GW1--02248_Well Construction - GW1_20240409

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WELL CONSTRUCTION RECORD .
Fig'Ilium!lisc 9NLY;. • . .
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This form can ix used for single ur multipk wells.. . . ,
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I.Weil Contractor Information:
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'14.-WATER ZONES-
' Scott.Hunt, Jr. . , . . . , 614051 - 40 -Dr-SCIUMON( I- ,
Well ConftactoiNunig; • 45 ft.: 55 ft.. rocky sandy, silt tan
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45 61-A . . . .
NCAVelll ConteactarecrtiliciaMiiNtaitMl - AS.OUTER CASING Craentutti-ensed ndisi 0 R.LINER Oran titabk).
FROM •70 ; DIAMETER.. f 7MCKNESS• " :i TATERIAL•
•SAEDACCO . . . ,fit- , , • •.
• Compauy Kam*, " ' . /6.INNER CASING Oft-7fUBINGliteathertual elosell-loop)
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. . -FROM - To• DLCMEIRR- •• IIIRCICNESS MATERIAL
2.*II Con4naethin Perri*fir • .. . - • 0 ft. -45 ft.- 2 -, strr.• -SCH-4 0. PVC . .
/Iv sti applicable salt ficirreits fix.amaity;Strar.Nariarrre.frieurian 4147.:y ,
ft.- . . ft.:
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3.Wei II liguttlicvleft*F3Ittelt . .
117:SCREEN
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Water Supply Well: • FROM. TO . .•OtAMT.Tr.R -st,OT Sim Tit ICtcNISs 1- TATERIAii. . .
45 • ft 55 •ft; 2 •ill• " fil" SCH-4 0 PVC
CIAgridultural. .CiMwkipaliPubilc.: .. . .
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EIGeothennal(licatingiCooling SupplY), CIRCsidentialWatcr Supply fsin-gle) - - ft; . . .
' • ClludustrinliConuriereial CIResidential Water Supply(anted) . •
70. ••' MATER/At. , EMPIACEIIDIT MEIROD da AmoONT
El kiigation-. . 0 It.• 41 •ft. Portland , Tremie .
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Non-Water Supply Well:. .4 fr.: • - .4.110nitoring . . . . . . PM:emery. . - , . •.
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. - Injection-Wett: . . • . - •
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IZIAquifcr Recharge ' - EldMundwarer Reritediation •lg.SAND/GRAVEL•PACK tif•Ippthubrt) - . . .. . _ _ •
- -. •- - - FROM - 70' . • 'NOARRIAI. , ENIPI AVM-MINT MErtIOR • .
ElAnoirStorage and 1-.*ciSetY. , 1:1Salirrity Ranier' .
43 ft 55 fi. sand , ' 2
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PAquifer-Test . 13StOnnwat' ct Utairia' & ft
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bEftpctitnental Tceitriotog. MSubsidence Control .. ' -. =20:DRILLING LOG(2112C14 additional stied if accessaml .
171Cmothrtniiii•closed Loop) . 'Eltracer, - . . .guota-. • To • - DEscRIPTIfts(eobr.hardriac suMnick um trill 14142.Cita
aGeothetirol(Reatinaidoolina Return) 1:10ther feviairt umier Ail Retuaiks) 0 ''rt• .5 ft. red'fill
5 'ft.. 25 . ft. red silty clay
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• 4.Date Weigg)conipliled: 3-5724 . -Wen liD#/454-6R ' . 25 .ft. 45 ft., red/tan Silty clay - • .
Sur Well Locatittin 45 „ft. 55 ft,-. tan rocky silts . •. .
. . [7rt..L..._,..;.....,..'
Edgewood Shell -......_.,.",.. V r7.—'i,7t...1. ! ..
FactliipOivoerName. - ' facilk:Op(itapplimblc) - • ---
" . ft.• " ft. •
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1210.Edgewood Rd. , Bessemer City, NC, 28016 . . . It., • ft.: , • , . APR 9 2024
. . . Pl6tiaid Altckscir Of-3ila'ZIP. qt.REIIIARES : 3
Gaston • .
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' . Bentonite seal from 41-43'
ry,";a:DOG •
. Comity • Parte)Identification No,(PIN) ' . .
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. • 51i,Latitude and Longitude in degreesiMintitesticcOnds or dechnal detrien .22,certifitatiom: . ,
0%1'a/I field,ourtlugloitg.isSuffickut) - • . — " ' "" ".
N • W , ..rye 3- ,5,2024 . .
• . Signs,'a:41,Cetitik• 41 Contractar- . Date
6.1s(are)the.well(g) .10Petinaneut or 13Temttorary. •/ty#gaing aris firnwi Ireivby rerfey Mar lhe we114,11.vra(way)araurgered be.frown/mkt.
Writ f SA Npic OW a)nk9 or int NCAC:02 .Q2019 Well Crutsnikrion Staadanis and that a .
7.js titis•a reliair to anexistiog ftelit DYes or R1No •refiiof rh it iecortf has Nero rovided tcydioi ITilifitmer,
If igs.11 a replir;fill our kaoivii well cansinictioainfonnarion and esp?oln the'wore of the .•
eepaietordee g 2!remarks irriiin dr rmi the bud arthii farm. ' - • - .23.Site di*am or adiliiional well details; .
You may use the barb-of this page to provide additional well site detail's.or Well
• 8.Number of Wells constrricted: 1 •- construetiondelaits. You stay also attaeltadditionlipages if necessity. . .
FoinralArde lakeilati or r!on-water itippkr wel.tv.ONLY bleu tbe sane construeiton,-,twi,i can „. I
. submit one form. . . sunkrrtAr,ENSTUiCTIoNs
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9."Total well depth below land surface; 55 . , • . (It) 24s. For All Walk; Submit this•loan within 30-dais of conviction of Well
Far nrahlpleWellelisr all depths if deeteo V(eXarnPle-3e200.and-263'WO) - . tonstiuctionto the foltoning; i
• 10.Static water level below tap of casing:30 '(fL), DiViSilm of Water Roottire'0,Information Processing Unit,
If Water.level Is above cusfav ate"+" . 1617 Mail Smite Ccnier,litalciOrt NC 27699-16 L7 .
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• 11.Burchole.diaincter;8-25 7 , --'O.) 24b.Far infection Wells ONLY: In addition to sending the fomt to the address-in
246 above.als,i.subrint a copy of tidi Miro within 30 daYa-of.cotupletion of well
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12.Well ci , iti
ntstrnetion Method:HSA consltuon to the following: ,
(ice auger.tatazy,oultle,direct Fisk um.) . ,.. •
'Divisitui of Water Resources,UndergroundInje .Injection Control Prograni; .
FOR WATER SUPPLY WELLS ONLY: . 1636 Mail Service Center.Raleigh,NC 27699-1636
ite..For-Water Suoniv&Injection Wells:
t451..Vida fgpm) NEelltod-of test:
. ..Also-subridi one capy-of this-font Within 30..days Of cotnidetiomof
13b.Disitifeetion type - • Amount:
WO"construction Co the calmly heallg ilemrtment of dm..eoun6-.wheic
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FormGW-t Korth Camilla Dqtauutemef Etwirmuueut and Natural Res?urces-Division ortghter Itatztes. Revised August NIA
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