GW1-2022-10147_Well Construction - GW1_20221110

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: !
©�r+�",� 14.WATER ZONES
John W. Huneycutt
FROM TO DESCRIPTION
Well Contractor Name — — 140 ft 145 ft 10 gpm
2465-A NOV 1 Q 2022 290 ft. 300 ft. 5gpm
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a licable
an PrOC80�'+0 111t� FROM TO DIAMETERi THIC9QtlESS MATERUII
Denys Well Drilling, Inc. l Dwomw 0 ft• 63 ft 6 1/8 SDR-21 PVC
Company Name 16.INNER CASING OR TUBING eoWermal dosed400
20-424 FROM TO DIAMETER! THICKNESS MATERIAL
2.Well Construction Permit#: ft. ft. in•
List all applicable well permits rt.e.Coutrty.State,Variance,Injection,etc.)
ft ft. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SIATSIZF. THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft' ft. ra
❑Industrial/Commercial ❑Residential Water Supply(shared) M GROUr
FROM '1'O MATERIAL. EMPLACENENTMEI'HOu&AMOUNT
❑irr; ation 0 ft. 3 ft. Bent.Chips Gravity
Non-Water Supply Well: 3 ft- 35 ft Bentonite Pumped
❑Monitoring El Recovery
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier ft ft.
❑Aquifer Test ❑Stormwater Drainage
rL rL
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG attach additional sheets if necessary)
❑Geothemtal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness."n/mIttypegritin she.etc
[]Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks) 0 ft. 14 ft. Brown Dirt
4.Date Well(s)Completed: 10/20/21 well TD# 14 ft- 42 ft• Brown Rock
42 380 ft. Blue Rock
5a.Well Location: ft. ft.
James O. Leone ft. ft
Facility/Owner Name Facility ID#(if applicable)
rt. ft- Seams: 76,115', 133', 140'=10g,290'=5g
1366 Trotter Circle, Mt. Pleasant 28124 ft. ft.
Physical Address,City,and Zip
21.REMARKS
Cabarrus 56718524390000
County Parted identification No.(PTN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22•Certification:
(if well field,one fat/long is sufficient) go�& W
N W r r u��'��� 11/5/21
Signat of Cerlified Well Contractor Date
6.Is(arc)the well(s): ©Permanent or ❑Temporary By signing this fiornr,I hereby certify that the well(s)was(were)constructed in accordance
with 15A NCAC 01C.0100 or 15A NCAC 01C.0200 Well Conslntetion Slandards and that a
7.Is this a repair to an existing well: ❑Yes or EINo copy oftlts record has been provided to theavell owner.
If ibis is a repair,ill our known well construction in formation and explain the nature of the
repair tinder E:21 remarks section or on the back of this form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number ofwells constructed: 1 construction details. You may also attach additional pages ifnecessary.
For multiple it jection or non-seater supply wells ONLY irith the same construction,you can
submit one form. SUBAIMAL INSTUCTiONS
9.Total well depth below land surface: 380 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths,fdi,(Jerent(example-3@200'and 2@100') construction to the following.
10.Static water level below top of casing: 30 (ft.) Division of Water Resources,information Processing Unit,
Ijri-aterlevel is above easing,use••-" 1617 Mail Service Center,Raleigh,NC 27699-1617
II.Borehole diameter: 6 (in.) 24b.For Iniection Wells ONLY: In addition to sending the form to the address in
Rotary 24a above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 276994636
13a.]'field(gpm) 15 Method of test: Air
24c.For Water Supply&injection Wells-
Also submit one copy of this form within 30 days of completion of
13b.Disinfection type: Granular Amount 1/2 lb. well construction to the county health department of the county where
constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013