GW1--01367_Well Construction - GW1_20240304

WELL CONSTRUCPION RECORD Far bite pal tJscONLY: •
This form clink.used for:Single or multiple.wells• • '
1.'Vel1 Contrttetor Information: 1
11;WATER ZONES I
Scott Hunt Jr. FROM TO • DESERIPtIONt
Well Cor4radoTtwnw 25 R. 30 ft, black compacted sandy silty
4561-A ft. ft.
NCWa1JConlmcaarCcniftcatiouNtuiber .i15.OUTER CASING'tforeantai-casedwcflsifORLINER(Ifap flcabk):
. tmoM To • ' DIAMETER. TIIICKNEM MATERIAL '
•SAEDACCO 1L ft. la'.•
Cgalp;utyNem _16:'1NN_ER_CASINGOR171BINGh:eatherrnatclased4onnl
,FROM • TO _ _ DIAMETER. THICKNESS MATERIAL2,Well Construction Permit#: . 0 ft; 25 R: 2 • �•i r: SCH-40 •PVC
.Lost oft atoffr ble wellpmaiir fi r..Colony.Sinn>:.Varian.IrfeCtiart or.)- -..(1.• rt. - tin: -
3.Weil..Use(cheeleWeiluse): I1 SCREEN '
Water Supply WelJ.: -.. _ - - _— FROM.• TO . •DIAMETER ,SLOTSIZE THICKNESS. 1 MATF.RIAt.
DAgticultutal 1DMunicipaliPublic' . 25 ft. 30 ft. 2 in,- 01 SCH 40 PVC
®Geothermal(Heatingi'Cooling Supply), ®Residential Water Supply(single) R. IL ID, _ -]
®I ndustiialiCon�mcrcial GlResidential Water Supply(shated) :ts.GROtrP - _ . !..
I7ROSI TO. -MATERFAL - - - EMPLACEMENT METHOD&AMOUNT
Diriipation . . ft. • .ft
NIM.Water Supply Weil:,
rt. n.
®Monitoring - . ORceoyery ,
Injection Well: fL ft
l7tlgnifcrltccbarge DGronndwatcrRentcdiation t9:'SANDIGftAVELPACKOfnpplkable)- , .
OM FR TO L:MATERIA EMP1.ACEMENTME:rnOhI. •
17Agnrtcr.Storngc and Rccovetp ❑salinity Antics. 23 R. 30 ft, sand ;, ' number 2
' CJAquifciTcst 1:1Stommateri}raitiggc R. ft.
17EYpetimcntnl Technology OSRbsidencc Control • - • - .
'2a:DRILLINCLOG(attach.ndditionalshrels if acressnn•t
DQeodtenual(Closed Loop) OTrdcer, .FROM Ti} DESCRIPTION Motor.tmnrnet,.wn4+n;knar.jxdn stir.ck:1
OGeothenmal(Heating/Cooling Return) DOtlter(explain under#2l Retnatks) 0 •m 3 f4 graver • ; •
3 fL. 12 it, gray silty sand •
4.Date Well(s)Completed: 1-31-24 .Well IDftSB-2- .
• 12 .It, 20 ft,. sandy cobble layer
54.;Well LHcatIIIn: 20 ft, .29 ft,. black compacted silty sand
Pactiv Evergreen Canton Mill ft. 30 ft. bed rock
Facfial',V norNante Facility IDII(if applicable) R • ft. i .
173 Champion Drive, Canton, NC, 28716 . . ft fL ' ' '
Pintie.iit Ad dips Clt}.rind Zip' :;y t:REMARKS
Haywood Attempted to collect gw sample via packer;
C-tuvuly Parcel Idenline;tlion No,(PIN) was slo '.
5b...;.Outride and Longitude in degreeslminutcs/sevwids or decimal*grecs: . ,2 •Certification: f
(If n011 Belt,Me l: Moog lesudllclaitI) tp
\'+.� f
.
• N Wh.L447'
MAkO42Q24 2/4/2024
• Sim :Ccnell Contractor I Date
6.Is(arc)the well(s): OPerutanoitr or $ITentlaoran •tlrsignnrb this fo,rrr,f hrrrb(eiz r�'t j'lg i f,#r''R iItili d •11IFx ,rerexl ter m cordance
frith 1M NC,EC 02C,0107 or TA NCIIC bvimetTonstructiair Standards(r»d thy R
7.Is this a repairfo an existing well: 1:7Yei or 1INo cofiyofrhu rrcon).hasNell prntvrled toil urlionm r.
ifthls'is o repair:fill oeirbtoisit meld c n,s,occtlan brforrtroilaa and rtpiadn the torture of the
repair ronler 1J21 iienuerts+rtiian pr on the bor.(of Asir forsr 23.Site diapran[b1'additional well details:
You may use the back Of this page M.invade additional.well site details or.welt
8.Number of Wells constructed: 1 - - cettsttuctiou details. You May also attach additional pages if necessaty.
For rnuftdpk lnleeilan or non-.eater Supple'wells Ou LY Writ the same eanstrnethm,po0 eon
sttGttritanrfnnn.• CUBMITTA I INSTUCTIONS
9.Totalwelldepth below land surface: 30 (ft.) 24a.•Fur All Wells:• Submit this fans within 30-days of comptetion of wilt
Fortnuhip1eu•ellsJlsrrrlld'ethsifdt ireiir(exomptr-3@e200'and2@100') construction to thefo€lowing; 1'
10.Static water level below top of casing. 12 • (11) Uivislun of Water Resource's,Information Processing Unit,
If water 1rwl is above cask::rue"+'• - . 1617 Mail Service Center,Raleigh,NC 27699-I617
11.Borcholc diomctcr tl 6" (in.) tab.For ijecsion Wells ONLY: In addition to sending the fomt to the address in
24a above. also.submit a copy of this faint within 30 days of completion of well
12.Well Construction method: sonic _ . construction►to the following: '
li.c.auger.rotniy,cnblc direci post.etc.) I
. 'Division of Water Resources,Underground Infection Control Program;
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Ce er,Raleigh,NC 27699-163f
13a Yield(191tn) Method of test: 14c.For Water Supply&Injection Wells:
Also submit one copy'or this farm(within 30,days ofcompletion of
13b.DIsinfectinn type Amount: well construction to the county heal h department of the county.where
constricted.
Farm GW-I NookCarolinaDepaument.ofEnvimnnrtnand:inturslResources-DvillonofWaterRtxatt s ncriscd August lDl3 .
1