GW1--01361_Well Construction - GW1_20240304

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WELL CONSTRUCTION RECORD Nit retitled raeON.ly: '
This forincan be used for stuglear multiple wells•
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1.WellCoutrnitur tuformation: I
'It WATER ZONES
Scott.Hunt, Jr. , FROM TO DR_SCttUPim)N
Well Contractor Nang 10 ft. 19 ft . sandy cobbles
4561-A ft. ft,
NC Wen CanlraciorCcaificaliatiNund:ct• .15.OUTER'CASING(for utulllzrrsrthrills)OR LINER tlf.Mi rflcable)'•
vilest Ito '•• ntantr.TRR.' 1111tICN SS MAItutAL l
SAEDACCO . .1t- f. 'Ill.•
. ComPvty Mane IC:INNER CASING OR TUBING(geothermal cluscd.loap):
.FROM 10 ' DIAMETER TrtiCKNESS MATERIAL
2.Welt Constrvctitin Permlt tt: . 0 ft. 9. ' ft: 2 In.' sCH-40 •PVC
. lduallapplicablewellprrmus,(:e.County;Sraa;•Varimrct,hferBb1'rir.I it. k, in
• 3.WeilIlse(chcel:11AI use): • t7.'SCIII:EN
- - Faust. . ID . DGMETRIt '.St.OTSt7): T111CKMh1S DIATttilAt.
Wafer Soppy'Wells _
u gneultutal • DMuuicipal/Pttblic 9 • 1t. 19 ft. 2 •in .01 SCE 40 PVC
E2Geothermal(Hcaling!Cooling Supply) I]Resideutial Water Supply(single) ft. ft. in,
0industrialfConuttctcial . ®Residential Water Supply(slaited) to GRot1T _ _
FROM TO •1ATERGI. EMPLAC'EMENTMET►tOD&AMOUNT
oirrigation •. . . .
0' 'ft, .5 . IL portland trimmy• -
. Non-Water Supply Welt: • :R. ft.
Monitoring ERccocety .
Injection Well: ft. .-ft.
DAqutferRccharge 1IGtoundwaicrRcinediation' -•19 SANDIGRAVEL•PACK(Ifapplicaltte)• -- _
'FROM' TO - MATIHWI. - EN11.1.�(CEMENTmExtion
DAqurfcr.Stomgc and Rccovcty - !]Salinity Harrier 7 • R.: 19 ft, sand number 2
I]A(1140Test ' ' IDSto nmaterintttiagc
ft. ft.
I]litgterintental Technology OSubsidencc Control . ..-
-20 DRILLING LOGitillach additional nhcdilftteccscnn•I
❑Geotltenual(Closed Loup) I']Tracer, •
.FROM- To DESCRtP lON ttobr.hnninett.Son:rock Inv.grsin vm.dal
• t]Geotltettnal(Heating/Cooling Return) ..i]Other(erplaht under#21 Retuad:s) 0 ,iL 3 ft. gravel •
' 3 • rt.. 12 f. gray silty sand •
4.Date Well(s)Completed: 2-7-24 well 1D#ow-5
• 12 ft. 19 I. sandy cobble layer
, t.Wel
l Location: - .ft. . ft,.. .
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Pactiv Evergreen Canton Mill f. ft.
Faculty ihicnctName • Facility IDN(ifappli able) ft, -• ft.. ' . .
' 173 Champion.Dr., Canton, NC, 28716 :it.. • ft. 1 '
PI jiraIAddicss-city.anti Zip' REMARKS- '
Haywood • 2' bentonite seal from 5-7' -
• r
, cow*: Pawel Ili sitification No,(PIN!) l'N ice', L j /
Sb,,Latiludc and Longitude in degrees/minutes/seconds or decimal degrees: 22,n fi;1 Cc Utlon: MA I
(ifu¢ d,ork aMougis'SullielciU} 0 2024
. N • W ____/ , r ... ir�,�, 2/4/2024
• Sigme :c:C,crl5fi• Weil Co bt'•&;1I rt'Z. ;,,2 Untie
• 6.Is(are)the nell(s):.ZiPermattent or fTemporary DWC i3OG
dF signing this farm;1 hereby senile that ter,rr ifs•l mu(Km)cxmrrnrcred brcrreou race
kith'I M NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Stahl-lards and thai a
7.Is this a repair to an existingwell: Oyes' or .181No cc&ofdidt record Fou 1'..ea proritled rathc rrll ender.
If this;isoiepalr;fillRatkovitor.n•encoastntctloairtfrtrmorlorrarilexplainthrmtrareofthe ,1' '
emir wafer0?1/ marksvretran or an the bird ryf tits form. 23,Site dial i am or additional well details:
You may use die:bash Of ibis page.to.ptoside additional well site details or'Well
8.Number of wells constructed:1 construction details. You)tray also-attaelt'addilionat pages if necessary.
For multiple letJecrlon itreon-utarer supply wells ONLY with the same construction,}'oil ern
.ntbtnirane furrn. - suumrrtAL iNSTUCTIONS
9.Total weil depth below laud surface: 19 - . (ft,) 24a, Fur All Wells: Submit tidy forte,within 30 days of completion of well • •
FermultipleweNrlistalldepthsifditi•ernt(example-3e200•am/2.RI00) eonstnrctiontothcfoltoning: - j
• 10.Static water level below tap of casing: 10 ((1,) Division of Water Resources;Information Processing Unit,
. if tong keet is above rasing;t ae."+" . 1617 Mat!Scri icc Center,Raleigh,NC 2 7699-1617
11.Borehole diameters 67 '(in,) 24b.For frilcettun Wells ONLY: in audition to sending lite than to the address-in
24a above. also.submit a copy of this farm within 30 days'of completion of well .
12.Well cnnstrttction'inethodt sonic constmctio►►to the follot4tiiig:
(Le.auger.'rotary.'talc.direct gash etc.)
'Division of Water Resources;Underground Infection,Control Program'FOR WATER SUPPLY WELLS ONLY:.
-1636 Mali Service Centitr.Raleigh,NC 27699•1636
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13a Veld(gpm) Method of test: ''-•lc.For Water Supply&lnlectton Wells:
_Also submit one copy of this him Within 30,days of completion of
I3b.Disinfection hpi Amount well.construction to the county Itcalai department of liic.cvnnly wi crc
constricted.
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FormGW-t North Carolina Deparltitent of Emlrorutrut and Natural Resources-D_ivtiiaa of 1VaIer Resatrt0 -.Revised August 2013