GW1--01364_Well Construction - GW1_20240304

WELL CONSTRUCTION RECORD For ti riddu coNny: •
This form can ba used fir Single or nultipk{rolls
1.Well Conte:Whir Information:
'Gt:WATERZONES i
Scott.Hunt, Jr . . . MOM TO IWM;ItIPt1ON '
Well Cot:iranarNano 30 f.: 32 ft, black compacted sandy silty
- 4561-A •
R. ff. I i_
NCWcllContmclorCcrtilcatioiiNwilicr .IS:OtffEft'CASING(fnrinulllaysed-li'cnsl'ORLINER(ifali ticabk),
PROM, TO DIAMETERL.
_ ,i THICKNESS. MATERIAL
SAEDACCO • ft, rt. ! ln. •
Co,npvq'Kanrc. T6:INNER CASINGOR TUBING(gcalhcrmal clescd4oept '
FROM TO DIAMETER THICKNESS MATERIAL
. . 2.Well Construction Pcrrnit#: . . 0 'ft .22 ft, 2 1'tr. SCH-40 PVC .
h a all applicubk wv11 pennita(Lr.Counn•;Stui!,.Variarxr.Meant 4 ex.). •
IL fl. In. .
3.Well.[lie(check Well use): V.SCREEN
• 'Water Supply.Well: - _ . rRosl. To DIsorrrR storm/4: TnfCK,rrss , MAMMA,. .
❑Agrfeultittal .LDhfunicipaUPublie 22 ft. 32 R,: 2 In 01 SCH 40 PVC
'I:Geothermal(Heatingl!Cooling Supply) I:Residential-Water Supply(single) it. ft„ in,
• . ©lnduslnnVConmtercial ®Residential Water Supply(silted) sa:GROUT. . - _
FRO;,f TO AWTERWL EMPLACE/4MT METHOD S AMOUNT
❑IrtipaLion . . 0 ft, 18 ft.. portlan3 trimmy
Non-Water Supply Well: ' ' • .
Monitoring . . . . pltccovety. - _ - R. ft.:
Injection Welt: rt. ft. '
❑AquircfRcdh:irge. ❑GrouliowtcrRel,lcdiaticn '19.-SANDIGRAVELI'ACKfif-milcabtet -' -
'FROM - TO . STATER/AL' RMPI.ACEHENTMEtrt0D
❑AgtiifcrStorags and Rcco{•sty • ❑Salinity Dania- 20 I),. 32 R.. sand ' • number 2 . , •
IAquiferTest CISiommateri iniriago' R. ft.
❑Ewetimental Tcclnolo y ❑Subsidcncc Control
"2a:DRILLING LOGiallach:nddhionat ehreh if at-cc:mini ' •
-
❑Geotltetnial(Closets Loop) • ❑Tracer, .mRost- TO DESCRIPTION Dolor.lmrdnes+.udl'tncklla.t.min wradt,
❑Geotltetmal(Heatiae1Coollue Return).' 17O11ter(esplain a nder#121 Rettiadd) 0 .ft. 3 . ft.. gravel I •
- 3 ft. 12 It, gray silty-sand '
4.Date Well(s)Completed: 2-8-24 ' .siYeii mgow-7 -
'12 .ft.• 20 ft, sandy cobble layer •
, Sri.Will Location: 20 it. 31 ft,• black compacted silty sand
• Pactiv Evergreen Canton Mill ft. 32 , ft. bed rock' '
Facllity.bivncr:Namc. Facility iDR(ifnppli:ablc) R: R. -
173 Champion Dr., Canton, NC, 28716 ft. f1 -
PlnsicalAddiess.City.and Zip 'It.REMARKS
Haywood 2' bentonite seal from 18-20'
Grimly parcel 1tkr�liRcaUun No,(PL\1} t j !�.
.a+b.l ttittrdc acid 1 ongitude in d rccslminutcs/scconds ardecimal degrees: 2,_,Ccrdt4entliln:' A ( !
(1J,,;uficld• ,9trot;w7angts'Stdllckia} - MAR; 0 4 2024
�r 2/4/2024
>\ W Signs v-'Ccn.-kx veil Ca,w 'S'a- F rl-7....� „g
re signing t
G.Ls(nre)tlrcuell(sy: xlFenLtaoene or LlTcmporan
L` ri(Q1 1. l
•By $ir farm,I hcrrrhereern*that 7he well s•}tswi rtrr LYlaYtrrrelert hr_rrcrordanLs'
• - with 1 Sit NOW 02C,0100 or 15r1 NCAC 02C,0200 Wet!Constractio r Standards and that a
7.LS this a repair an ctistingwell: L7Yes or KIND copy ofrlrir record loahs&n prorkkel rorlw urn owrrrr. .
If trls;&a remit..fill ors lrr1,11ii well conanrcnod hrforotcrlon and t:rphahr the aarare of the I
repair tinderP21 ienratkeir aunt oean the hail of ihts forme - .24.Site diagram or additional Neil details:
• You may use the back of this page.to provide additional well site detail's'or Well
8.Nntuberof{{ills eonslructed: 1 construction details. You may also attach aidditionatpages if accessary. •
For aria,*Infection or rion-iyater kip*welli ONLY'with'rho same construetioa.paean - j '
sabutubne form. .SCiBMIITTAL iNSTUCTIONS
9.Total well depth below Land surftice: 32 ((1t.) 24u. Far All Wells: Suhndt Lids•fans within 30 days of completion of well •
For malrtpJrirdUrllsi all*Ai f1diR-etem(examine-3@200'owl 2@ WO) construction to the following: I,
10.Static water level below top of casing:20 ((14 Division of Water Resources,Information Processing Unit,
if saner level is drove casfay:sae•4'• 1617 Mall Service Centery Raleigh,NC 27699=1GI1.
II,Borehole dianlcten 6" . 'tin.) 24b.For ti jfetinn Wells ONLY: in ai ditionto sending the form to the address in
24a above,also submit a copy of this faun within 30 days of completion of well
12.Well construction method: sonic • . construction to the following: 1
(i.e.auger.rotary.tole.direct cashew.) Division of Water Resources,Umler ound Injection Control Flagrant,
FOR WATER SUPPLY WELLS ONLY: - 1636 kali Service Center:Raleigh,NC 27699-1636
r ,
13;f Yield(�►m) Method of test: •
24o.-For Sholy'&InIcctinn Was:
Also submit one copy of this form within 30•daysofcompletionof
13b.Disinfection tape Amount: well construction to the county health d'cp?,nment of the.connfy.whcre
constructed.
Fe nn GW-L Noah Carolina Depannrent of Enviro,urrm and Natural Resources-Dtvislon of Waier Resources ' Rer'iscd August 21113