GW1--01371_Well Construction - GW1_20240304

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WELL CONSTRUCTION RECORD For Intim!UsepNLY:
This Conoco be used far single or nitdtipk wells
1.WetICuutractor Information:
• II.WATER ZONES
Scott Hunt, Jr FROM TO Or t Ittn-lox
Well Contractor Name . 10 ft.' 20 fi, cobble •
d zone . '
4561-A it. ft.,
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' NC Weil CaNmcrorCcrttftcalionNiuthcr • ,'iS.OUTER CASING tforututlkrised"ncUs)OR"L1NER(Rini'lle0A1 -�
mom t0 • : DIAMETER.• TI1ICRNESS, MAITMAL
SAEDACCO .ft. fL- • • In. .
• Contour).Nautc " • iG:INNER CASING OR:TUBING((geothermal eooscd-oohs).. -
-FRom TO DIAN(ETER - THICKNESS MATERIAL
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2,Well constiictirrn Petit*#: 0 •ft. 10 ft. A4 '.lit. sCH-40 -PVC
List 411 cp ulicn1k well primitr(Le.Calmly.Slide..Ynrinfree.II,ti<erdari etc.)
R, 4, i to,
3.Welt tise(eheelc.arll use): n:SCR N
Water.Su(Ip1Y%Ve'll: - -- .. . FaOM-. To •DtAarETER sUttSl?i TIIICKNIS"$ I MATttNIAI,
•Ciilgticultirtal C Nfunicipal/Pubjic 10 ft. 20 ft, 4 in 02 SCH 40 PVC
®Geothermal(Heating/Cording Supply}, ❑Residential Water Supply(singe) rt. rt. in.
©Industiial1Connneicial . • ©Residential Water Supply(stated) -`tac GROUT .- .
FROM. TO.- �L►TERLIL EMPLACENIENT METHOD&AMOUNT
❑lr'ripntion . . 0 ,ft, 6' ' , P an ft, ; rem Tie
- `NDu-Water SupplyWoli:: - . n,, . ft:gMonitoring •W 'Recosei . .
Injection Well:- ft. ft
• C7 AquiferRechargc ❑Gtoiuidnatcr Reentcdiatiori' .Iv sANu1GRAVEL-PACK(Ir atipucat td" -
"rROM TO MA't8RrAI. F.MPIACEMENTNl trim n
❑AquiferStor,igc and Re Orrrty °Salinity Hairier • 8 ft,- 20 ft, sand #3
IDAquiferTest EStomnwatcrDrt(iage fa h.. , .
IDEVedmcntal Technotosy °Sribstdci:c Control
•2atDRR.LING'LOG(attach additional sheets if necessan•1
❑Geodtt:ntral(Closed Loop) ' ❑Tracer ttnoI- TO - DESCRIPTION frubr.ln,nine.++.,nlit,tekPPt.Mill•wanrr
❑Geotlieuual(Heating+Cooling Return} ❑Other(explain under P21 Reuiai s) 0 'IL 5' It,. gravel/fill
5 it:-. 10 rL gray silty sand .
4.Date Well(s)Completed: 2-6-24 ,well mgRW-9 10 ft. 20 R. sandy cobble layer "• '50.Well Location: •ft. . . ft. ;' ,.
Pactiv Evergreen Canton Mill • - f. - It, '
I.
Facilitq,Oiellcr:Nerne, Facility Ink 6fappli able} R: - R,
173 Champion Drive, Canton, NC, 28716 ft. . ft..
PIDticnl Addiuss City,and Zip' ..21.REMARKS
Haywood . 2' 'bentonite seal from 6-8'
Gaunt+' • farce]ltkntiricaili n Na,(PIN) • +a ^'•'+_•..• ,;1, I
Sb.1:otitudeand Longitude in dcgr•ceslminutcslscconds or decimal ilegrces: �"^ L.— V I..
22.Ccltlituidnn:.
(Ifneu acid,Wtc_I;tttlaug is cullicizni} 'MAR R
�- 0 4 2024
N �Y ®� �ii. 2/11/2024
Stgrzt r,x:Cen.siell Contrxtor �� aqo
trwofri anted t , �bvi VR$:
6.Is(are)thC-it'CII(s): ZiPC1711anettt. or I7Tengtorary . . -ft).signing tku.farm.'r Irerdt resit)-rltar the u' W(`'3GQ cwru7rucrrd io naarrinncx•
with 1 M NCAC 02C,0100 or 15A NCAC 02C A:0i7 Well Constnier7ar Staixfards and that a •
7.Ls this a repairt'o an ciiatingne}I UVes or PNr1 nt ycfgtar record bas.Item pr.nhkd rote he'll mvner.
If Oa'is a repair; ill airkat+iivr well construction itrfamurtlon awl explain te tutrare of the -
rrlair under#21 reniarkr3rciian ar on ilia heel of thin fors[. 23.Site dhhiram or additional well details:
You may use the back of this page.to provide additional well site ifetails-or welt
8.Number of wells constructed: 1 • construction details. You may also attach additional pages if necessary.
For nuihip e Btfecrlon oraai-leaf rsupply welts ONLY HIM the same cmrsiruirlar.yogi ma -
Submitmefn= SITB IITTALINSTUCTIONS 1
9.Total well depth helm hind surface: 20 ' - (ft.) 24a. For All Wells: Submit this forum within 30 days of completion of 1+'ell
For mnhlpleireelrlrsrall depths ifdiPi•rent(exaatpie-@200'anti 2esAV) ' Con5lnictionto die following:
' 10.Static.water level below top of easing: 10 • (ft.) Diliviun of Water Resources,Information Pnaeessing Unit,
if maim:levees above oslirx itse"+" 1617 Meet Service Center;Raleigh[,NC 2 7 6 91-1 6 17
11.Borehole diameter:8„ - '(ilr.) 21b.Tar i,ilcetion WeIic ONLY: In addition to sending the fonn to the address-in
24a above. also submit a copy of this fonn within 30 days of completion of well
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12.Well constiuetion'method: sonic construction to the following: i
(i.e.anger.rotary.Cable,direct rash etc.) • - . •
Division of Water Resources,Underground Injection-Control Program;
FOR WATER SUPPLY WELLS ONLY: - 1636 Mall Service Center:Raleigh,NC 27699-1636
13ri V(Ctd font/ hT4Niod of test: l Ie.For-Water Suet*&Injection\Veils:
- . Also submit One copy of this foint within 30•days ofconipletion.of
13b.Uisinfeetien types Amount: weltconsinrctian to the county health department of the.connhy.where
constructed.
Fans G W-t Nal11i Carolina Dcpanntcntof Envirarutriu and Natural Resources-Division of tVolerlhc mrees Rc4Lud August Mt 3