GW1-2021-01271_Well Construction - GW1_20210209

WELL CONSTRUCTION RECORD(GW 11 For Internal Use Only:
1.11ell Contractor Informs tion:
Kyle C. Shaw
_ 14,RATER ZONES
11 ell Contractor Same FROM TO DESCRD'TION
4521-A R R
R R
\C Wee Conaaclin CeniOcation Number
Advanced Well Drilling, LLC 15,OUTER CASING far muIn dsyelis OR LINER fife lie ble
FRO\\ TO DIAMETER THIC1Tl FSS 1LATEMAL
Company Name p7 '1� -7 H' R 6 In' Heavy pVC
2.wellConstivction Permit#:(/�PiI I (7 I �a"LV I / '7 16.INNER CASING OR TURING errant closed-loo
FROM TO DLAIIETER THICKNESS MATERLAL
Litt aU urplirnble xell cwuma'onn pemnit p.e.LIC,Coanm.Smre, tuliance,etc.i rL ft. In.
3.\Pell Use(check well use): R R in-
Water Supply 1Ve11: 17.SCREEN
❑.Agricultural FROM TO DIAMETER SLOT SdE THICI.T6SS MATERIAL
❑Grothznnal(Henting Cooling Suppl}) ❑.Municipal Public a. It in,
OResidental Water Supplv(single)
R R I.
❑hldustrinlConnnzrclnl ❑Rzsidemia]U'ater Supph (shared)
❑hngation 18.GROUT
❑Wells> 100000 GPU FROM TO \IATERLAL E\IPLACEMET METHOD&Al10UM NondVaten Supply q'cHc rL R Bentonite Poured
❑\Ionilorutg ❑Ruovzn
R R
Irtiectlon Well;
❑.Aquifer Recharge ❑Ground R R
water Rzmediation
O.Aquifer Storage and Recovaev ❑Salinim,Barrier 19.SAND/GRAVEL PACK ifa linable
OAquifer Test FROM TO 1LATERLAL E)IPLACE\IL\7\IEFROD
❑$tD(ntwater Drainaoe It. R
OEAperimelltal Technology ❑Subsidence Control R R
OGeolhermal(Closed Loop) ❑Tracer "L DRILUNG LOG attechadditlotml sheets tfnecessaev
OG011lemal(HeatingvCOOline Return) ❑ iller(esplain under=2l Remarks) FROM To DESCHmT10N(rolor,hardness Wilawskne,yarn size,etc.)
13a IL ) O R
2- WeII IDR' (r \
4.Date Well(s)Completed: '0-Z- O R )CO IL
5a.11"ell Location:
1SQ R R nl-
('- r,1raCk)y >S5 It ] It. t
Factlin.Otrner\ame Facilin'ID=(if applicable; f( rl 1 2- R
L�/}fit[y,� ' (' �r f��I � /� vv /
-T-�� j N d /cav IN
Physical��Addresgqs,Cm.and Zip )�[' IL
osr'asJtiZT 211.�.REMARliS J
County- Potcel ldenntication So_TIN) V }
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field,one lad sufficient)sucientj '� I �LK
22.Certification:
o o Q-S9
6.Is(are)the well(s): CPernwnent or GTempolwn S,an.IWi:.f crnmed Well Comracmr Dale
th signing this(ornt I1wrebr ceni/h Hwi the a'III(s)vas(a erel constnrned in acrordanre vith
7.u this a repair 10 an existing well: [Ves Or [!-No /li s recc 01C.0f en or/Sd d to di 0?C0100(Tell Corutn¢don Standards turd that n corm IR/rir is a repair,hit out 6w o ael/ronsr bs,4- irfornradon and explain Nre nature o)Hie of tlpt rerord lazy been prmvded to the ae/f oan¢r.
r¢➢mrvmder 921 renwidrs section or me Ure back ojrAisJarm
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Well,hay no the swne You map use the back of this page to provide additional well construction info
construction.only I OW-1 is needed. Indicate TOTAL\I-MBEr Meuse Lj 2�1,add'Su Over in Rzmarl:s Box).You may also attach additional pages if nzcessan-.
: Is i drilled
24.SUBMITTAL INSTRUCTION'S9.Total well depth below,land surface:.
For nudnple uc/1s list all d'➢rlu iJ dgerenr lexample-3^a_200't nq lOPt - (ft.) Submit this G{V-I within 30 days of well completion per the following:
10.Static water level below top or casing; (rt) 24a. For All NiVeis: Original form to Division of Water Resources (DIVA).
Ijnnrer lei el is abov uie cn el.use••.•• latermalion Processing Unit. 1617-MSC,Raleigh.NC 27699-1617
11.Borehole diameter: 6 ��) 24b. For Injection Willis: Copy to MR Underground Injection Control (IL'C)
Program. 1636.\ISC,Raleigh.'NC 27699-1636
12.WeR colLstrvctlon rrrethod:�JT ���'eYri
(Le auger,rotan',cable,direct push,etc 24c.For Water Sri and O[En-Loop GenthernmI Return Wells•Copc to the
ty coun emtronmental health department of the count,where installed
=ATERSLTPLYLLS ONLY:
24d. For 1later\Veils roduc' over 1(11000 GPD:Copy to DR•R CCPCUA
P�� Mtethod of test: Alt' Prnnrt Tugrant1 1I \I ,RaeCeh,\ 2 -I6 1TH Amount.� I•�. S � �1 _ i \ C 0.G`� `'' `
"' - - Sane Czmlina Deoar..ment of Enmonmentnl Qualls*-Division ol- Pater Resources

CATAWBAL tUNTY
0 Public HcalthL;^ cnl Casca WELL-09.2020-138754
Environmental He,Ith Division Subdivision CRESCENT LAND AND TIMBI
PO Box 389.25 Government Drive,Newton,NC 28658 PIN# 460603434047
a [phone] FAX[phone] TDO(828)465-8200 LOIN 123
she Address: 5054 tNICKF')RD LN, DENVER NC 28037
Name on Permit: 'UNITED CONTRACTING GROUP, INC
Property Blm: Acres 0.7
olreetlone: Starting at Old Hwy 16 and Campground Road in Denver, Go.6 miles on Campground Rd, Left onto
Catawba Burns Rd, Go about 1-19 miles, Right onto Bankhead Rd, Go about 1.1 miles, Right onto
Salle brook Lane, Go about.2 miles, Right onto Wickford Lane 8 property is on the immediate Left.
NEW WELL PERMIT
REQUIRED WELL SETBACKS:
Septic Systems and Repair Areas for Single Family Dwellings
Septic Systems and Repair Areas for Businesses and Multi-FamilyResidences 50 ft.
Underground Storage Tanks 100 ft.
Animal Barns 100 ft.
Lakes/Ponds 100 ft.
Streams/Brooks/Creeks/Rivers 50 ft.
25 ft.
Building Foundations 25 ft.
All Other Sources ofGroundwatcr Contamination 100 ft.
Saprolite Septic Systems and Repair Areas 100 ft.
Septic Systems and Repair Areas to Wells with 2 or more connections 100 ft.
PERMIT CONDITIONS
'Do not drill well in drainage pipe.
'Call Catawba County EH before drilling.
Wells shall be constructed in accordance with state regulations:
Article ISA North Carolina Administrative Code Subchapter2C
The well driller most verify all setbacks before drilling the well. If the well driller is unable to maintain any of
the above setbacks,contact Catawba County Environmental Health at 828465-8270,before drilling the well.
Grouting Depth:20 feet minimum
Casing Height: 12 inches minimum above finished grade
ar newsy consonimed pnvate drinking vew wells ore required to be sampled in accordance with the North Cmohna Rules R
Drinking wow Well Tmng(15A NCAC I BA 380a}The fee for this sam I In is included m the coy or the well ���two
P 8 perrniL h is the applicam or
prnperry ,oxnm's responablliry to notify Eovnonmmsal HCJth when 18e well is ready for sampling.Wa T= lea will
rau unless orherwsc P befrom an ou¢ide
spxified For questions or for more infamiotion,please conucl Environmental Hcmth.
Autnmraed 5une Agent
Permit IssuMa Dam 09t182020
0911&2025
Perms Fapvedao Dam
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loro�rzozo nss