GW1--01544_Well Construction - GW1_20240312

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WELL CONSTRUCTION RECORD For[tactual Use ONI.N., I' '
This fano can bouseal for Single or tiadtipk wills' - - -
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I.!Welt Contractor Information:
tWATER ZONES . . .
Scott Hunt, Jr. .. FROM TO ' DESCRIPTION Well'Contractor Naive 16 ft. 24 It, red and yellow tacky silty clay
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4561
NC Weil ContractorCertificatieli Ntubber-
• AS:OUTER CASINGNorroutik‘ised*east'ORLINER Mari firableY. • - •.
FROM '70 ' DIAMETER. ' THICKNESS' mATEtatAL
SAEDACCO .rt,
Conic uty Nania. . .1 ,'INNER CASING OR TUBING .earbermat'dosed-Ion .- I
FROM 70 DIAMETER t THICKNESS MATERIAL
2.Well Contwiretion Pertnitfi; - . 0 ft: .14 ' ft.' 2. Vbs. SCH-40 PVC
Ila 0.0 apirdicatdo well pemlits Ale..County;.Stahl;Vailairce.frjethat elr.4
00:
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3.Wc11U5C(ClicCic Well use).: 17:SCREEN-
Waler Supply Mg:
' — FROM'. TO .DIAMETER storm*: THICKETSS. I MATERIAL.
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14- R. 24 'ft. 2 . •im• :010 SCH-40 - PVC
0Agricultural CIMtniidipakPublic , . .
OCRotheimai(Heating/Cabling Supply), frIROsidential Water Supply(single) R. • . Irt' .In. . .
18;GROUT
fludustrial/Contotercial . CilIcsidenfial Water'Supply(shared) '-
TO . - NIATERVa. - EMPLACE,WENT.11ETHOD.4 AMOUNT
' ID Irrigation -. .0 ' ft.. 11. • ''ft, portland trimmy .. .. '
Non-Water Supply Wit . -
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10.Monitoring - pRcvo .vciy • • •
'IttjUtflWq1.1:. • - ..ft. . ., - .
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• °Aquifer Recharge Eldioundwater Remedial ion t9,'SAND/GRAVEL PACK(if applicable)•- . . . ... .. _ _
.. . 'Poem' -—' TO' • ---NIATRIUAL ."• • • EMPLACE.MENT METHOD -
1:1AttniterStorage and Reemtiy 1:fSalinity Battler 13 ft.- 24 ft. sand 2 . .
CI Aquifer Test OStOrtreSitter Dmittage
-rt.. rt. , . ..
• ClExperitucotal Tcelinolog CISubsidelKe Control .: .. • .. . .. .. ...
•2oi DRILLING'LOG(attach.additioaat slice4 if occesvarvl
ICIG.eothettual Closetl Leap) ICITracer. THOM.• TO DESCRIFTION(cob r.hardno,unto&ty rt.Ftftili Nile.de.)
1:1Geotheima1 aleatina(tooling Return) IJ011ier(explain under Ii21 Rennuks) ° '14_ 10 ft.- red fi.3,..1 i dirt
' 10 . ft.. 16 . ft; silty clay red/brown
.4.iiii .W01(s)Completed:•2-21-24' Well mom-15 fr.
16 It.- 24 ft. red/yellow tacky silk clay
Sa.Wril Location: - .ft.- tt, . . ., , r- '\/ I: •r... ,-,,L i ...,. , .
Walk-On Products ' "- ..• ft: .ft. . ' 0.ik.... .,t.-- .
FacilityMitoarNiuttc Facility IDM.deapplipble) - ' -
•'maw. 1-2"2021 •
- rL. ft.. "
1170.Chuck,Taylor Lane , Salisbury, NC, 28147 . . it. it.-ft:- . .
PIOical Akddicss,CRY.and Zip ',21.REIRARKS' •
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Bentonite seal from 11-13'' •
Rowan .
Omni). • Pardo metioneation NO.MN) ,
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Sh,Latinide•atid LOngitadc hi ilegreeittulnutesiseconds or&Chita!gegreesi 22,cenifitati- on, "
tituall truld,otieratnott.kaufficicht) - ,
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' N - • W. .40) t../14// - ttriGr,c-rd:::.7):73,..."... „',,g,1,",„':,,
2/26/2024
5igtot' arCeritik, Will Cannortat , ' Dale
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6.Is(are)the well(S)r.BRennanctit .or LITemporary • •
•Hy.siening Ws foniri'l Ircreby certify then Ilic refits)war(ivery)cooszruard fir accordance•
with/M NCAC 02C.0IO2 or ISA NCAC-02C,0200 KW Constniferion Standards and that a
7,Is this a repair tit an.inistiog well: ElYes or No . r,-/iy of Mir recordbas Non provided ra OW!,,rii owner.
If*Isla a iepair;fill oar krivisii well consititataa brforrnafian or espial))gm nature of the , : •
'repair tinder#21 remarks Scalar)or cw the bail cif gbh fqrnr. 23.Site diagram or additioiml welIdetails
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You may use the back of this page to provide additional well site detail's or vell.
8.Number of wells cottstnieted: 1. • - - • Consnuctiott details. You.may also attach additional pages if necessaiy.
For muilriplg injection Or nan-irater supply welds ONLY aide the Same construdion,$ou can
. submit on o form. $UBhf[fr AL ENSTUCTIONS• ,
9.Total welt.depth below land surftte 24 (ft.) Sta..Par All Wells: Submit WS:form within 30-days of completion of Well .
For moftlialcirelfs nil all depths if difiirila(examPfc-3€100'ezof 2@ 10P) con.struction to the.foltowi ng:
10.Static water level below tap of casing 16 (I() •DiyiSion of Water Resources,Information Procesidng Unit,
/limier level is above mat::tue."+" 1617 Mail Service Center,Raleigh,NC 27699-1617
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EL Borehole dianicter.8. '(in.) 24b.For Infection Weill ONLY: In'addition to sending the form to the address-in
24eaboVe.also,submit a copy of this faint within 30 daYs of.completion of well
12.Well cOns1ruction method:SSA mmultudion to the folloWittg:
(Le.auger:rotary.Cable.direct push etc.} ,
'Division of Water keseurces,Under ground Injection ContrOl Program,
• FOR WATER SUPPLY WELLS ONLY: " 1636 Mail Service Cdnter,Raleigh,NC 276994636
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' 24c.For-Water Supply Se Injection'Wells:
13a,Yield(gptu) Method.of test:
Also'subMit one copy-of this-faith'Within 30 days of completion of
13h.Disinfeetion type. Amount: well constructitin to the cotmty hezittli depanment of ihe..county.where
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Fano OW.[ North Catalina D...votiroont of Etaironamt and Natural Resources-Division of Water Fttanurem .Revised August 2013
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