GW1--02662_Well Construction - GW1_20240501

H
'' WELL CONSTRUCTION RECORD .
Far infern� al UseDNIN:
This Conn can b ttsdCer.nnglcermtdtipkucfls•;_ 1
•
I.Wcll.Contr•utor htfOnuatlon: , I
V. . - I1.WATER zt)Nts
Scott.Hunt, Jr . . . . . FROM TO •DFACR1PT17)NI `'. . .
Well CarrnnotNattw 32 ft.• 43 ft,. gray.sandy silt
4561 .ft. f.. ! '
NC Well CouirxtatCcnifteatiooNmobcr tS OUTERCASiNGtferituftl-casednefis'i°WEANERfif3f•liestk1'. • .
. - FRONr TO • DIAMETER�. '. TRIMNESS- .MATERIAL-.
SAEDACCO (It ILjfn:,
Company NaniC • : . •• 16.iNNERCASiNG OR TUBING(cj tberinal dosed-loap)r'•' ' ' •
• 5�t FROM TO ,DIAMETER TnICKNESS` -
• \NIA'rERIAL
2.We f.Conittruction Penult is WM0301344 . .. -. 0 ft.' 28 .. . ft. 2" . ills SCH-40 PVC
l rg al alprlfrebk well pdimits,(ir Cmtnty.Slur;.Uarinattr.Iryrgout elc,i' • • •
3.Wcl.Use(ehccicwell uce): 17:5CRCEN •
Water Supply Well: . . - FROM. .i TO . 'DIAMETER :SLOrT Fin. TIIICKNMS 1 MATF.RWI.
OAgriculttual • CJMuntcipatIPttbliic 28 . R. 43 •ft. 2" ice' ':'oio SCH-90 PVC .
®Geothermal(Heating1'Cooling Supply). • I:Residential Water Supply(single) R' ' Ft' in.
Cl!ndustiiallConmicrcial . ®Residential Water Supply(shard) :OM 711
t1U7 TO. MATERIAL Ea[P[ACEMENT.\,vnaoD s AMOUNT
' ❑friigation • ' 0 •ft.- 24 •• • ft. portland trimniy '
•
•Non-Water Supply Welk' rt.
10Alonitoring . . 17ltccmriy. .. • . • .
. ' Injection:Wel:- . . ft.• . .ft. . '
13 Aquifer Recharge ' EldiountinatcrRcntcdiation ,19-SAND1GitAVELPACK011ap)dieablel' - --_:
• FROM • tO MATRRWIa ' • RMP1-AITAD NT MI3nt1D •
PAi tufcr.Steragc and Rccevcty •• []Salinity liarricr' 26 f., 43 ft. sand 2
. . . 17Attlu fcrTest t7Stommatcrf rwiagc ,.
• R f6: . .
•
DENvctim •.cntrl Tolhnoto . I:Subsidence Conitwt ._ . , .
•2e;DRILLING'LOG(attach additional sheets if necessary) .
- 1:Geed:einutl(ClosedLoop) . DTr.lcer. • FROM . .10 . . DESCRIFTIONkobr.DampiM.soiWWkkispe:C,r+iun4aacte.i .
EIGeotliefinal(HeatiuvCooliite Return) . DOlker(explain under lk21 Rewattsl 0 :fL 15 . ft. red/brown silt
15 dt.: 30 f. gray silt with rock •
4.Date Weil(s)Comlpleeted: 3-18-24 .Well iDiKMW-12' •
30 .'h. 32 h. grey/white'silt compacted
Sa.Well L.iicatino: 32 -tt 43 r4'. gray sandy silt
Sweetwater Road Dump . I 43 ' ft.' ft, rock • *_-°' ..,'-,.'° i. 0;. -,-• ,
Facility,'OivocrNmec . . . Facility 1Dki.(,fappliablc) • � �.�r•& +` �3
k. . ft.
15th.Ave, S.E.,.Bickory, NC; 28602' . . ' 11.• •. ft.- - MAYu 1 2024
Plasical Addiass.City,and•Zip' a2LREhtARfc.4 . . .
Catawba • - Bentonite seal from 24-26'' 1T1,70;i;:igiI.,il i'ff:%a:Qa?-'✓F,i
' Comity Nice:Id.utituallion Nct,(PIM} .
•56.1LatiludC.aull Longitude in degrteshninutcslseeonds or dcchial degrc 22 Cenila.cation:
(en ell ficld,at• it7oars.is suftleicot) ... • . ` • . .
N W t : e _ 3/21/2024
' -' - Sigro ...7:1'ensi well Counactar. Daie-• ._
6.IS(arc)the.welt(s): >flPealnanene. .or DTemporar' Lly signgtg thir form;i Irerdbp errr**th.ii.lag well{si way(Krnt ramrrnrcrecf lit is ,ndancc -
with I M NCriC OZC.0100 or 15A NCAC r72C,0200 Well Constmerlon Stab:lards caul that a
7.is this a repair to an.eii ling well; DYcs or •12No :air nfthis recortd 1w1!rcnrprorirfe4 to*a,irl owner.
Ifrltlsiv a nlsalry fall oar At:visit well connnicrlon hrfornarlon mad etrfaln the narare girlie : - . •
repair:lode,A2i irmnrk irctian or cvi for brark of ntis form. - . : • - 23.Site diagram or additio nal well details:
"You may use the back of this page to.provide additional well site details_or,Welt- . -
• 8.Number of wells coustretned: 1 construction dettits. You n)ay also attach additional pages if necessary. .
For 111110ie bleeilon arrow-crater suppii attic ONLY Oh the same caatatruetion,you.et n
• • .cab:item ford. .. ' . . . • SUiRMiFTTAL iNSTI1 IONS. 1, - •
9.Total well depth,below land surfaces 43 (ib.) 24a. lair_ail Wells;•Subntil thus•fonti within.30 days of completion of.welt •
• For ms{ltiple(cells list all 41elsrhsifdi2i.reiit(example-3@200atu120lt70' construction to the following; • ' II'
10.Static water level below top'of easing:36 • •(R,) • Division of Water Resources,Information Processing Unit, .
if,t ire,lei-el is'dove oostirn;use"+" 1617'hlai Senicc Center:Raleigh,SIC 27699=16(7
1.Burchote diameter 8.257 . (lb.) . . - 246.For Infection Wellq ONLY: In addition ddition to sending'the fomt to the add=in
24a above.also.submit a ropy of this'thou within 30 days of completion of well
12:Well' nstruM(on'method:HSA . . - conslmction to the following_•
• (i.e.auger.seamy.cable,direct push.Ctc:) . ' I. '
DMsiou of Water Resources;Undetro►nld Injection Control Program; -
FOR WATER SUPPLY WELLS ONLY: ' - 1636 Mail Service Ce ter.Raleigh.NC 27699.1636
e3 0 'kidd(gym) Method of test: 24c.For Water Supply St Injection,Wells:
• • Also submit knee copy of•this forni Within 30•daysofcotupletionof
136.Dixinfc.tidn�Spe: Amount: well constnrction to the county health department of the.connh•.zahcte '
constructed.
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FonuGW-L . . Noah Caro linaD.pawlmernofEoriroiuisni ndNaturlResources-DiviclonorWaterHesolr RevisedAsu 1U13