GW1--02659_Well Construction - GW1_20240501

WELL CONSTRUCTEON RECORD . FarI eriuI Us O Y: . . .
'Gift form can be used for single dr tnultipk wells•,
1.Well Contractor Itteortnation: • .
`II.WATER ZONES 1 •
• Scott.Hunt, Jr -FROM TO ' DFy[RIP1N)NI
WcIlCoitlrsdorNaase 30 ft. 41 ft. gray.sandy silt , , . ,
- ft. ft. I,.
4561
NC Well CanlractorCcnifisationNua Mutter • " 'aS;O11TER CASING tor nutli-ca'sa icct1ss OR LIl1IER Rif la•i eibkl.,
Glom' TO • - DIAMETER, TRIMNESS. \rATEnrAL
•
SAEDACCO - rA IL- 'daa .
Company Haute En:INNER CASING OR-TUBING(geollermal closed-loop).
, FROM •• 1O- DEA.\METER. THICKNESS MATERIAL ,
2.Well.Constntcteon Permit 4:WM0301344 - . 0 R. 31• . It. 2" •;fa. SCH-40 PVC ,
• Liu all applicable wet(peinvtsfL.!.County:S:u1c::Voriarxe.Nectienetr.•)'• , .
R ft. i 110•. ,
3,Well lise(checl:\sdl use): t7:SCREEN
. Water Supply.Well: - FROM-.• 10 •DIAMMETER sr,OTstir. THICKNESS. I MATEIUA1,
0Agricultural DMumictpalPub)ic 31 • ft.- 41 R. 2" tau .010 SCH-40 PVC
DGeotlaennal(Hcalin toolin Supply). - DResidential Water Supply - •R. It. . . In.
fi+ S PF (single)
•
DludustriaVConut[crcial - ElRcstdential Water Suppi)'(shared) itt:GROUT.
. .. FRO\r TO '.NrA.TE1tL\L '. E\[PL\C'E\fEVE\iER1OD&AMOUNT
Dirripatian • . 0 it.. 27 'El. portland trimmy
Non-Water Well:
D., ft.
QDlblonitoring . DRecoyery . . .
injection Welt:- . . ft, t4 . . . . .
l7'AgliifcrRccitarga' GtdroundwatcrRcnicdiation • rt9_'SANDY:ItAVEL PACK tir,yridlcabtcl°
'FROM • ' 10 •NINTRRr'tt. t:MPI\Ctl*NTMFTUOD
DAquifcr.Storagc and Rccovcty. °Salinity Bamc 29 . f. 41 ft. sand , • 2 • - •
• ElAgriifcrTest I]Stomm;stcrl}raina . .
• re.. 11.:
DExperimcntal Technology DSubsidcocc Control • - -• - ' . - - ' .
10.,DRILLING LOG(attack additional aicds irteeccssan•t ,
DC�eotltennal(Closed Loop) OTricer_ .FRo\r•: ]U DESCRIPTION isbbrtaaidaea.,un'riteunnr.sut,t,zte.tur .
DCeodieimal(lieating'Coolttig Return)' -DOther(explain under#21 Rettiatks) .o • :ft." 15 rL red/brown silt
15 - R:, 24- rL gray silt with rock
' 4.Date Weil(s)Completed:'3-21-24 Welt ID/#MW-2R•
24 ft. 30 fL. grey/white silt compacted .
Sa,Wdl Lacatinn: 30.' ,fL 41 .'f,, sandy silty"gray
Sweetwater Road Dump ' _ ft. 41' ft, bed rock „
• FeeilitglQCeocrName Facility iDR(ifappii:able) ' . — — ,y,.y�'^
• . 15th.Ave, S.E.,.Hickory, NC, 28602 . ' . IL - ft,: ti
P1ty3ical Addicss.City-and Zip' ILRL. MARKS' MAY d 1 2024
Catawba Bentonite seal from 27-29'' •
Cctnuly • Parcel kb:Wiftealion No,(PIN) uW ,.
511.1t itptbdc and Longitude in iicgrecs/minutes/sccOnds(Jr decimal Ste iva. .21,Certification -
(if sen field:ere,i iiiioag is uuf flcli4) .
. . ®eJ; „/
• . r✓ . �' 3/21/2024
N 1Y
. Sigtit F .•'WelI Contractor , .• Dale
6.Is.(.ire).the s ell(s):..giPer7Danent or IDTemporan' -llpsig,ting dr.&fbmr,1 hereby LeroJt r11ar.Mg weals)was(tnr.i Lar_yrn Creel IR actc we
. , iridi 15A NCAC 02C.0100 or I5A NCAC 02C..0200 Well Construrtio,Staiulards and that a
7,Is this arypairtoane_vgtingwent Elites or iIINo . ' ccyirnlr krrcanihastncrtpmridrdtotty:rirlimrtirr, - '
1/this'k a re allr,find eat findu6a ws'eldtvasrnctioa itfomwrian and top ta In Me nrtrtare of the '
repair ander1121 remarks a'retiaoaraarthe boa.ftftsfornc 23 Site diagrtim'or additional well details:
You may use the back of this page to'.proc'ide additional well she details or Weil•
8.Number of wells consttricted: 1 . - .constluctioti deiaits. You may also atlaettttdd ilional pages if necessary:
Far timidple lt*cilnn arooutdiairer supply wads ONLY with rile same cmrstruetlon,,}nti cars '
saabnrft'one font. SUBMITTAL iNSTUCTiONS
9."Total well:depth belo land surface, 41 (f(.) 213.-Far All Wells:."SRhtnit ILis form within-30 days of completion of welt '
-For rnrtlrlpfc ireflrlist off depths lfdi vtvit(crosvptc-3^e20D'arxl2@-WO) ' • 0n51ov:60n to tic follanirig: I ' .
•
10.Static water level below top of casing:'30 - • . 414 • . Division of Water Roans-Cgs,Information.Processing Unit,
limiter level is above mititg,to"+" 1617 Mail Scnicc Carter,Ralctgh,'C 276!19 1G17
IL garchotedianic-ter 8.25"/6" . -On.) tab.For infection Weill ONLY: let addition to sending the Rant to the.address in
.24aabove.also'submit a copy of this fano within 30 days-of completion of well .
12.Well construction'method:NSA/air-rotary - cotulmction to the following: '
(lc:auger.rdary,cabtC direct Fink crd) - 'Piston of Water Resources;Uudcrg•ound injection Control Program,
FOR WATER SUPPLY WELLS ONLY: • 1636 Mail Service Center.Raleigh,NC 27699.1636 •
Zoe For Water Supply&Injection Wens: •
13 t ti idd Om)_ Method aftest: Also subtilit one copy of this foml''\lit iu 30 days Of Completion.of
bit.Disinfection lope: Amount: well construction to the cdimty health department of the.Coitnty.w krc
conslmcled. •
Farm GW-i Muth Carolina Depanntenl of Encironnrnu stud Nato r l Resources-DL'iiion of Water Reatrt , ' Rei feed Atgtat2t113
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