GW1--02658_Well Construction - GW1_20240501

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.'WELL CONSTRUerICIN-RECORD . • • • - • -
For Internal Use ON.LY: . . •.. . • • •
Tills farm eon be'used for iingletir multipk wells'.
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I.Wdl Cnntriterot Information:
c•CD.WATER ZONES , •• . ., .
- -, . FROM ' '• •
Scott Hunt, Jr . . . . . .• ' 110 outrattPromi- . .
Wen C9 tiacioilla Ric ,
•. • - • ft.: . ft, rock fracture -
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• . :ft. ft. • i I. , •
4561 ' • , . ' •
• . •• • AS.,OUTER CASING abrrant111;ensedlaills)OILLINER fif-tai fleableY - - •
NC.WO.II ContracMr Certifteation Nuttier • • •
•FROM TO • : DIAMETER--. TRICKNESS• MATERIAL
SAEDACCO
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. ' . 0 . ,ft. 34 ft. •6.25" in. SC.I14 0 • PVC
Company Nam . . . . 16.INNER CASING OR TUBING(onabetreal ellesei1-loon) -
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• . . - FROM .. TO . DIAMETER TRIMNESS .....MATERIAL
• ' 2.WII tanttructinn itrtnit ti:lim0.3 01344 .
0 . ' •R.• 50 . It: 2" '. 1111. SCH-4 0 - •PVC •. ' • . ..
-. List on rriplicable wilt peirtritr,kr.County:.Stirm.Voriarxr.Necikft elo.*
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• • 3.Wc11.1iso(check Well use): . •.' . . . .
• 17:SCREEN
- • - -Water Supply Well: . - . .
' . . - FROM, TO .•DIANtimr.0 st.orstrx THICKNESS M RI ATEAL .
.. . •. . . • 50''ft., 65 :ft.• .2" ill ;010 SCH-40 PVC• .
ClAgricultitral • • .CINfunidipal/Public• -. . . .
in,
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. . • . (2Geolltettnal(Ileating.COaiing Supply). OResidential Water Supply(single) . ft.
'LK-GROUT. . • -.
ClIndustrial/Conintdcial . • EiRcsidential.Water Supply(shard) • ,FRosi . . 70 . . . ..N.rATERIAL- . _ „rp(A. „„orr METHOD 4 AMOUNT
. 0 ktigation . . . • . . 0 ' It. 45 ' ••ft. portlarid trimmy ' , . - .
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- woo-watt,Suppl*Wen: ' .
• - • 0 '. ft. 34 It- portland triramy • .
1111.1onitoting '•pit=Om . .
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. . Inject1011 WO:. . ' .
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. - • lAqftifcr Rectiargi • • ' ClUirotuitiOutor RcniedialiOn• • •t9SANDIGRAVEL PACK(if applinte)'• . _
FROM - • TO •M ATRIUM: ' - • EMPLACEMENT NiETtIOn '• f
tIAIHOCUSIF4t4101 Ro:orct) . I:ISalinity Haider. • • 48. .ft. 65 ft, sand • 2 1
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. • 13 Aquifer TcSI ' 13Stonnwatcr Dminage-- • . • , _ . . ..
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CIESperintcntal Toon:dog). - ' . fiSubsidence Control _. .. . " • . .
.'20.,DRILLING LOG(attach additional sheets-if necessaryl
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• tiGeodtennal(Closed Loop) - , • oTracer. .FROM TO DESCRIPTION foobr.,hardnew,soillowat si nc.-trsio At',.......W.1
EIGtedttIllial dleatingtOoliva Return) '.ClOther(explain under kl Rent:mks) ° ..ft. 15 It, red brown•silts
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15 ft:. 25 If.. gray silts . .
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. . 4:WO,Wel.1(9)compliCed: 3-21-24 - well mt$MB-4D . -. - "25 ',
.(L.' 34 it gray-slitwith sand boulders - • • .
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Wdl'Wootton: , • - " 34 - „tr.- .65 rt.. blue and white rock •
• Sweetwater Road Dump . . • • • _ . -ft; . .. 01: . : !, . . •- ' . • • - . . .
. FacilityKliv.wrIlante ' . .Facility Mk 6f.applizablc) • I . ' . . .,
.• R'. ft, • ' • • - -•s'-'''•----,,•i: ••''P-:•..,li .• ,•Ii•=,,r'";
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15th.Ave, S.E.,.Hickory, NC, 28602 •. '.ft., • .
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Platioal•AiAftess.City.aid Zip• 121.R•ENtARKs• MAY -;• 1 -2074 . ' • -
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• -... Catawba • . . - • , . Bentonite seal from 45-48'
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Quint). • . Nivet Identification No;(PIN) • - 1r4;4.3rFr'...ii•-c il ecc..c.....5,-.artif.:g UFA - • '
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51r.,Latitride.atid Longitude in'ttegrecriminutett.tccOndsoy dccintal itegrcci: .22,ceetifi eation:. . , .
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(iftliill fidd,ouu lattlunk la ttuftlakiii) . .
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• • . N . • . 3/23/2024'
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• • : 7 s, .ifob.„,..,...:e,.,Contrac. tar• ' • • . Clod . .
. . ' . 6.Is(are.)the sell(s):.1:Permanent. or 13Temporary .
ify-signing thisform:1 Iremby cerrey did ha-11-111(si rats(virrej corgiructed br,accorriffnce -
- . • iridi 15.11,Npic 0 cmpo'or.1.riA xotc OW e,9200 11`4,11 Construction S40041045 and the:a
• . ' . 7.Is this a.repairtO aikedsting well!'' 1:3Yei. Or ENO • - ' • .eopiof gels'card has kien provided ta ilic toll 0W0411
• 1:f*hi%0 erimil.rdill twokrrois;u will consuurtion information and esplahrtlie mane of the• .•.
repair-larder*21 iv-marks iroirin or on rim bail of thii form. . . 23.Site diagram or additional well details:
. _ You ntly use the hack Of this page to provide additional well site detaiis-or.Well
' • • 8.Nirmberof wells constrticted: 1 • • ' ' • . - consttuction details. You may also atiadtadditiond pages if necesSoty. , • -
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For arairtpl.e Ittierrhm or non-rearer.rupplr writs ONLY with Vie same construCtion,tea am
- • • satunlione loan. " . SUBNIITTAL INSTUCTIONS. .. , • .
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9.Total well depth below-land surface: 65 ' . • . (ft.) 241a. RI r All Wells: Submit this•tozin within.30 days of completion of well
For nrairiplei,:Talistall cl'epsirs if diftirer4([e-mail].201470) . . tonstruction.to the following; • • •
10.Static water level below tap of easing:. 6 • (ft.) • DiviSion of Water ReloOrtes,Information Processing Unit, • ' - •
• - lf huier leVel is above aufitz'tui..'!+" . . . 1617 Mali Service Center,Raleigh,NC 27699.;.1617 • '
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H.Borehole iliamdcr:12.25"/6" . • • • - • 2-lb.For folectiou WON ONLY:, in addition to sending the Gm to the addmr.s in
, ' , .24a above,also,submit a copy of this;(aim within 30 days'of completion of null
' 12.Well constitution Methoth HSA/Air . . • .
. . ConSIntetion to the follcniing:•
(t.c.-augat mini.,table.direct pink ctc.)
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' Division of Water Resources,Underground Injection Control Pro.grrant,
FOR WATER SUPPLY WELLS ONLY: • ' ' ' 1636 Mail Service.Ceittir.Raleigh,NC 27699-1636
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• 24e..For-Water Supply&Inject/on Wells: , .
- 13a.ileld(gpm) - Method'of rest: • • '
- Also submit one copy of this-form Within 30.days Of Completion,of . -
13h.Disinfection type: ' ' - . Amount: . . well construction to the county health department of'dm_Countywhere . .
• constnictod,
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Fa tv.I.GW-L • , Nola Cara4na Dquittnent of Envirounryi and Natural ges9tarcs-DAtiou of Wafer Rautp;s , - . • Revised Auggliil I 3
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