GW1--03833_Well Construction - GW1_20240628

WELL CONSTRUCTION RECORD For Internet Use ONLY:
his isrm car I teed 1..1'smile or imdlipk.real,
I.Well Contractor Information:
II.WATER ZONES
Scott Hunt, Jr PROM M DVS4:'RIP1It IN
sscllI tsraanr'�.inw 13 4, 20 ft, tacky red silty clay with sand
4561 ft. ft.
NCWcUComnieturCMitis,nxm .nniur IS.OUTER CASING(farsub-cs dwells)ORLINERIII Nesbit)
room ! a
TO DI METrk THICkNiss \1‘'IT RI II
SAEDACCO fL n. .
Is.INN!!!4'ASING Oft TLRING INrr,•aldeiedaua
r5OM iO DIAMETER THKT: I Mnllultt
2.Well Construction Permit#: WM0301351 0 ft. 10 ft. 2 le. SCE-40 PVC
Liu all apple uhl.-it elI proud,I i r.C'ounth..Statr,t'unnlrer,Irfecbo4 rtr.r
D. j R. in,
3.Well Use(check well use): 17.SCRZrN
W'aterSupldy Well: note TO DIAMETER s4OTrlrr _ Init',N1 ss rl..ltNIsi
0Agu►eultutal DMunucipal,Abluc 10 ft 20 ft. 2 ►a 010 sCx-40 PVC
DGeothetmalIHeatingCoolinuSupply) OResidennal Water Supply(single) R ft. is
OhidustriaUComnncrcial OResidcntual Water Supph(shared) IS' WOOT
INOM TO MATERIAL EMPL.II F MENT METHOD A AMOUNT
Dtiipation 0 R.16 ft. portland trimmy
Non-Water Supply Well: ft.
D Motuton ne ❑Rccovet)'
Injection Well: R• ft.
I I Aquifer Recharge ❑Groundaatcr Rcmcdi;Lion It SAND/GRAVEL PACK(If applicable)
riot TO M ATI-RW I. EMM.ACTAIENT Mrrnot
❑Aquifer Storage and Recovery OSalnuty Hamer 8 ft. 10 ft, sand 2
❑Aquifer Test OStomm:scr Drainage
n. ft.
❑Expenmcmal Tccl nologs OSlbsid is c Control
b.DRA.LING LOG( add itH,naI,hedaIfaeepgry)
❑Geothermal iClosed Loup ❑Tracer ►coal TO I nI.I itrr tlttNrl„yr.Wawa,rwaeh Opt.wale sin.etr.t
DGauthemtal1Neattug'CooliugRoom, ❑Other(explain under#21Rentadsi o R. 13 it red silt
13 n. 20 it. tack red silty clay with sand
4.Date Well(s)Completed: 5-10-24 Wdt IDNWW 02
ft. ft.
Sm.Well Location: -.. --
ft. ft. I. .. •• t
PPG Industries, Inc. II. H. ,.
Facility'Ow Err Name Facile}tD#Iifapplicable) — ft. ft, JUN r 8 Z0Z4
940 Washburn Switch Rd. , Shelby, NC, 28150 f. r n.
Pi"sical Address Cm.and Zip biter r Pa pr
it.REM OtArs'10411
Cleveland Bentonite seal from 6-8'
Emil IsksitificAtiouNsi INN,
5b.Latitude and longitude in d gay cs:mirwteslseennds or decimal degrees: 22.Cerdfleation:
or well field.mr l:u.loug is sotticm. i t
N. W ! I 5/17/2024
Sipta'dP::E:l en'I t.!Well Contractor Dow
6.Is tare)the%ellls): LlPennmrnt or Tcmporan
14 signinx Mu from.1 hereby certify that Mr treats,was tartan emu:fuel d in acerdan.r
with 15A NCAC 02C,0100 or 154 NCAC 02C.0200 Wei Catarnn'tion Stasdarda and that o
7.Is this a repair to an existing well: Lill es or IC No rope of Mil record ham firm provided to the earl!minim
1104a is a row,.fill lntl Otosn Kell,Online.noo rnfors4INH1 ar41 r 1pi t'l the moire of Mr
repair under 821 rrtn an&station or on Mr bait of Mir form. 23.Site diagram or additional w ell details:
You may use the back of this page to proslde additional well site details or well
8.Number of wells amlatrneled: 1 construction details. You may also attach additional pages if necessary.
For mrltplr lrtfel thin err anal-water with we(11 ONLY,tt/t rhr Name construction I<HM rap
nitwit one form. SUBMITTAL j,NSTUCTIONS
9.Total well depth below land surface 20 (ry4 21a. For All Welly Submit this form within 30 days of completion of well
For laahiple Kress hat INdrprhr if different tctranpk-36'200'and'w Mal consntictian to the following-
10.Static water kscl helms top of casing: 13 (ft.) Division of Water Resources,Information Processing I nit.
II noir,brat r.,i....r,,,...,, . - 1617 Mail Semite('enter.Raleigh,NC 27699-1617
I I.Borehole diameter:8.25" ties.) 21b.For Inkedon Weill ONLY: in addition to sending the form to the address in
24aabose. also submit a copy of this font% within 30 drys of completion of well
12,Well coastrwctlon method: HSA Construction to the following.
tie.auger.rota,.cable.direct push cis-1
Dhision of Water Remy ryes.Uadergrusd lejectlon Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh,NC 27699-1636
I Ja ti'itld Iglmrl Method of test: 24e.For W Ater Suppy S.Injection With:
Also submit one cops of this limn within 30 days of completion of
IJb.Disinfection hpe: Amount well construction to the county- hcahh department of the counts wheir
constructed
Fenn(,W-I \rah Catchan Dicotrmern of Ent inmuela aid Natural Resources-Damon of Wrier Resotroes lea reed august 2,1)13