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Home My WebLink AboutGW1--01272_Well Construction - GW1_20240229 1 WELL CONSTRUCTION RECORD Faa[I�ariuduscONLY: This fanm can be used fefstnglc or nudtipk•walls' - 1.WitLContt tetortit orwatlon: °t4:WATER ZONES.- Brian Ewing. FRo:at TO -DE.SCRtPrii7Y - Well Glmr rieiorl`antC It. ft, I ' 4240-B ft. ft. I NC-Well CoolraelarCcnifichtioiiNuti ef' =(S:OUTER CASING(fai:ntutU�easOii iclls)OR LINER drop'ileable)- . Fti01 TO ' • DIAMETE.R., • THICKNESS MATERIAL SAEDACCO R' ft. in. Cangruiy Boole. _16.1NNER CASING OR TUBING%ntbenna!crowd-loop). •FROM 1110- DCLNETER. T.THICKNESS IUATERIAL. ' 2.Well Construction Pstmit is: . . 0 ft, 20 ft, 1 i'lit. SCH-40 PVC List u!1 crytlirtble rsri peimits,(L.County,Stutz;.Varlmg e.Ttry'erdcet etc.), -set, it. ' itl. 3.Wc11,Use(check well ucci:, fx SCRl EN. WaterSupplg Welt: Elton. . TO I•DtAatTTER sr,OTS17Z TiltCNNt4.s. I MATMRrAt, 20 1DAgncultutat 17Municipal/Public ft. 25 R. 1 ire 010 SCx-40 PVC DGeothetnxal(Heating tooling Supply}- . DResidential Water Supply(single) " u ft.. In i 1ndustlialiConrntetcial ®Residential Water Supply(shared) ':18 GROUT _ . - - , &'RO3f TO . • -MATERLAL I EMPLACEMLNTSIEfHOD 4AMOUNT ' ❑htipation - . . .ft. ft. - - Neti7WitterSupptf Welk . . . . . ft R. ' :'Monitoring . lRccotcty . _ ' Injection Welt: - ft.. ft. . , . .. DAilnifcrRecharge CWGmtuulisatcrRcntcdiatieu 49:SANH!CRA,VEL,PACK(if appltcabte1 - - - - ' mom - ' TO' iLV NIATI:1 . - , FINIPI.,%err\t•Arsi ution ' tligniferSto?agc and Rccoveiy 1:I alinity Barrier 18 ft.. -25 ft, FILTER SAND # 2 ' ' • IDAgiiifcrTcst. IJSiommwatc(f?ralntigc' ' ft. ft.. , • f71: pctinlcrtt t1 Tixhno[og}' ❑SnbSlden C•COrlttol' " •'2a;ORILLONG LOG(attach.additional 9hccis if aceeccant i7Geodteima['(Closed Leap) OTracer. .FROM' TO . DESCRIPTION twta;hanrncri.uuiDniek tl ortxain we.ck1 DGeodie final(IleatinalCeotitigReturn) D0tlter(explain under#2LRentatisl 0 •sea 5 ft,- FILL SILTY SAND 5 IL• 15 . ft. MOIST TO-WET SILT/ CLAY 4.Date Wetl(s)Cuuipleted: 1-22-24 ,We11 IDilTNW-1 . 15 ft. 25 ft.. SANDY SILT/SAPROLITE/PWR Sd.Well Locations . ft. tt'. ++^'%•tl'^' *; f.... Pactiv Evergreen . ' rt. ft, Q. "" ' FaeRi$IDimerNanae .Faoaity 3DR(ifapplicablcj R,' ft, FC R 34 Park.St., Canton, NC, 28716 . . . .R. ft,: . . . • Plrysical'Mdiess:City.dot Zip.• =2L iirl'iARtiS' lflffNinaUei !....1 • : e Haywood BENTTONITE SEAL 16 TO 18'' ��Q%' 1 + )vrnt CaaWy - Parcel hkolificaiieu Na,(PIN) I • mi.Latitiidcatid Longitude in.(Icgrccs/minutcsiseconds sir dceimul dcgeec4: 22.Certification:' (If hell field,oh:1aVlong Is'sufficiiii) N �v B:ri� n Ew: g . 2/1/2024 Sigrutureof dCettilk Well Ceiilmctar Date 6.Is(are)the well(s): Df ermanent ,or ElTemporary 11isigning ihts Amt.I hereby certify that•ihi welll's)arts Ovary)cexinncted Cu mnosdm ce liith-!S.t NVCAC OTC,01AI or ISA AICtC,O2C.0200 Weil Cousrrrtr.-tiotr Sraiidards aid what a 7.Is'this a repair to an existing well; DYe s or 19No ' cope of Mk record has tn'n:provided to*Ik nrll owner, If this'll it repalr;fill tut krsohti peel!coostnrcdoa brforta Lion oral r tpfabt the aware of the ' repairrimier i)?!remarkssriwuorim the Larkojthisform. 23.Site,diagram oradditional\will'details: You may use the back of this page(o.(mc'ide additional will site details or Well 8.Number of wells constmeted: 1 consttuctioitdetails. Youat m also aftac[rtidditionat pages if necessary. For taalr)pie Irejecilmtar non-Water supply welds ONLY with the same construe:ion,yos con =Omit'am c jorin. ' StiBMFUFAl:iNSTIJCTIONS. 9.Total well depth below land surface 25 - (It.) 24a. Far All Wells:, Submit this'font:within 30 days of completion of well For maihlple iwells list all depths(fdl,Qi'reti:(emanate,3g200'atu(.2@ I00) - toniitntcttion to the following; ; 10.Static water level below hip of casiug: (it,) Division of Water Resource's,Information Processing Unit, If xw1ei leue1 is above eaang.ate"+" 1617 Mail.Service Center,Raleigh,NC 27699-1617 rl.Borchute diameter:2.25" "(in.) 24b.For•Ii ketion Wells-ONLY: in addition to sending the fomt to the address in 24a above.also submit a copy of this,form within 30 days of completion of well 12.Well constivetion method:DRIVEN cousltudlinrt to the following: i (i.e.-auger.ro(nrp,cnbtC direct pimsh etc:} 'Division of Water Resources,Uudetgr'.ound Injection Control Program,- ' FOR WATERSUPPLY WELLS ONLY: L636 Mail Service Center.Raleigh.NC 27699-1636 2 13a �7dil(fipm) Method of mesh Sc,For Water Sufiplw&Iq[c ction;Wells: Also submit one copy-of this feint'Within 30 days of completion of 13b.Ui)Infectiun type. - Amount: well construction to the county health'department or the..Conn .where • . constntcled. FormGW-1 Nooli Carolina Depattnicnr of Envitoti :Or and Natural Resources-Dita1oo of Water Rmeiunin Revised Augu t:0IS