GW1-2023-01956_Well Construction - GW1_20230227

KNELL-CONSTRUC'I'llON RECORD
.- Fat[tlrcntnl Use ONLY:
'Phis farm cm be uwd fin singtc ar,nfultipk ncHs-
1.Well.Contmetorllt£ornlatiou:
14.A VAT ER20NES
Scott'Hunii .Jr FROM .7i1- 09SCRO'TION
WoICotarsdorNanto
4561-A fL 1L f
NC.Wc17 CanlmctarCattiftratioaNwed�cr
1AS.01I'['ER CAIRNG if�e�n[ti cs4cd�icfls)'OR MERMEAL
6ROht TO DC.�ti4E:'rfiR THICKNESShrATEArAL
SAEDACCO Inc 0 f4 30 ft, 1" sa, SCH-40 PVC
Ca»gtcut}Nani4 - - E6:[NNE1tCASINC'ORTN®IIYlia _ ,cberIDateWcedaoa" _ -- "
FROM TO DMrEMR. THICKNESS MATERUL
2.Wc1I Consttu,etion 1'et't#: ft. ft, trt
fist OiliepplpcaNe sss l.p rnzzfts 0 c.County,State,.Uarianre,148c M U.---) ,
3.Wc1B.Grsc(ehc&Well,ase): t7:SCRkE N.
WaterSupplgetl��IL• — - enure TO RrARtRT6tt SGOTSr7k: THICKNESS MATRRiAL"
30 ft. 35 R• 1", 'la• 010 SCH-40 PVC
ClAgt6cultatal CI24InnieipaVFuU)ic �.
Meethettml(Ri atirotooling Supply) ®Residential Water Supply(single)
OludustriaU(3aaunercial. ®Residential Water'Stippty(Shued) Fkohr- TO htAT-E- AL- L+\rPLA-M—M iT hIEIHOD dt AMOUN17
❑Irrigation
NOEL.-Water Supply NVelk
ft. ft,
Mhlonitoring dRecovetg
Iujection Well: �'' fb `
QAtluife�Rccliarge. �Cieour►ds}�ttcrl{etncdiatian ;19:'SANDIGRAVE➢,PACK(ifa' dleabtk),
FR0151 TO 4fATRRrA[: DWI AM—WNTMESHu1n
QAgttifcr.S16Pge aiid Rccovel QSalinity 8ariicr 28 R. 3"5 ft. Filter_ Sand #2
QAtltiifer.Tist ❑Slormatctl tain R, ff.
❑>tagieriirtcotti0 Tvchnato�� ❑Subsidcricc Control .
• ^Za:nit➢G➢:1lVG�GOGt'altactiadifitioniat"slieelsif'teccessnei•} -
❑Gs akenugl(Closed Loop) ❑Tracer FROM TO DESCRiPTIOh mbr.hanbcv.star'nsek M olio,etat
❑Gaotltennal(Fkalil doling Retunl} ❑Other{ p>sia ur�dei.#21l&einnrRsl o tt, 14 ft.- gravel'
14 ft. 35 - M sandy silt
4.Date Well(s)Camipleted: 2-8=23 Welll])9TW-03
h. (t. 5y "• fit ��'
3a.W�'lI Ialeaatitrn: _ � ��' j; ., - .. •
Speedway 7963 f4 ft t ' " �.
Fact7ity OwncrNamc Facility lV#(Tapplimble)
2418 Springs -Road NE,. Hickory, NC, 28601- ft, ft, [3 ":�3
F]WskW kpicsr.City,and Zip -2U REMARK$'
Catawba temp well,for -a'water sample
(,t'7pt11?' }�`'I.cYCI IdCn1�CC.11i4tt Noy(Pill) i � -
f,I..atitade and Lkitude in dcgtees/minutcsJseconds or dccirital degrees: Z2:Certifec4fitfa: ,
' (levee!!ftiW,�>c i�iUlossg is Su(1'lCiCW) ,
2/15/2023 IL
5igmttiraarceititigaw:encant earl !laic
6.Is(awl,theuell(s): oPerroaneat or ETemporg
fly,sigdirtg!Iris famr.1 herby rertifj thm.11u wk,14y)titres(wire!cvminwied ise ucxarrlaiee
with 15A NCSC 02C,4100 or 13A MCA ur1C,01M WN ConslrrectMon Starxfards and flyri a
7.Lv this a stpair to an eQi ug well: E]Ws or ®Nit, copy gftftxr Mcord has beers Pmrided 1?16"1aril inviter.
If ih(s is a repair,fill 4MI WAVI R'ell emminfc ion 11ff0MW1101f ATn1 exprdhf Me 1wrare of f11C "
re'pPail.uidrr0-1 rernivkvs:efian ortm the 6iark of fhis farm 23:Slte Il Vz am or additia=l tval details:
" You may use the back of this page 63'proxidoadditioival n'eil'site details or well
S.Numllerof wells constricted: 1 . coustntctioiu details.'You ittay A6 ailaclt additionalpages if 11ecmaty-
FurinafirlFle.dr{(errinnorora�t-si+arersupplj'ncflsO,VLY.srUhrhrsameconatructlar,yoercgrf - �• � ,
saPxurit one form SIIi➢hi tEAC f1VS C fTCTT@NS
9.Total well depth below land surface: 35 (fp.] 24;L Fur All Welit Subii it this form within 30 kys of c?ompk4i 5d of*11
For Aulflplrive:lls fist all ifMhs(fd1orew&xmepf,i1@2.00'aul3@MO) entt4irnctfgato(hcfolfowina; 1!
10.Static water level below top of easing 2 0• -. (ft) Division of Water Ito+you fours,Infortnatinn Pruiessing Unit,
1f,tuser Wei is irhape ius(ng'um 160 Mail Service Eater,Raleigh,YC 27659-1617
11,Borehole diamctcm 2.25^ (in) 24b.ar injgt.tian Welly tRNLY� Im addition to sending the fomi to the addivo in
244 almie,also submit a-copy of this form within 30 does of completion of well
12.Well canstrmetlofi Method:DPT cronspiuctiontotltefalloMugt I
(Lc:augccr..r�ary,cable,din•c-t push.eta:} - , I
Division of Water Resa=66 Underground Injection Control Progrdun,
FORWATER SUPPLY AVELLS ONLY' i636 hlmll Serelee 6nler,Raleigh,.1C 27699.1636
13a.!field(gpm) Method of test: 24c.For.Water Supply&UR ectlna Wclis:
Also submit one copy of this faiui•withitt 30 days ofcompletionof
13u.disinfiYtidn tape: Amount• 11-CH construction to the county 11611th department of the cou",,Lv icu;
constnictcd,
Fan i GW-t NonhCoialina Mpa intem of Pm immocniand lzbouW Rcmuuoes-6ivisiouofwat �ft,e.oe trees Revised A gust-2913