HomeMy WebLinkAboutGW1-2023-02084_Well Construction - GW1_20230307 1
- • WELL CONSTRUCTION RECORD For[Mental Use ONLY:
This form can be used for single or multipk wells
1.Well:Contrtctor 1nforrtratiou: i ;
`Lt:VATER.ZONFS-
Scott Hunt, Jr FRO\I m DESCRIPTION •
Well CotltrddorNante 14 ft. 15 ft. rock fracture
4561-A fL rL
. NC Well Corn or Ccrtifte.qtioo Nuither AS OUTER CASING(faritailkiwthrifIstORLINER,titaii ficabkl'..
FROM TO • DIAMETER THICKNESS-• \TATERIAL
SAEDACCO Inc 0 ft. 14.5 fL 2" ' in. SCH-40 PVC
•
Camputy Nam 46.1•INNER CASING-OR TUSING(grathermal cBuud-loa jn.:
FROM TO DIAMETER TERCGNESS MATERL\L
2.Well Construction Permit N: ft. ft. 'tn. •
Girt ullapplir..rrhle weltpenirita(Et!:County.State,Variance.irje 10 et,;.)
'ft. rt. in. •
3.Well Ute(chat:well nsc): I7:SCRI EN
Water Supply Well: • FROM TO DtA5IE.TKR stair Slit: TIIICKNFSS I TArRRfAM,
LoAgrtcu!tural 1:11Vi nicipal/Public 14.5R. 29.5 R. 2° in O10 SCR-40 PVC
DGeotltennat(1FleatingjCooling Supply) ®Residential Water Supply(single) ft. ft. in,. .
DkldustrialiCottmicrcial DResidentiat Water Supply(shared) tt:GR°U]T. ;: .
FROM TO .fATERrAL ENIPEACE.FIENT:METHOD B AMOUNT -
Dirrigation • 0 ft. 10.5 ft. Portland Tremie '
Non:Water Supply Weil: •
ft,. ft
131lvlonitoring •
•pRccovery
Injection Well: tt. rt.• .
0 Aquifer Recharge t0GnoundwatcrRcmcdialian 492SAND1GR,AVEL.PACK(irupidivabtet ..
'FROs1 ' TO RIATR10.41. - ESIPI.ACF.MENTMtinnn
C]Agnifer Storage and lceovety CaSalinityBarrier 12.5 ft. 29.5 ft. Filter Sand #2
D Aquifer Test I7Stormwatortirtinagc ft- it.
❑Experimental Tsehaotogy OSubsidence Conlin t:
'30 DRtLLi C!LOG"(attach"additional sheets ifaecessan•Y
OGeodtennal(Closed Loop) • ❑Trtcer .Fnor TO DESCitIPTION trnbr,I,arNneti,way+rck 1rt50.CFtein ware.the.)
DGeotlteimai(l;IeatinglCoollue Return) DOtlier(es-plain under#21 Remarks) 0 ft. 10 ft. Pwr
10 ft. 29.5 ft rock '
4.Date.Well(s)Ca'mpl tcd: 2-7-23 Wall iDr#MN-11 -- - -
ft. fL ff >_ A
5 r.Well Ialcatinn: C," , 't ., __; :w l�n- ._..
rt. "n 0 (�
Upper Piedmont Regional Landfill ft: ft. MAR 7 2023
Facflity,'OwncrNanic FFcr7ity IDk(if-applicable)
9650 Oxford.Rd., Rougemont, NC .27573 it. •
'�;,"'" 71 P ;`r, "-.;,:::9(Jr:a
g . . rt. ft,' vt.01130(4
Physical Address City_and Zip .,I;REMAIIK$ .
Person Bentonite seal from 10.5-12.5,
Caranly' Parcel Ith:iildleitliou No,(PiN)
Sta..Latitude and Longitude in dcgrees/minutestseeends or decimal degrees: 22.Certification:
(irvtlt(wt4,ins:(atIong is suftlekal)
N W c5'« l�y(r� 2/14/2023
SigaitnreofCeitiilcdWellCo ctor Dare
6.Is(are)the well(s): *Permanent or. DTetriporai}' dt•signing thin form,1 hereby certify that the yells)i,vs(rime)conrtnrcted iri accorrlrtnce
with 15A NCAC 02C.0100 or ISA NCAC'02C,0200 Weil Construction S(andaids and that a
7.Is this a repair toanetigtingWell; DVei or El No .eepcof MIT re onlboxbreapicniddreprhoroilmiiter.
if Water rep alr,fill out lmoitvi well rorurrueiloa htfoeraark.n and i.tplohr the narnre of the -
repair wider Pi remarks seerims or on the&ark of this farm. ' 23:Site diagram or additional well details:
- •You-mayuse the back of-this page to provide additional Well site details or well '
8.Numbered wells constructed: 1 construction details. You May also attach additional pages if ueeessaiy.
For multiple Ia/oaken.or trend-nnrer supply lulls ONLY.whit die smite.constriwtlon,vats-ears
saint toneford. SITRMiTTAViNSTEICTIONS
9.Total well depth below land surface 29.5 ((y.) '21a. blip All Wells: Submit this form within 30 days of Completion of welt
For m ildple wells list all depths Ifdlflurrnr(e xanmiple=3@200'and 201flr'y constnlctipn to the.following:
10.Static water level below top of easing: 15 -. (pp,) Diyiriun of Water Resources,Information Processing Unit,
if muter level if above owing.use"+" - 1617 Mail Service Center,Raleigh,NC 27699-1617
II.Borehole diameter:10.625"/6" - (ftl.) 24b.iur TD(eetiorl Weill ONLY: in addition to.sending the fonu to the address in
24aabove,also submit a-copy of this foam within 30 days'of completion of well
I2.Well construction method:Auger/Air construction to tlt,e following:
(ix:auger.rotary,cable direct Push.cte:)
Division of Water Resources,Underground Injection Control Program,
• FOR WATER SUPPLY WELLS ONLY:. 163611Lail Service Center,Raleigh,NC 27699-1636
• D3a.Yield(Rpm) Method of test: "24e.For Water Sarirply 14 Injection Wells:
Also submit one copy of this form tiithiu 30 days of completion of
Il3h.Disinfection type Amount: well construction to the county health'
department of die county where
corlstnictcd. l
Faun GW-t Noah Carolina Depanntcnr of Enviroiurinrand MEOW Resources-Division of Water Resources Revised August 20li
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