GW1--05357_Well Construction - GW1_20240909

WELL CONSTRUCTION RECORD For!mental Use ONLY: I
This form can be axed for singk of multiple karts
1.Well Contractor Information:
II.WATER ZONES
Scott Hunt, Jr PROM TO RPtit'ROPT nrN
Well Contractor Name
ft, ft,
ft, (I.
4561A
N( Will C oranKlorCenificelion Number15.OUTER CASING tier msNt-cased wend OR LINER lif iui Waikiki
FROM TO 1naMTTFR TRH'KNFss M\TTNt\I
SAEDACCO Cl. ft. i..
Compost)Name l Ifs.INNER CASING OR RING Istoibemeal closed-Iuopl
PROM TO atasIFTFIt ' ! '! ' _M 1TERIAL
2.Well Construction Penult N: 0 ft. 20 ft. 2 r• SCH-40 PVC
l pl nppJirnbfr lira permit:fir.County.Stair.Varian,..bliaca'al rn.i —4
ft. R. la.
3.Well I•sc Iohecl.well user 17.SCRi) -t
Water Sunlit!. \\ell: PROM TO Dt MTITR 1I.01-Sl r THI(1iNNY5 I MATFRIAt.
LI\Ikultural OMunicipal/Pitblic 20 R. 30 ft. `2 `.010 SCH-40 PVC
OGeothemail(Heating/Cooling Supply) DResidcntial Water Supply(single) IL ft. a
IL GRO
OhidustrialiConsniercial DResidcnnal Water Supply(shoed) UTwi
TO MATERIAL EMCEMENTMEn10DA ANOINT
❑Imgation 0 ft. 15 ft. Portland IM EMPLACEMENT
Niue-Water Su tmly Well: --.
n, ft.
lleMonitonne ❑Recovers• — ,
Injection Well: n' ft. 1
CI Aquifer Recharge ❑Groundwater Rensediaion ItSANDiGAAVEL PACK ptapplkahkl
❑Agoikr Storage and Recovery ❑Saliniq Barrier 18
TO mantis'. EMPLACE-. ENT MTTR(M
18 n. 30 ft. Sand 2
❑Aquifer Test ❑Stormwaxer Drainage Cl, n•
❑I N:wnmclaal Technology ❑Sdbsidewe Comm!
29.DRILLING LOG Iatlaci additimlal sheds if aceessan 1 1
❑Gaotltemal(Closed Loop i ❑Traver FROM To DF'.S(-RIPT ION.tubr,hatrdarw,led:rock11 pr.trail.%arc tic I
❑Geothemal lHeat111g('ooling Return) Daher(explain under#21 Rematts) 0 n. 15 ft red brown silts
15 it. 30 ft grey green saperlite
4.Date well(s)Completed: 8-16-24 Wdl maCLF-24-501
n. f1.
5a.Well Location: L n. ft.
Duke Energy n. n. r-
Faellm'01sr1crName Facility TD#(if applicabk) "' •y -'
n. II. • `#L. *A ('>t,,,,.
8320 NC-150, Terrell, NC, 28673 ft• iI SEP 4I 2024
Plnstcal Address.City.and Zip IL REMARKS
Catawba Bentonite seal from 15-18'
lf.fs:r4.i:f'1,1•r ysrl i2 Ll,
('oaten Pan:cl ldcntdcatistn No t PIN I V'ti. y.a..
•�" Vl3'
5h.Latitude and longitude in degrcestmilmte&Jsccnnds or decimal degrees: 22.('crii£icariun:
ofucli field.one Laiong is sldlkktai
K W 8/26/2024
Si r,isr: ::Ccn.iic2 0%c11 Contractor Dale
Is.Is iarej the well(v): X'Pennanent sir DTeaiporar}' Sr signing thu horny,I hereby irrftfy that the wrlOGsl win iwrnr)er asrrueted in aarordante
with I5A KCAC 02C.0/00 or 15A KCAC 02C.0200 Weil Cn umo-neon Sksadards and that a
7.Is this a repair to an existing well: Jilts or DIN° ropy medal w on/has hero proeakd as the aril owner.
/f ihia 1s a repair.III oat ant.Nn well.rni.sou.tarn InforMllriesisraid r.ipirtlti rJw,WOW of the
repair tauter 121 remarks Arc/ion n a on the hag of this form. 23.Site diagram or additional well(Mails:
You may use the bock of this page to pros ide additional well site details or well
S.Number of'welb constructed: 1 eonstniction details. You leas also attach additional pages if necessary.
For multiple r h'fhwn Of non-Nsiter hippos wells O'\/.) ...Nth(Per sane construction ssw sure
MANIOC one forth. SUBMITTAL INSTIICTIONS
9.Total wdl depth below laed surface: 30 (n.) 24a. For AU Wells: Submit this form suhm 30 days of completion of well
For maftrplr wells liar aft depths if di(krent.. .mpfe-30200'and 2g 1001 constriction to the following
18.SSRIk water ks el talon nip of casing: 10 (f1.1 Division of Water Reseurces,Information Processing l nit.
If water kwl is ahnnT,,i:av ,.. . 1617 Mail Service Center.Raleigh,NC 27699-1617
II.Borehole diameter:8.25" tea,) 24b.For Inn iclion Welty ONLY: in addition to sending the form to the address in
24aabole. also sobmil a cops of this form within 30 days of completion of well
12,Well construction method:SSA construction to the(ollowing.
u o.assort.runs..cable.dircct push.cue
Division of Water Resesnes,It mierlrnond injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh.NC 27699.1636
IJa Vivid 1>pm1 Method at 24c.For\Later Sigrid,. 4 Injection Wells:
Also submit ow copy of this limn is iihRl to day s of completion of
IJb.Disinfection type: Amount well construction where
to the county heahh deportment of the county.
constricted
Fonts GW-I North Caiolma 1hisurt tciu of Em ttoiuirm and Natural Resources-Donlon of Water Rentaca Res wed August 2013