GW1--02249_Well Construction - GW1_20240409

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c WELL CONSTRUCTION RECORD Fru ttaitaa11.1segtN.LY: •
This Coup can bo used for-single&multiple INVII'S'
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I.Well Contractor Information: :
. . 5tii:WATER ZONF.S . .
Scott Hunt, Jr - • PROM • 10 'OFSCR1FTMNI '
Well Cpraliactor.14rime. ' 45 ft.: 55 ft.. rocky sandy;.silt tan
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4561-A
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NC Well Cordmetottertificatioli Nadi& AS.OUTER CASING-(fOrmulii-eakilwifli)ORLINER Olin'lleabk).
Pa051 •TO Dmitri.HR.. I .TUICKNES.S. :MATERIAL-
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sAEDAcco . - hil • •
Company.Name. • I6iINNER'CASING OR TUBING figotbenall dosed-loopl•'
' ,P111011 TO- DIAMETER. , j TRICKNESS MATERIAL.
2.Weil tonitroetian Perin it i: • 0 'ft. 45 . ft:- 2 .:Ili. •SCE-4 0 ' Pvc '• "
/is'raft aFf4A-airle'windmill(ix.County.StatO,Variance.lifediart do,-.I . , . .
.-ff. • ' ft.' , .ittg.• . .
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3 Well,Uk(ebrelelIiist): . . .
• . Ft SCREEN
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• Water Supply Well: • • .
' • naust.• TO . .'DIAMETER SLOT sinr. THICKNESS. NIATERLA I.
,, . . . . 45 rt. 55 'ft;' 2 .bli.• '101' ' SCH-40 • PVC• •
CiAgricultitral • ClhfuniaipaldNblie: , . • ft. fc ' • is.
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OCeothennal(Eleatingtooling Supply). tlitesidentialWatef Supply(single) '-, - ••,
13IndustiialiConuttomial • . CiResidentiat Water Supple( )sha lai GROUT . •• ••
. . - • - ' FRONT- TO. • . . '•MATERIAL -, - ENTPIACEMENT METHOD&AMOUNT'
' El friiaution . . . 0 *ft. '91 ' -ft. Portland. Tremie . — •
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Non-Water Sultpkv W01:: • • ' .
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• . 10Monitoving' ', : pl Keen:my . . .
InJection:Welt: . • • ft.
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D'iknitifcrlIeeharge • Odrouriditatet Rciiicdfation- '19SANDIGRAVEL•PACKlif applieabret- ... .. _ .-
FROM TO NTAITIRIAI' • - . - • , t• , itstpt-tr:LUrasir mcrtion . .
PAiguisfCiStafaienni i?cF.'ovC4.' 1:1milinitv Daniel'
-. • • . .• ' 43 ft.. 55 ft.• sand ( ', 2 • .
13,4ipiiier TO: 13Stainniater iiittia;:ige• .. •
•.ft. O.. , - . ' ' • '
. . 120tperimcnital Tcchooloa oSubsidcnr.clOwlret
'202DRILLING LOG•laitacIfeddllional 1Sbeets,if:wassail',
laCteothennal.(Cipsed Loop) : o'fracer. .vnosr,'- TO • DESCRIPTION IoNlon hardaemisoll'ot(121TP&VIIIII gAN.tica •
. . . OGeotileimal(ileating(Ctioline Return) : 12011ter(otplain under#21 Reutaiks) .0 '''f4 •5 . .
ft red fill!
• • 5 ft.. 25 'ft. red silty clay • •
4.jiate Well(s)Chnipleted: 3-57'24 .'W.di inffmw-4R • ••
• •25 R. 45 ft. red/tan silty clay _ •
' 5a.Wc11Lacalitatt ' 45 4L 55 k. tan rocky silts .. , .
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Edgewood shell • ft. ft. •
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• Facnity•tlitocrNansc, Facility11Jip(ifoppliFrible).. .-. '. ,
R. ' - ft. "• ' '' "
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1210.Edgewood Rd. , Bessemer City, 'NC,. 28016 ' . . . . '.ft. - ft.: - . . AllR ) 9 2624
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C83.-Ani211'' ;21.RENIARKS
• . .Elentonite seal from 41-43', ill f, ; ::1 ::‘:•'..,-, ••:.1'14,2 ' a . •
Gaston. ' • • .- r)Vii.',.::11.-IG
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County Parcel laerilifieMion•NO;(PIhh)
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5ft,Latitude atid-1.0ogintilejn INglECSIIIITEUteiticaind cirde'atital clei;ria.i. ,22.Certifitatioin:.
(Huai!rpeld,m4.10'101;11 i id)s'artfirie ' ' ' ' ' '' - . '
W ii .4--.. ,, . ' 3/5/2024
Sigtc$,W-e7iSit Well Co tamotof• t • Dale
6.Is(are)the.well(S)i Xiiitermattent, ,or EITemporary • •It)signim;tkis.famr..I Iremby certify that'4.1.1444 wax(von e I fongnittett Irr accord/awe
• • . . ilia,15A NPle 02C.0100 or ISA NCAC(12C.00 Well Consrmetton graikiards and that a
I,Eithis a repair to an existing well: tzlYet or 111No„ copy rldr'et-17411ms becifprovitleara ati,6fi?ririvner,
Il 0443 a 01,oly,fill mat kovitil wcII cotagiuction,htfomation and explain themerure of rue . ' . .. , „
repair tinder 621 irtnarkx:Wolioia or on tie book of.thil:form - 23.Site diagrani"or additional sell•detall .
You mai.use.the.back of lids page'to pros additional will site details.or.(veli
8.Trouper of Oils constructed: 1 . . consfinetion.delairs: You nay also attkEtadditiOntli page's if necessary'.
For multiple!ejection Or omorater sip*wells.ONLY w ith the mmeemistruittott.yoit can
sauna ono,Prrn.. .SUBM1TTAL 1NSTUCTIONS. 1. '
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9.1otail well depth below land surface: ''' - . (ff.) ,24a. Om-ALL Wells: Subfitit thii Tann wftliin-3)'diiys of completion of wells
-For multiple irellslist all depths If different(example-30200'am1.20,too) " • consourtion to the-following:
10.Static water level below top of ming:, 30 Ott.) Division of Water ResOurceit,Information lisocessixig Unit.
. If water it is'above eashig:ige-"i-" .1617MaiiScrtice tender'Ralei-h,NC 2769tiLiG IT. •
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II:Borehole diabieter:8•25" - On.) - 24b.For inieetion Wells ONLY: .addition to sending the foml to the address-in
• • 24daboye. 'also subntit a.copy of lbs faun within A days:of.completion of well
12.Writ construction-Method:ESA construition't6 the following: l'
tie.augor.rotary,Orible.direct push.etc.) . ' I -
'Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: • ' .1636 Mail Service Center.Raleigh,NC 27699-1636
itc.-For.Watee Sueplv&Injection Welts:
14a.Yield(gwnl Method of test:.
Also• .submit one copy-of'this ftinn'mithitt.30 days of Cototdetion of
13b.Dhinfeetion type: . Antount: well'constnictitin to the calmlyhealth depanment of the.couriti.whete
consinicted.
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Fenn GW-I. NorthCarollnaD,..varlairnlof Ermiroomem and Natural ftesourees-DMisloo°rhymer RMuon .Revised August NIA ..
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