.
Fonu GW-1 NonhCarolina Dcpw nitcm of Eovima m1u and Natural Resources—Division,of Water Rmuiros Revised August:NM