HomeMy WebLinkAboutGW1--01545_Well Construction - GW1_20240312 II- ,
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WELL CONSTRUCTION RECORD
is o c ag . •. ' •
rA or bdcnal Use ONLY:
Thlamcanbiscdfiinglcttmultipkwells
1.Well Cntrattor Information: •
,CI:WATER ZONES- . . •
Scott Hunt, Jr .. . FROM 70 • 10:SC101.110N
Welt ContritclorWanw " - ' 16 ft. 28 ft. red an yellow tacky silty clay
ft. ft.
4561 .
' AS.',OUTER CASING(fortnitItkintdineffs1 OR LINER Wan Heald& ' -
NCWcJI Corttructorartilication Nadler
Fitold 70 : . DIAMT.1.ER•' " THICKNESS" 3IATEIHAL
SAEDACCO . ,rt... . h.. : in.
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. . Computy.Nape . ,16."-INNIIR CASING OR TUBING(geothermal closed-Innit) • '•
• -FROM TO DIAMETER THICKNESS MATERIAL
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2,Well tonStructn Perna tri: . - 0 • ft." 13 ft. 2 i.LIL "SCH-40 PVC
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40 4711 Waal*welt penult-31k.C'eunry;&Tee.,.Varrairee.Infecticti,err.)
• it. ft. I'in:•"
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. 3.Wcil.Use(thoeltWell 054: •
- • 17:SCREEN- ' .
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•' Water SimplyWell: - FROM. ., 70 DIAMETER SLOT MEE Tit ICKNISS. I MATERIAL
• 13 ft: 28- 'ft: 2 its• '.010 SCH-40 PVC
C3Agricultitral 1:11i4tutidipaUPublic '
nGeothennal(Heatingtooling Supply) ClRitsidential Water Supply(single) " Ft. ft.
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ClIndustrialtConuitercial OResidential Water Supply(shared) • ..--.:071°uT"16• • -- " _ , ... _ .. _ _ . ,
UMMI'. .. EMPLACEIHENT METHOD&AMOUNT
ElkiiPution . S
. - 0 • ft.' 10 .11. portland trimmir . .
Non-Water Supply Well:. .• •
• h. . 1
111.Monitoring . . , ft
_ -jiRecovety •
Injection WO: • - . , • • .rt, • ft. • ' :.• .. '
ClArptifer Recharge" Odioundvitticr Reritcdiation" ,IT:'SAND(GRAVELPACIC(if attalicabte)•
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'FROST •70' MATERIAL EA I PLA CEMENT mrroOti
1;1 Atpiit:CFSI0rdig;ROI RcoFcty 1= alipity Barrier 12 ft.": -28 it. sand ;: 2 .
• 13thittlfer Test . 1:1Stominatcr Ihaitiagc
I. ft..
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:Eioperinicntal Technology ESubsid.en e Co n* i .
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' ' •IltDRILLI?GLOG kisch additonalshoilaf neccuarel
ECeothenal(Closed Loop) • :Tracer - . •
FROM , .70 - ' DESCRIPTION Imbi..liartInevi,WI:Pick nut.mrain Stithdo.)
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" • . LIGtmthetmal(Fleathiatdolin 1: thin
a Return) : 0ther(explain under fal Reks) . ° ' -'1' 10 ft. red fill dirt
, 10 ft.: 716 It: silty clay red/brown •
4.Date WOO).Completed: 2-21-24 well m M41-13 . • •
'16 it,- 28 tt. red/yellow tacky silk-clay •
5a.WrIl[location: ft. it , ; ., • •.. ; i'''.4---4
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- . „,--.- •--.r L.-,, . . , 0
. k k,.....i....a I__;, Ve hmal,
1.-...
Walk-On Products ft. '. 1,
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.FacilityKlierri-Nitrao Facility IDA 6E74011,1W) ' A ' .
ft. . -
1170.Chuck.Taylor Lane , Salisbury, NC, 28147 . . .rt.. • ft; - , •
.illitrirt;,:',...i2r) ?r7.:-...wn:flg I.J.Fi '
Pkticai AdliF:gs.City.aittlZip• ,,2t. i'/ARKs' , . .
' . 111,.kr.."1."-).‘z •Rowan
Bentonite seal from 10-12'.
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County , Parcel ItionliticatiOn No,(PIN)
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5b:I:Minute atitigamgitude in degrocs/rninu MS/seconds or decimal degrees: 22.Certifitation: ,
Orwell field,ens Lutleng.isrticicto - ,
N - • W it, Aritlii.?
2/26/2024
- Sigz a ,Cettii ,.Well Contractor'- .Pale •. . .
6.Is(aril the sell(s):-.X1Permanent. .or 13Temporary .14:*fling ibis feiM,:l hereby eererfy that Mr nellfs)vi-urrivirrei renorilered 111,covorrlancv
lei&1M NCAr OZC.0100 or 15A NCAC 02e;0200 Well Corral...redo!Stattdards and sliti a
7.Is this a repair-fa attraistiagINclit- Elites or 110 No ;ropy of Mk recorif hos beers'providrelto rhe livii onaler. •
1101Slio repair:fill oat kruinit ma cm/maim Worm:Ion anti explain the nature of the
repair tinder 021 remarks Arciirin any,the bait of thfr Prat. 23.51E4 tlittgram'or additional w011 details: .
You may use the back of this page.to provide additional well site detjilior well
8.Number of wells.canstracted: 1 . consItuction details. You may also attach additional'pages if accessaty.
For rirnalple Infeeilon or nail- rer supply wells ONLY WM the same construerIon,you con
• =tank one prin. . StiBNIITTAL INSTUCTIO 'NS . .
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9.Total well slept!,below laud surface: 28 . (fr) .24a. Fur All Wells:-Sithmil this faint within 30 days of'completion of vell
For nuthiple ivelirlisr di depths 4-different(example-30200'orni.2@l(V) constmetion to the following:
10.Static water level below top of casinw, 16 . _ - (ft.) Division of Water Roan ree.s,Information Processing Unit,
If water level is'above easing:ale"+" 1617 Mail Scrvice CeUtcr,Raleigh,NC 276994617 .
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11.Boreimicilianiemr:8,25 7 ' (ill.) 21h.For-bifection Welic ONLY: In addition to sending the form to the address hi
24a above,also submit a copy of this form within 30 days of completion of well
12.Well construction Method!RSA - Cothlructitlii to the folloWing: I
(Le:auger miry.cable,direct musk etc.) j '
'Division af Water Resources,Underground Injection-Control Program,
FOR WATER SUPPLY WELLS ONLY: . 1636 Mail Service Cdtiter,Raleigh,NC 27699-1636
24e,For Water Supply&Injection Welts:
pa,Yield(gpm) - MeRiell of test:
' Also'submit one copy of•this fonts Within 30,days of completion of
13b.Disinfection type: _ • Amount: well Consuoition to the county health department of the.counti.whem
Constructed. I '
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Fenn GW-1 Noah Carolina Dcparnitcat or tiviroonria and Natural Resources-Dleision of Water Rottrrz. Revised AugustlOI3
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