GW1--02663_Well Construction - GW1_20240501

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• WELL CONSTRUCTION RECORD - •
For Irrettud Use ThhONLY;V; . •
form can be toed(of single er multiple wells., ' • . ,
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1.Well•ContraCtor htformation: "
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• • • , 14.-WATERZoN ES
Scott Hunt, Jr • . FROM TO DESCRIPTION
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Well CornractotNattie . . ft.; 48 ft. rock,fradture • '
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4561 _ . • -
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' NC.Well Contraelot.-Col ilicatioiithuilier'. ' . :. • : .. '. ".:15.•01.1TER CASING(intioultkisedlAinfls)OR LINER(if all linablelI. - '
. . . FROM . TO '• . MANIETER••' 110ICKNESS• -, MATERIAL ••
SAEDACCO • , • • .ft., fL. . 'in.
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C.omputy Nome -,- ' Id:INNER CASING OR TUBING•fgeotharmal closed-Wool.
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. FROM TO• DIAMETER. TOIELCAF.SS MATERIAL '
2.'Welleonstruction Perinit i:WM0301344 : ' 0 R. 44 . ft. 2" ' •:iti. SCH-40 PVC .
fist a appliciable we'll peintftsr(hr.County;Shrtec:Va.eituree..kiEetyli...fr..y. •
-ff. ' ft. 1,in, . .
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3.Weili:Use(00:Well USc)l- • ' 17.:SCREEN• ', .
'' •' ' Water Supply Well: . ' FROM-- TO • :utAitETER s t,OT Sin, 111ICKNS I•MATERIAL
• 44.• ft. 59 'IN- 2" 'III- •.010 SCH-40 PVC .
DAgitcultinal . • ItiMinticipal/Poblic . •
EIGeothennal(11eMingiCooling Supply) 13Residential Water Supply(single) . ft. . .iis,i'L I
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ElitidustrialiConnuercial .• •
.. 12Rcsidgmiat Watcr S"OPIY(shatid) IsSztOsi 13.UT TO . MATERIAL. • EtitPLACEMENTINIETIICID&AMOUNT:
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'. . Dirtipation - ' - ' . , . . .0 ft.-'• 39 ' ft, portland, trimmy •NtiWell: ' . .
tt7Water SupSupply . . • ,' • ,
0 •• ' ' . .
1110n1tOring . • i ft. i ft: '
- • 1: 1.ccovsly , - . -
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Injection.Well:- , . , -.ft. . ' . :. .
• . 1:1 kuifcr Recharge'' - Odtoundwitter RcniediatiOn ,t9:SAND/GRAVEL PACK fir applicatitet'. • . . .. _ ,
. •. — - • • -b-aost - TO" •' NUMMI, ' ESIPIACEMENT ornion
MAinufceStottisc and RCCON•et 1=1Saliriny El:thief • - 42 • .R..• 59 11. sand ',• 2 . .
ElAquifci Test.
• - EIStormwater Drain : ' • ' • •
. . . . . . ft. it. • ' • , . . ' ' ' ' '
DExperimcntal Tcclinotoa CISubsidence Control- • • •. •• - • • • - .
:-20/DRIL LING'LOG:(attach ndditiotial lootss if tbticessarv)
1:IQ‘Jultennal(Closed Loop) ltinacer . FROM-. TO - DESCRIPTION(Mar.,lotrdactl.bianicktylIciwnin lit'c..tit.) . . •
LIGeothenual(Heatinkaoline Return) -1:10ther(explain under#21 Remarks) 0 At. 15 . ft,- red/brown-silt . • . ,,
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15 'ft. 24 .. i 11, -gray silt with rock ' • .
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•. 4.Date Well(s)Completed: 3-25-24 %WM.ID0)54-1R • • : •
24 . .0.. 34 R., grey/white silt compacted • " : '. :' • .
5a.Well Location: • . 34 „rt. ft,. bed rock •
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Sweetwater Road Dump 49 . It. 11, rock fracture
FaeilityKtivnet"Nme. . • • - .Fneility lay.(ifnpplkable) ---2 .---1,-..-12,==-9.9,- '=.77.--- 1-.—f.I, 7'.. • - •
59 R. ' ft. rock' ' ' " • .• l.K.. ...fL-...÷i ki t--';,i .) •
. . 15th.Ave, S.E., Hickory, NC, 28602 ft, it .
PILYSitial AitIMSs,c'.4.atid• REM
Eip• MAY. .tin 1 2024
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Catawba
• 'II: ARKS' •
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- : Bentonite seal from 39742' .
• '- ' jr V7`"'"''''''''':'7.F 1^"7.::e.-....... ",.k1
COULOY , ' - Parcel Idnolifiention No,(PIN) . . ,1"."
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. • . • • • 51i.L-atitude and Longitude in.dcgreestorinuikifseerinds or decimal degrces: .22 .•• . • • '
....ertificadon:', .. .
Orvell field,one laillotig.NodlIclefill • - : ' . .
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. • NV* legki'lligV,. , .
. ' 3/2 1/2024
. ' '. : ' . -. ' • ' - ' Sighst Cgosi -.WellConiraetai i• ‘ - - -.befe---
. . 6.Is(are)the well(s):.XlPertnanent .or EITemporary - -ItelignAtg this form,-I hereby certify rhar•dil.well(%)wax Own!?cerrignraed ire eretvrtlahre•
itith FM NCAC 02C.0100 or ISA NCAC 02C.0200 Welt Conitnietion Ssaitdards and Am a • .
7,Is this a repair to an_eaistiog Well: ElYes or KNit 1- of-this rt.74-oni has Nen proyide4tto tb u:i rit mown •
- . • Ifilysis a iepalr.fill oat krtp.tvii well coasmaloa•inforalofion mil oplaln rho intrare of the ' •• •
repainitulei621 irtnurks.:ire-thin.ei-im the hairkilditi form. • -, . . • '..2 .Site:diagram or additional well delaits: .. • : ' . . • . .
• • , YOu-mq.use the back of this page tb.Ptovide'additional well site detail's or.Wejt •
8.Number of wells constnicted: 1 . ' ' construction'details. You may aLto anachadditionaipages if:wassail". ' ' -
• • For'*wilds*Injeerlon or oon,water supp.ti•wells GA'LY with de sante consirudion,you eon . ,
sahtnirohe form. ' ' ' SLITIMITTAL INSTUCTION§ i• . . .
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• • 9.Total well.depth below land surfac SP- • - • - •.- (ft) -24a. For All Wells:i Submit dos•fonn within 3(1-days of completion of Well
• flie snaltlole es list all.deprld Ifdteialit(example-3re200 and 2e/90) '- . nonstnirtion to the folieui ng-,
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tO.Static water level below lop of casing:48 -
• '-Mt.) Division of Water Resat:re es,Information Ofticessing Unit, .
If water kvel is above aura's;Ose.4". • • 1617'Mall Service Center,Raleigh,NC 27699-1617 . .
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' 11.Borchotriliameter:5•25"/6" (in.) - 24b.For fiblectiOtt%Ilia ONLY: in addition to sending the fort to the address. in •
24a above.also,submit a.copy of this,fonts within 30 days of completion of well
12.-Well cousintetiou method:EisA/air•rotary . . . • construction to the folloWing: I I . .
tie:ituptr:total?,ethic.direct pash.etc.} - . . I' ,_. - . . •
• • ' ' MI:110110f Water Resources;Underground Injection Control Prog-nuit,
FOR WATER SUPPLY WELLS'ONLY:' • " 1636 AEA Service Center.Raleigh,NC 276994636 '
ite.corWater SUDDIV&Injection Wells:
• 13a..Yield(ppm) , Method of test:
Also submit one copy'of'this frinti,Within,30.days Of dompletion of. •
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13h.Disinfection type: -- ••. :Amount: - - well Consul:L-6(in to the ceimly henithi department of thc..County.where •
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constructed.
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on GW-I North Ceralltia Deptutment ef Enviratuirtu and Nantril Resources-Division of Water itesoorm. : . Revised Augustlilli
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