GW1--05058_Well Construction - GW1_20240830

WELL CONSTRUCTION RECORD For internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor information:
Huneycutt .WATER ZONES
John W. Hune
Y FROM TO DESCRIPTION
Well Contractor Name 165 et. 170 ft- 1.5gpm
2465-A 298 rt. 300 ft. 6.5gpm
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
FROM TO DIAMETER THICKNESS MATERIAL
ft'Well Drilling, Inc. o 132 ff. 61/8 i'll- SDR-21 PVC
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
22-366 FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: ff• rt. in.
List all applicable well permits(i.e.County,State,Variance,Injection,etc.)
ft. ft in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SITE THICKNESS MATERIAL
n ft. in.
❑Agricultural ❑MunicipalPublic
❑Geothermal(Heating/Cooling Supply) FiResidential Water Supply(single) re ff to
❑industrial/Commercial ❑Residential Water Supply(shared) la.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑irrigation 0 ff• 3 n Bent.Chips Gravity
Non-Water Supply Weil:
❑Monitoring ❑Recovery 3 ft. 20 ff. Bentonite Pumped
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier
ft. ft.
0 Aquifer Test ❑Storrnwater Drainage n It.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,sollrock type,grain du,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 ft. 125 n Brown Dirt&Rock
a.Date Well(s)Completed: 7/24/24 Well Intl ft.
ft• 300 ft. Hard Brown Rock
n ft.
5a.Well Location: n n
Pinnacle Homes USA, LLC -
ft. n Seams: 165'=1.5g, 180',220',225',245'
Facility/Owner Name Facility ID/(if applicable)
3917 Vann Sneed Rd., Marshville 28103(VannSneed, Lt 1) ft. ft 253',267',298'=6.5g
ft. It
Physical Address,City,and Zip 21.REMARKS y
Union 03-111-025A 1'(1 o i) 2,i
County Parcel identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 1 i
22.Certification:
(if well field,one lat/long is sufficient) -
N W "" • J ' c - 8/15/24
Si ire of Certified Well Contractor Date
6.Is(are)the well(s): ©Permanent or ❑Temporary By signing this form,i hereby certify that the well(s)was(were)constructed in accordance
with ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or FINo copy of this record has been provided to the.well owner.
If this is a repair,fill out known well construction information and explain the nature of the
repair under 421 remarks section or on the back of this form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same coasiractkm,you can
submit one form. SUBMITTAL INSTUCFIONS
9.Total well depth below land surface: 300 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@l00') construction to the following:
30 Division of Water Resources,Information Processing Unit,
cas
ing:Static water level below top of (ft)
If water level is above casing use"-" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 (in.) 24b.For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: Rotary construction to the following:
(i.e.anger,rotary,cable,direct push.etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 8 Method of test: Air 24c.For Water Supply&Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b.Disinfection type: Granular Amount: 1/2 lb. well construction to the county health department of the county where
constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013