GW1--02661_Well Construction - GW1_20240501

WELL CONSTRUCTION RECORD . Forti cmtdUseONLY: . • • . . '
• Thrs farm Call bc used for-singicor[multi,*wens.
I.Wei‘Contractor Inforwation:
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• :U WATER ZONES -
Scott Hunt, Jr.. . .. . . . FROM TO 'DESCRIPTIONI '
WON Con tclor,Natne, • 34 • R.: 46 ft,. ,gray sandy silt.
4561 It. R: I I
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NC Well CututaclorCctliQcaiiotiNnrolicr • AS.OUTER CASING ftor nutt142sn4nclIOOR-LINER(ifai Nab*},
• FROM I•TO DIAMETER. THICKNESS- SIATERIAL.-
SAEDACCO IL L. 'in .
Ccmfir;ta�'Nants. l6.iNNER CASING OR.TUHINGf lltentatdosed-loop), .'
• - ERoM • To• DUI:METER. THICKNESS MATERIAL
2,wilt Conimicttrur moult#:WM0301344 . , , . . 0 R. 36 ft. 2" in. SCH-40 PVC ' •
Lit Stub:..trariance..14pcbeetear.1 -s .
'R. ft. in .
3.M1Vd1.Use(checkwell use):' t7.SCREEN
• Water SupplyWell: PROM• . TO .- 'DIAMETER st0TSI?Z THICKNESS- i MATERIAL. •
OAglicultntal . . Cfl' ii icipaliPttbltc 36 ft. "46 R. 2" iti O10 SCH-40. PVC • .
®Geothermal(Heating(Cooiing Supply) • 13Residential Water Supply(single) _ fL ft; 13.
I hidust ial1Conmiercial.. ©Residential Water Supply(shared) . ER
arROtFP TO �I%TEIUAL taawl.CrMS r UEnioD&ANooNr
13kii'pation . 0- ' .ft. 32 ''ft. portland ' . trimmy
• - • Non Water Supply Well:
• •
4IDbtonilonnr ' . -" . :.itiRcccweiy• . R,. R'
. •In]ection,Well:- '. - b'. tt .
ClAquifcr Recharge • • G3Gioundisatcr Rcnicdiatiort• -°14.SAND!GRAVEL•PACK(if airplieable) .. . .
• . . . FROM • ' TO - \tAlliRIA4., • EMPI.tC '.iI 4tMETHOD ' '
IDAiprifcrStortgc and Rccovcty . . 1:1..dinity Hamer, 34 • .11... 46 ft, sand 2
. ' l7AgnifcrTest : C1StommatcrDrtiiyaae • '
ft. fL' .. .
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• ElEgtr;rimatlalTcchnology . 17SubsidcrtccControl - " ' . .
'2o.DRILLING'LOG(atlacit additional'sbcetdif nccessani .. .
Derreotllemu 1(Clased Loop) . :•tin-Jeer. • ' -. .FROM•. .To . DESCRIPTION mobs.hardaci.:snn'„n:aImmi raid Nra nO .
17Geathennal(Heating?Cooling Return) . ❑Other(explain under#21 Retnatks) 0 :ft.. .15 ft. red/brown.silt .
15 'ft„,. 30- ft; gray silt with rock - '
4.Date'4Vel(s)Cornpleteri:-3-19-24 •• ,Wt t ID#MN-9R
• '30 tr. 32- tL grey/white silt compacted
Sa.Wdl Location: 34 tL•' 46 ft- gray sandy .silt
Sweetwater Road Dump • 46 ft, ft. rock '
. .Faclityt�0isnerllamc. . . Facility'AV(ifapplicabk) " a " a G"'e , ,%�. s
AveS• .Hickory• , NC, 28602 R
• " • . ft..- MAY 5. 12024
.Plnsicnl Add_css.City.and Zip �21 R.Eli/AtticS .
Catawba Bentonite seal from 32-34' '
Gaunt)' • Parcel ltludiltcalion No,(PIM) •, ..OWQ 3U'.0
S •
b:Lati tude and Longitudein itegrscc/minutes/seconds or dcchual itetttti a. • .22.Certification
' . (If si$Il field,on Iaf ion iS i6lielci,t) �.
N W 4itJ7'
11t . 3/21/2024
Sins - Welt Contractor. • Datd
6.is Ohl.tie ttell(lig•,xiPerinanent: .or fTentporan' ' lip signing iris Rims;I hereby certify ilia!'.ihi 7relii.,)is-in Dirrei c 711trucks(in a wn/.nCY'' '
. . - . iiith 1 M NGIC 02C.0100 or l Set NCAC 02C.0200 WW1 Construction Sraivlards cued that a'•
7.Is this a repair to ate.a fisting well: • ova, or InNa 'apirofMit rrrord haslie'cn'trroridrd"to the rirll airier.
. 1f thhrsts rrRpair.fill txu kro en well coastructlaal rformar'un mul eiplaht rfic aware of the • •
reta:irtinter 421 rrmarks,rritmi or on the beak ufthii form. 23.Site dia rancor additional will details: -
You may use the back of lids page:to ptoVide additional wen site detain or Well
8.Number of wells constructed: 1 • eouslnlctiortdebiits, You inay also attach additional pages if neecessaty.
For mai:01e iajecilon or non nouer iupp(i wills O2sLY with the aatrreconstructto,, son con
submirone farm.' SUBM1f UTTAL INST[TCTIONS. I, . •
9.Total wail depth below land surface: 96 ((t,) 21a.-Fir All Wells: Submit this 1mm within 30 days of completion of will
. For multlpfo wells-list ail depths ifdiftirent(ex'mnple-3O200'aad.2@-14W) constnuction.to the following: •
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• 10.Static seater level beltia•top of casingi 37 • (ft.) ' Division of Water Resuuriert,Information Processing Unit,
!Akita . 1G17idta Service.Carter,Italcirh,,'iC2"t699=1617 •
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• 11.lioreholediameter:8.25" . . . (in.) • • 2-lb.scup liiicctinn Wells ONLY: in addition to sending the form to the:address-in
.24a above.also.subnut a copy of this;faint within 30 days'of completion of n+ell
12.Well construction method:RSA • . • • . • • . • conslmctloit to the following:' . ! •
(Le:auger.'rotary.cnble.ditto pick etc-) I i - '
' . ' Division of Water Resources;Undevgroutid Injection Control Program;
FOR WATER SUPPLY WELLS ONLY: • " 1636 Mail Service Ce`ter.Raleigh,NC 27699-1636
13s Vidd • •
23Gfor-WatcrSupply&iniection Wells: .
(ttpm) • Method of test: t - .
• Also subn>it one copy'of this form+within�0 days of completion of
13b:Disinfection type:. Amount: wenconstruction to the cdtmly health department of tbe,counly whete
constntctcd.
Font GW-L • 'North Carolina.Dcpw iitettt of Enritannclu and Natural Resources—Dtri;ioo of Waiei Riktter s • .L cviscd Aogust 21113
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