GW1--02250_Well Construction - GW1_20240409

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WELL CONSTRUCTION RECORD ` Fysltutmnlusot)NLY: .
This farm can be used,foi single or nndtipk wels•• ' `
I.W L1.Contractorlifotluatfou: \ '
•
• "1:OG IVATER 2.0NES
Scott Hunt, Jr . FROM 10 )' IflPIION1 !
WellConliador.Namc. 45 ft.: 55 ft.. ,rocky sandy' silt tan
4561-A :IL fL.
NC Well Contractar Ceti iftcationNwi>bei !:IS.OUTER CASING(rormutlt-itiser0 wellsl OR LINER(if apprleabkl
. FROM - •TO -. DIAMETER. I' ;THICKNESS. • .MATERIAL..
SAEDACCO •ft,• ft. ia:
•
Coayt:uty Name. [6.1N.NER'CASING OR TUBING(giodies-6 A elnsed-look):_.
•FROM To• DIti.METER.. .'rnICKNESS MAI-CRUL
2,Well Constrpetirin Perinit ar: . . -SCH-40 PVC ""0 R: 45 ft,' 2 `iu:
list ofiapliliodfde will pennies(Er.County,Simi!:-Variance.Neil t 0;1' ft._ .. • . .
. ft.
3.We:IL.Lise(che ck.wdl use); I7:SCREEN
• `Voter Supply WelkFROM" TO tttMETRR SLOT SIZE TittaiscSs "IIArh.Rmt. .
- l7Agmcultutul . CRdmiie paUFublic . 45 ft. 55 ft: 2 in :Ol SCH-90 PVC
_ ClGeotlteimal(EleatingiCooling Supply) CiRcsidentiat'WaterSupply(single) ft: ft in
is:GROUT _7lndustnal/Conmtercial clResidcntiatVah rStppt}(shared' :FROST- TO . • "MATERIAL . . EMMACESIENTMERIOD&AMOWT
' ❑riieation . . 0 ft. .41 .. 'ft. Portland I rem Tie
• Min Water Supply Wett:; •
EllvMonitoring '. •.Rcco)ety . . . R.. ft
InJectiott:%Veti: . . . IL. O. .
.
OAnnifcr Recharge ®GtounderatcrRenicdiation ' •LS SAND/GRA.VEI..PACt,firattidieabter ....: _- -
• 'FROM-- 10 ! "MATPRUt. I - EMPLACEMENTlit:Tn0n
. ElAguitcr-Stoiagcand Rccovcty° ClSalinity Elamcr 43 . R.. 55 ft. sand I 2 •
• 13Agiiifer'fcst t7Siomnrttcr Drainage
ft. It. " I.
❑Everimcntal Technolo • DSubsidence Consent
•.20 DRiLLiNG'.LOG(attach additional sheds if eeccssarvl •
"❑Geothetwat(C Posed Loop)• []Tracer", . - .FROM TO . ' t DESCRIPTION tuobr°hankie*vlMwkttpr. ao Ate.cu:t
❑Geotiteimal(Heating/Cabling Return) Clother(tviaiiiuttder#21 Reumtts) 0 :It.i 5 . ft. red fill)
5 ••R: 25 fL red silty clay .
4.Date WCu(s)Coniplcecd:_'3-4-24 „Wdlill#MW-2R • •25 ft. 45 R. red/tan silty clay
Sa.Well Gtcati»tit • 45 ft,,- 55 (t, tan rocky sirs: ,--',,,
Edgewood Shell f. R. • , . d' (,.u,'L.is°►J' 3, i
FacilitloiwurNana: Facility ID#(if able) - - - A w.
R.' ft.~ APR .�24
1210.Ed ewood Rd. Bessemer City, NC,. 28016 ' A r
g , .ft.. • fl.. •
. Physical Addicss,Citl•.and Zlp• .•21.RESIARKS' ' . '1I t9.,.vrx::.:Z 'r =r,.•, +r:
tr.,f
Gaston .Bentonite seal from 41-43! riVil:S3OG
Couuly . Parcel hkulifsc;ilioe No,(PIN) -
56.Latitude'and Longitude in dcgreesltninutcs/secctgndsar decitnarctegtres ' 22,Ccitifieation:' •
(if u¢II field,met l/10rig 1g grdfrcicni)
Jill
� �.. . i , . .
N - W. 3/5/2024
Signa's:xn Ccif.tiS.1 Sir"efI Can1mctar I ; - - Uatc
6.Is(are)the_well(S): ElPerinanent .or ❑Tentporary. lip signing ibis farm'(berry certif}'char the irell(.sI was(isrmi amorist-fed brorconlancr
irk!'/5A NCAC 02C.0100 or 1,54 NCAC 02C.0200 Wi if Conatnwtlou Staizdards and that a
•7.Is this a repair to an cusling'acR: l7Yrs or R No cdpv oftleis record has brat pmrided to;tlr.'gyell Pawn
fjthfs ll,o rrpalr;fie!tort ku6eii wild coustrtrcttoa lu fotrrratlort owl captain the More oldie
repairwrd'er 421 ierruarLv arciinn or on the boa of Air form. .23.Site diagram or additional well detailst - ' , _
You ma use the back of this page.to pro6'16 additional well site,detail,or"tselt •
8.Number of wells constructed: 1 • • - : cotistruction details. You may also allaclt additional pages if necessary.
For nruttlpde lttteerionor iron-carer mppir welds ONLY with die same coustrurtlotr,you can - 1
.suburironr form: SUBMITTALiNSTUCTiONS
9.Total welt depth below Lind surfitce: 55 (fr.) .21m•Ftir All Wells:. Sarni(this•fomt within.30 days of completion of welt
For molelpfea•ellslist off depths(feA.0-•rent(example-3e200°anii2@WO) " Construction to the rationing:
j ,
10.Static water level below top of rasing:30 .-(I,) Dilis°iun of Water Resources;Information Ptuecssin„Unit,
. 1prater level Is above tvtsfidn:use"+" I617 Mail Service Centers Ralcig t.NC 27.699I6L7
IL:Borehole diameter;8,25" '(in.) 24b.For Infection Wells ONLY: IA addition to sending thefomr to theaddress-in •
.24d above.also submit a copy of this foam within 30 days-of completion.of welt
12,Welt constpitetiou method:NSA construction to the follov@itig:
(Lc:auger,'tteary.cable.direct Festi etc.) -
Division of Water Resources;Underground Injection Control Prograli,
FOR WATER SUPPLY WELLS ONLY: 1636 JNail Service Ceiiter.Raleigh,NC 27699.163E
•
13a,Yield(gpm), Method of test: 24e-For •Water Supply.tt Injection Wells: -
Also subtiut one"cop} of this famllawthiu 30_days ofcotupletiotlof
13b.Disinfeitiun type: ,Amount:
well construction to the cotmty health;department of thc.countycwhere
consirected,
Fonn GW-i North Carolina Dgaument of Envier irmu and Natural Resources-Division of Water RelotSem Revised August 2013
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