GW1--03831_Well Construction - GW1_20240628

WELL CONSTRUCTION RECORD For hernial Cu:ONI_V•
The form can be assd Inc single or nmttipk wells
I.Well Cunt victor Inform/11io11:
14.WATER ZONES _
Scott Hunt, Jr - 'mow ] TO pitSCtiPtiii\
Well C'nnncu t`• . 13 ft, i 20 ft. tacky red silty clay with sand
4561 ft ry I
NC. '4,l)(ottlrtctrn(riviti�,anI nn.bir i 15,OUTERC_.SING(for u1() Dl{uhitatedWclhiORI1NT*litapplica►k)
FROM TMFTFR J T/tl(E�fS'i l(ATFMRSI
SAEDACCO ft. n. ia.
f anq:u,,N.tnw le.I'isi iu ASIN(:ORT7.'INNGINe+lbornudeli 4u.p)
'ROM 1 to DNMFTFR THk'k\ihs ‘1%tiRIA1.
2.Well Construction Permit#: WM0301351 0 n. 10 ft. 2 ill• SCH-40 PVC
La all applicable wellpenmh ftr.County.Stair.Variance,htatliarl etc., .---
ft. • ft. lo.
3.Well I-se check well use,: t'.SCREEN
Water Stupid',Well: PROM . Ill , 014SI1,1/R I s1 u1 nun Icon MVI S MSTFRIOI.
°Agricultural ❑MunicipaIPublic 10 ft. .010 SCH-40 PVC 20 f1 2 'n•
OGeothennal(Hearin oolitig Supply) ft rt its
g1C OResidential Water Supply(single)
OhdustriatComntercial OResidential Water Supply(shared) 11Rr3BOVr
1n10M TO MATERIAL_ T EMPLACEMENT METHOD t AMOUNT
Ohngation 0 ft. 6 ft. Portland trimmy
Nen-Water Supply Well:
ft. ft.
KMo(Iimnnr, ❑Rceos'cr)
lejeetltta Well: II n.
❑Aquifer Recharge ❑Gmundwaicr Rentcdi;uion 1•t.sA.ND(.K►'t_L P SCK lNapplkablel
PROM iti ----- i M viral 11. PAIN ACEMENT 1MY.ritoo
❑Aquifer Storage and Rceovcrs DSalinin Barrier 8 ft. 10 ft, sand 2
❑Aquifer Test ❑Siomiwater Drainage
R. ft.
❑Eq)e(imartatl TahnDb}'t ❑tiurhsiikmcc('warol 7't IIRII I1NG LOG fatted'additioual'hee/,if ecorsnars)
❑Geothemutl(Closed Loupi ❑Ttacet Elms, TO oast-RIFT MN i,..br.hardecw,ra'r.aektpne.1w srr.Or.)
OGcodlcnnal(Heatutg1Cuoling Retuml DOiher!explain ur der s_I lethal).„ o ft. 13 A. red silt
13 ft. 20 ft, tack red silty clay with sand
4.Date Wrl(sl Completed: 5-10-24 Well IDAWW-03 -- -- .
ia.Well Location: A.fL i L+! e�#z ii
PPG Industries, Inc. fl. ft. JUN 9 8 2024
Facilii Owner Nene Fuiliis 1D00(if applieabkl R. ft.
I1-•43;xea`c, 2.
940 Washburn Switch Rd. , Shelby, NC, 28150 �— n. ft u"
Piosical Address_Cin.and Zip IL REMARKS
Cleveland Bentonite seal from 6-8'
(bunt. Parcel Identification No IPIN I
Sh.Latitude and I.nngltlldc in.kgrres&minetesltceondsor decimal degrees: 22.CMitkatLts:
of well licld.rni.:I:n•lnt, is sidfu:retdI
N W 5/17/2024
Sigroi P:r:CMrlk- all Contra/to( Luc.
6.Is tare)the wellls): %IPennanent ur T]Temporan
$y signing iris form,f hereby certify ohm the swills!*03 turret coma rend in accordance'
With I SA NCAC O2C,0100 or I5A NCAC 02C.0200 Well Construction Standards and else a
7.Is this a repair to an existing;well: :J\'es or It No rrpr n(thl,rrrnnf has beet(erm'tded to its sell owner.
1f Ihi's as a repaie fill out(knout(urn.'motto non at/urarrrtrot and eaphatn the notate of the
rquirurrrfr,'#21 rrmor3e a-,Ir.,,or.n fur hod of this form. 23.Site diagram or additional well details:
1'ot mas use the buck of this puge to pros ide additional well site details or well
8.Number of wells constructed: 1 cORMIUctiun details. You rout also attach additional pages it IKtiessah.
For maniple sujecrlan or rn ,.. ,.,.: r wells ONLY.ruh rho tante construction sew rr.n
snhnur.me lam. StBMITTAL INSTUCTIONS
'I.Total nett depth Yells land surface: 20 (f1J 24a. For All Wells: Subnni dos tons wohur n dam 01 completion of well
For mtdttpk orll>Jut oil depth,(Idrfrrrnt ir.utanpfe-T•'''' ..., '''- c'nsrntctinn to the following
11.Sade water Intl below tap of casing: 13 Ift.i Division of Water Resources,Information Processing I nit.
ff wo rr lr.rl n',hoer i eurnr use 'a 1617 Mail Service('eater,Raleigh,VC 27699-1617
11.Bereiok diameter.8.25" (la.) 21b.tar lnjeclion Wells ONLY: hi addition to sending the form to the address in
24a above. also submit a cups of this fonn within ?0 dass of completion of well
12.Well coestraction method:RSA construction to the following
tie.anger.reran.cable,direct push.etc.i
Within of Water Resources.Underground Injection Control Program,
FOR W.'TFR St PPLY WELLS ONLY: 1n36 Mail Service Center.Raleigh.NC 21M194rite
13:�Vivid!t mr) Method is/6pt _ 2k.For Water Suppis &Injection Wells:
Also submit one cops of this fool, withm ou dassof completion of
13b-Disinfection n pe: Amount: well construction to the counts health dcpanment of the counts where
constructed
Form GW-1 North Carolina Lhaninnidru of Ear rmimrlu and Natural Resources-Division of Water Betatron tic,.bud Algtmf 2011