GW1--01342_Well Construction - GW1_20240304

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WELL CONSTRUCTION RECORD Fig[Menial Use ONLY: I
'(his Corsican be used for single at multiple wells I
1.Well•Contntctor Information:
'11.-WATERZONES .
Robert Miller . FROM TO ' DESCRIPTION ' •
ft. ft, I ' .Well Contractor Name
.ft. (L.
2675—A
NCNcllConlmcfarCcuifccatianNu ei •:15.OUT'ERCASiNG(forinatti�easer0<icllsiORLiNER(tfan llcabtc). ' .
FROM TO DIAMETER .THICKNESS ' MATERIAL
SAEDACCO ft. IL. hi.
Campnnj•lama 16.INNERCASING OR THIIINGi'gearbennat elused-toop)-
-FROM TO DIAMETER THICKNESS NATURAL
2.Well Constructirin Permit h:WI03000514 —ft, • . ft. I.ln•
list all applicable well pernatr(Le.County.Stare..Variance.Inre[delt or.),
ft.. R. I in.
3.Wc11,Usc(cited welluse). 17."SCREEN
Water Supply Well: • FROM. ., TO • DIAMETER SLOTS171: THICKNESS MATP.RiAI. "
DAgncultural OMunicipaVPubllc •
ft, tt. •to
CGeothetmal(IicatinglCooling Supply) CResidentialWVater Supply(single) ft. ft. In.
0Indusirial/Conratcrcial . . . °ResidentialWater'Supply(shared) trnoGRODT To MATERIAL EMPLACEMENT.1lEllon.5AMOUNT
' Olttip;rtian • . ft. ' fl.
Non-Water Supply Well: R. Ft. '
❑htonito ing ORccoveiy.
Injection'Well: • R . ft.
f]AgniferRecharge RiGroulidisaterReincdialien ;19..SANDiGRAVELLACK(ifaigdlcabtd'' .
FROM . 'TO' MATERIAI. • KM PI.ICI:HENT MEtnon •
OAgnifcrStoragc and Recovers• °Salinity Harrier R. ft.
°Agliifer.Test OStornm:ger Drainage ft. R.
Ill glcamcnTal Technology 17Snb5idenee Control .20;DRILLING LOG;(Mach additional sbccts.if nccessan•1
CGeotlieimal(Closed Loop) OTricer FROM• TO DESCRIPTION(cour.!mined:wn'nkkt}p¢pyin Kim de.i
17Geodu:nnal(Fleatine/Cooliog Return) ElOther(explain under#21 Retuatks) . rr, R•
4.Date Wells)Completed:-2/14/24 Well IDIIB-1 — B-6 (t. . 1 1,1.__L�L+? I� } ) .
Sa.Well Location: .ft. n. M�K ly 4 207RL_t•�
Sorrier Rudisill's 66 . -� fL V CY
. 1050rrreau-:due -
Facility,OivlrcrNamc FacilityiDk(ifappliablc} R. R: ' "F
D+QAAl . .
2707 1st Ave., Hickory, NC, 28602 ft. ft
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Ph sical Al dress.City.and Zip• 2l.REMARI{S ' . . . '"
Catawba Injected 208 gallons of Cool-Ox per boring;
County I reel i liidifictlioa No,(PL.1) 9-35'
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51),LatiftideMid',attitude in ifcgircsiminutatifseminds or dceiMal degrees: 22.Ccrtititadnn: '
(Ifticll field,wr:I:rtrlo�t¢ssdiickW) � �
14 " /y�f i, 2/27/2024
Siga:turrof.::yeti rtt;'rs ?s.<-::f• --- Date
6.IS(are)the well(s): OPCrramtene or >OTemporar}' sr air ibis orn.Ilrereb certify drac;rhe well a1 ma fd>rrel c rer:nrned ire nxordaace
D3'.S fi f 3' f
wills I NC.1C 02C.0100 or l5t NCAC 02C.0200 Well Conatrriction Standards and that o
7.Is this a repair fit anccistingWeft( f]Yes or IDNu colyof this record has teca provided rorLvi aril owner.
If ibis'is o repalr;fill arrkrrunia well coasrnrctloa.lafornwdon am!explain the ware of rhr I .
,repair nrtderP21 remarks xecriin or on the bad:of tld i form. 23.She diagram or additional well details: _ -
• - YOu-niay use the back of this page to provide additional well site details or well
8.Number of wells censtrricted: 6 .• construction details. You may alto attack additional pages if necessauy.
Fur irrahlpk Ifection er non-serer suppli n'eNs ONLY with'the sortie censtruelion,you can
sabmtonefarm. SUBMITTAL INSTUCTIONS ,
9.Total well depth below laud surface: 35 (ft,) 21a..Far All Wells: Submit this Mono within 30 days of completion of well
For milrlpla w•ellrlis,oil depths lid eron(trample t@ •and 2010O) construction to the following: -
10.Static water level below top of easing: (fd.) Division of Water Resources,Inftlrmatian Processing Unit,
limner level is above casing,cue•'+" 1617 Aia[1 Sery ice Center,Raleigh,NC 276994617
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11,Borehole diameter 1.5" • -(in.) 24b.For-iiijection Wells ONLY: in addition to sending the fort to the address in
24a above.also submit a copy of this!form within 30 days of completion of well
12.Well construction method:DPP - coitslmctlOu CO the falloWiltg: (k
ti.c.auger.'ro(an-.cable,direct MIA etc.)
Division Of Water Resources,Underground Injcction-Control Program;
FOR WATER SUPPLY WELLS ONLY: - 1636 Mail Service Ceiuer,Raleigh,NC 27699-1636
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13a Yield(Wm) Method of test: •
24c.For Water Supply&injection Wells:
Also submit one copy of this form Within 30 days ofcompletionof
13h.Disinfection type: -Amount: well construction to the county healthIdepanment of the.county where
constructed.
Fonn G W.l Nardi Carmlina D.paantciii of Enirannein and Noma Resources—Division of Water Mourne; Revised August 2a l3 •
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