GW1--02247_Well Construction - GW1_20240409

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..- WELL CONSTRUCTION RECORD' FgrltsttrnniuscONLY..
Thy formcpn be uscd.fof�sin�koi tmultipk wens•. • i .. :
li W4l Contnetar lrMorntatiatt , •
:ICI:WATER ZON tIS
Scott,Hunt, Jr .." FROM.' - :70 'DFSCREPtto;r ' •
WcII.Cati7tadat,Natne 45 "R ; 55 ft. .rocky sandy.silt tan •
4561-A •
H. fti.
NC Wa CosilkeibreertifidatithiNuiite '-15.OUTER CASING-Ivor'entlirinatweilsl OR-LINER aria Rata
- .FRoat • •TO .D!AMETEIt muctorEss. ]VTATEtarAL:
SAEDACCO • . 1.. (1. ia:
Con>,truty:tYome t6:INNER'CASiNGORTURING•(r.ea�ttain [loge[aon0)• ' .
•• �•RR05I —TO DtAAIETSR, 1 .Tn1CKNESs MATERIAL •
. "- 2,�YcIt Constrcit [tin P•eimiit R: 0 R: 45 R: 2 1>i SCH-4o PVC
. .2..Weil
County;$2uti;:Vanarrre,"f a c4efr4'.
3..Wcfl (cbccl.-ncllise)
se . . r7 SCCRE:EN, •
WaterSupplyWe1L•- - -- FROM : TO 'DIAMETER SLOT Sin.. TTIICKNIIS. 11MATERIAL •
®!1 uIt(ltal C11Gluniei 45 It. 55 .R 2 • 'EL• "•')Ol SCH-40 PVC
�Itf paliNblic'
l7Geotlieimat(iieatingtoohng••Supply). " ®Residential NaterSupply�(single) . ti: ft u� i, ;
®Iudttsifia1(Coi uteicial CIResidsntiallVater'Su CIFI
Rp .( '�`md� • Fa BA:orr.RO' To. MATERIAL .,, catruCEMENTstemoD s AMOUNT
❑hii€;[lion 0 . ft.. 41 •ft. Portland'; Tremie
'Non-WaterSutil}ly,Well:; . .
Monitoring - 17Rccoyety' R•; tt I,
Injection:Welt: rt tt
L]'Aqutf rRecharge` • DGmundnider.Reincdtalion 't4:SANDIGRAVEL1'AC[KtilmtphuMcl'' „_
PROM' ' TO ' 'HATRRtaI. E.MAmum-watiOn .
i3Agnt('crSioragc antd Rccoi'cty . 11STlinity, Bamer - 43 .ft.: 55 ft. sand I 2
• 17AqurfcrTest•. ElStomntsatcrffiainagc +' ' •
' tt ft. .i, ; .
CDE tpetnncnhtl Tgetir oatogy JSubsidceeg.Con tol 20:IlRILLtNt;'I OG7altaci addii7otial sheets' teccccsan 1 - -
. OGaotltenwat_(Ciosedd Luop) ' DTracer. • ' • .FROM' .110 • -. DESCRIPTION(color.n,tvacc.,,niEa,ct:Olit,:riu»:ru t • ':
DGeollteanal(Heafinn Cnoting Return} ..ClOder(explaiicunder#21 Rettiatlg)- .0 ;14 .5 ft.. red fill I.
'ft.. 25 . . ft red siTtyi'elay . -
4:Date Well(s)Com-pitted;,'3-5-24 Ar i ll#MN-7R.• . .25
., _ `tt.' 45 tt. red/tan silty clay
I,
Sit.'Wd1 Ltncatatn 45,' it, 55 (t, tan rocky.silts
Edgewood Shell. ' - -. I.' 4t. i" .. C 7,. - . r,
t„..,,kv, .,.t )
Fact�it},Y)ieocrNttmc. Faetl7t,mA+6fapplinWe}. �" s--�r •3 ,
1210.Edgewood Rd: , Bessemer City, NC,. 28016 fA _tt j \PR 2024
. P1n5tcol.Add[ess:City,:alyd Ziif- '2 t:RI:t[ARKS.•- '
Gaston „ Bentonite seal from 41-43' is In.., irfTG "? a,._..74, zj M Lin
County 1Vrcct.w ttftcation NU,(PIN} - ' . I, .I JYvl.7 r:' G)
5U. :atitudlesod:l:_ongitadeinttegrcellmintifislsccnndsorttceitt,TictctlIcei: . ,.21iGertificatioQ::. . -• .
(0t:tiell field;o t.lciflong 7s'stdtlelcid) ' - .
N. W c 3/5/
_ 2024
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' Sigtst€; Ccns W cIt Contiactor Date •
6.Is.(are)thesteli(s): 10Permattent. .or DTemporaty. ..
`N3'plbubr6 that fotm:;11rercLp+;ergf}thru flu;ux11t'sJ sm.(Krm}cxrnrrructrd ia;ayxnrrlmiar
iehlr l5A NC!(C OTC,01 X)or 15A NCAC 02e,0200 Rt7!Constriiettat Standards and km a •
. ' 7:Isthis a repair to an.eristtag Fell; §7Y or KNo taprojfhdr wool hat•h en pnruled,iotf;c a:1;110 ter. '
if rlr(s'&o repel fit/oat krruw.isall causmrctloa Frrfamun(on mut rap(alft'rlte rtrtrure of*
• ' -rcpairtlmder 021 trrrtl2rt-Su..w`f(an or on the bad nftlits fornc •„23.Site diapt•am'or additional well details: - ,
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'You niay:use tie back of this pagertO.pro�,ide additional well site details or.iiell
S.Itutitber of Wells Constructed: 1 consttuctiotidetails, You way.alsaatiactt additional es if ne.essaty. -
. •koisitillzWe trtjeeilmtornru_i-tinttersuppl weItsdh'LYIdrisrile.saniecomtruetroir,"yaucatr I
e tu submit onrn. - SUIBMITTAL iNSTITCTit)NS 1. - .
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Totalwell iepcll belowI.vid aortae.: 55 • op,') ,21.a. For All Wells: Submit this font tyithin 30 daYs'of completion of'.w'ell •
For mi.Itdple llielfrlistalldeprlhs itdi ferent(esar: (e'3@AV LT1 .20"l00) - - construction to the fotioaing; • •
10.Static wsaterle%cl below tops of casieW.30 .MOIthtsiun of Water Resourc'�•,Information Ftueessimg Unit,
!Ante fevef is[those casing;itu"4" '1617 M.ul Service Ccntrr';Ralc gh.NC 27699=1617. .
II,Burcholedianictcr 8.25" (�) 21b,mop lteJectlort Willa ONLY: in addition to sending the foam to the address in ' • .
' 24a above.also.submit a copy of this;feint within 30 days'of contpletion.of cell
12:Well construction"method:NSA constmetiouto the following: ,
(i.c.auger.iotnt}::cable,dbxt push ire.}•
. 'Dls•ision of Water Resources,Underground Injection"Control Program,
- FOR WATER SUPPLY WELLS ONLY:-" •T636 Mail Service CenteC.Raleigh,NC 2769v-1636
13 t Yield Method"at list: 24e.•For"Watcr Souls-&Injection Wells: "
,_Also"subtilit One copy-orthis faint'Within 30,day Ofeompletionof
13h.Disinfection type: • - A-mount: - Ira Cons[action 6the county health'ettadment of tlte.coun. ,.where
constricted. ( I•
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Fonts GN-1 Noah Caroltna D.cpott matit of Hm imttniia and Natural.Resourcesi L Division of W iet Reat» -Revised Auguat'3013