GW1--03832_Well Construction - GW1_20240628

WELL CONSTRUCTION RECORD .C) For Internal UseONL'i:
Thu form can be used Inc single or nadnpl;,.c'I. `�
1.Well Contractor Information: `\` �\
14.'MUM ZONIS
Scott Hunt, Jr VI*OM TO 'Wit RrrlIttN
Well I min,10,N.ink 13 R. 20 ft. tacky red silty clay with sand
4561 ft. O.
NC Well Caratttclor Cenificatbn Nantbct IS.OUTER CASING(fur mMitasrd wells'OR LINER 1 if applicable)
new 1 m MRMFTFR ] rnk'kcrss SIATTRt►t
SAEDACCO n j n i'
Concuss Name I4.INN[R CASING OR Tll_RINGAealberral rimed-kept
itiost Ill r DIRNFTrR TwitANT ss Mtit-RIM
2,Well Construction Permit M: WM0301351 0 n. 10 fi. 2 is SCH-40 PVC
Liu all apphiwbk urnpenntms((_e.County.Sum,('an zirce 1t.yeThUj. r _ - ,
rI. ft. is.
3.Well Use'cheek well useu _ _-_,
1'.',( f SCREEN 1(
Water Supply Nell: 1•14t/11 Ill _' DIAMITER MOIST/It Twt(TtM9rt MA1191141.
ElAgrrcvltival ❑Mau upa6'Public 10 rr, 20 N. 2 .OSO SCH-40 PVC t
❑Geothermal(Heating/Cooling Supply) ['Residential l4`aler Supply Isingle) ft. ft. ~
Dlndusfrial'Commercial ['Residential Water Suppy ishared)
ADM TO MAMMAL tMlt.wC¢ME'VT METHOD a AMOUNT
Dlmpatum 0 ft. 6 ft. portland trimmy
Non-Water Suppl Well:
ft. ft.
R Monttonng ❑Recover
Injection Well: R• IL
,
[I Aquifer Recharge rlGronndwatcrRcmcdiation IS.SAND/GRr AS'1LPACX(If ellibtablel
El Aquifer Storage and Recovery ❑Salinit} Barrier now TO MAQRut• RMMJt(lMI!tT MFTWm
8 ft. 10 ft. sand 2
❑Aquifer Test ❑Storm titer Drainage A. h
❑ENpdnmctYal Trtihnobt'\ ❑St►hsidcr►c('marl 20 DR11.I INC;LOG farssl sea!sheets if accearaeti —
❑Crothemwl lamed Loop i ID Tracer FRom a ill DISC1TirnoNustur.hareem,want.etn or.ores are,Nr.l
DGeotheal(HeatintYborlittg Return DOther(espianl under 021 Remarks' ° ft
13 ft. red silt
mn
13 ft. 20 ft. tack red silty clay with sand
4.Date We•Il(sI Completed: 5-9-24 Well IDAWw-04
n. ft.Sa.Well Location: t--� f� I%`Lf •VEL.l
PPG Industries, Inc. It. ft.
Facility,'Onser Name Facility WO(ifapplicabkl n. . ft. .frdtt r 8 2024
940 Washburn Switch Rd. , Shelby, NC, 28150 R. ft.
f
Nosiest Address_CM.and Zip �0' F l 1w"^!wk.4 t}
--- e -
21.musks ... .
Cleveland Bentonite seal from 6-8'
Cotton P.n:c!Idcnofvalinu N,, 'PIN, _...
Sb.Latitude and Landslide in degrecarmilmtesisccnnds or decimal degrees: ,2,temilkation-
Orwell field.MLL 1 0-long IN sidmcieui t
lfi W IA[ry(/�J i 5/17/2024
Siaratl€:e%Cen•it ±Well Contractor Duty
6.blare)the well(s): %IPennanem or :'TrmlNurary
By Ugnitrr the hum.I hereby certify rhea the wrlXrl tau Camel constructed in accordance
with 154 NC•4C 02C.0100 or i SA NCAC 02C.0200 Well Constrorno,,Standards and that a
7.la this a repair to an'mistime well: JYcit or KNo ..rt Of Ali re,-,,r,lhas her,,(,,.rr,ited r,,,he well„weer.
If toils it rr repair fills i(Mawr'well,cR1110ll lion firjurruhruoo.)WI a wikon raw nature of tic,-
repair under921 remark:..inter,or an the bat of this form. 23.Site diagram or additional well details:
N.011 ante use Its bar't of this page to prosaic additional well site details or well
8.Number of wells canatvuceed: 1 5onstru.uun details. You may aLw arach additional pages if Ilecessan.
for multiple infection IN mum-waiter swish welts ONLY nvth Mr wme.,rnatruetioi t/,w Pam
..ub,nir one fore. SUBMITTAL(NSTUCTIONS
9.Total well depth below lard surface 20 (fy,) 21a. For AU Wells: Subnnt lus loon tstthnr 111 dins of completion of well
For nruhiplr wells ltst Ode/nits ifd/fecens(erawgife-.r@200'and 2@ lINt'y construction to the folbwimg
18.State water kW!ln•hio tap of(asin2: 13 (f1.) Division of Water Resources,Information Poucessine I nit.
ft ow,'h-,rl„,d,,,,,,,,.... - 1617 Mail Service Center,Raleigh,N('17699-1617
II.Borehole diameter:8.25^ tin.) 2411.Fur lllitction Welly ONLY: In addition to sending the form to the address in
24aabo'e. also submit a copy of this fort within 30 days of completion of cell
11.Well etraslrwction method;NSA conslnlction to the following.
{IC.auger.roan.cable.Oita push.etc.I
DO Ohm of Water Resources.Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: I hit.Snail Service Center,Raleigh.N( 27(.99-163(t
13;u S idle IL'pmt Medved of dyne -`lc.For Water Mytph .ti Injection Wells:
Also subnul One Copt of this form whim ill days of completion of
13b.Disinfectionhpe: Amount: well construction to the counts health dcpanment of the county where
-- constructed
Fenn GW-I Non)Calcium Dapmmtenu of Ens mown and Natural Resources-Drt molt of w.nir Resoures Re.bed August*1i I t