GW1-2021-02707_Well Construction - GW1_20210527

WELL CONSTRUCTION RECORD Forlrtc ItkeaJNLy:
'this farm cur be owd far shtgk or mmtiyle s+rtls
t.Welt Contmctorinformation:
;Ixx V►�1l lt.
Dylan Fierst rN M: TO SPAMIP110N
NV4di Contr8dof tftme 3 fL 20 IL PWR
R, rh
4507-A
l Otty#'tt C er ni lr t ` t}R 6
NCWcllCarnnictnrCcrtifir ionNiunb R41t:cr FROM. To ntAMLTER. TiffEw.W ASATENtAL
SAEDACCO Inc 0 h. 5 (I, 1° in. SCE-40 PVC
Can>p;my�ttamc
oM , To DL%Swmk TinCimm MAIrSUAL
2.Wad!ConstrvrAon ferMjt#: 70002870 IL A. 6i.
fist all uppliroUr wrilprom is(i_r.County.Striae.trarianrcrr.Iiierdnrl ar.)
3.Well liceWWI;wellIpse):
Water Supply Well: verJst; To 01AN1R9Tt&.I st:OT OM I 71111CRNMI MAYRRiAL
�Agtculftrrtl C7MintitVl'Itblic 5 it. 20 A. 1° trd; .010 SCH-40 Prepack
OCreothermsl(HetitinglCooling'Supply) OResidential Water Supply(single) �` t
0hAUStdfl1V0on MVrciat DResidendai Water SupplyYtl f3KOi3T . h;
{511aiCd) PROM TO MATERIAL k�lf?1ACT'MMTMl3Mon&A)&om
❑ltii Lion it. ft.
Nora=Water Supply Wdl:
'rJ: rL
mmitoring OREatti
Injection well: tL (L
Mqutfer l cchmp admuMmiter:Remled ation
_ .pR 14 TO. - MATFUIAL.. . MFT n
1'3Atit$ter•SWmZc sod,Reco-my oWinhyBartier 3 li. 20 ft. gravel/sand #2
O qu*r Test ❑$#Orin mcr 11*1A c
0expetimcnial Tcclmoiogy OSldtsidcncc Control
30;13) j143 iiCclira ' Owe SIK*(,Vwf
aGeothermal(Closed Loop) 07racet FNOM- TO IOKSCRt !t a►br Rinet . ;e� net' n Y
t7Geotuenttal 0katiAgConlial Return) OOther in under 021 Reroaft h. fL PirR
f4 fL
4.Date Wgll(g)Complded: 5/9/2021 Weil tllAT -6
Q: tL
Sa.We"t ocatlon: (L n.
BIN-GRAHAM LLC lL 114
Focflk)0uwrNanv FwintyiD# riwiacabici
4823 N. Graham St., Charlotte, NC, 28269 g h,
111
PiOsimlAatdteaS Cily:andzip
Mecklenburg 04519101 Bentonite seal from 1-31,
County Farad Identifwt a®'No.(PIN)
Sh.t atitade:tltid#,ongitude in delprecfirnimitcslsetandsor decimal dtgicw' 22.Ctdtil'rcation:
tit"ell he ame lafila�is arvfnriafal
35.281589 -80.809399y 5/16/2021
sigrota a of Ceitilled Wen Cortmetor Dade
6.Is(are)tft well(s): 13Permanent or ZTemparary
By*nhts Air f6m I hrrrbp ern*thmttht xrll(&)war{►rhr!conthwted try aS;OMMre
idth 15A NCAC 02C,01iA9 or.ISA NCAC(11C.OIAI)1yeff CarrtrwWo t Smndarda arndOw a
7.h this a repair toIm existing wen: over or MN6 rc1i ihlsrrsrmrll sbeonprovhkdtoth+r.trti+mircr.
IfAlt Lett repdr,flit nor inn;*1 coownr Eton ktfnmafflan egad rig4in*e-natwe of Me
rrpnlr amdnrb2l remnr�[x xeetann or rat tht Mrrt o/rids jmm 23.Site dhigarn,r additional wdl details:
Yon may use the hack of this page 40,pw%ideadditional-well site details ortt�ll
8.Nufnberofwells constructed: 1 constmetion detalls. You may also attach add tiom1 pages if neeessmy.
Forntatr♦jltl errlontOfnrurasnm/rufplvwHs ONLY"Itli dip
amnGcansdwrtkry,tintclan
mbonit ate foam. SURNInMAL INSTUCTtONS
9.Total wdt dcpth beioir l#Dd stlrft w 20 {tt,) 24a Por All Wells;'Submit ih,Gnu-.viiirh130 doys.of convkdon of Ati!
Foor witiplr tolls f4r.o0 drlmla.t Jjdyjrrmt 1exmv{ptr tonstnntton to Or fotipirina:
10.Statle water lml below top of easing. {lt,) DiVislnn of Water Resourtes,Information Processing Unit,
11 n,nrer levrl 1.time Cidka, 1617 Maff Ser iee Cntcr.RnilcW Nit 27649-1617
1t.Borehole diameter 3.25° OIL) 24b.Flnr ini oail&a ONLY.rin addition to sending the forth to the Wress in
24aabove. also subtitil a copy of this tiorm within 70 days of completion of icrlt
12.Well torStMCtla"method:DPT consU credo t0 the following:
(i c supr.rotary.table.atvtdpesKctc:) DhImlon of WaterResaurm.!Uadetgruuad Injection Coatrtil Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Sorrier`Center,Raido.NC 276"4636
l3a Yittld(gpib) Method of tlx 24r_For Water SD &1n xtitrn Wells
Also submit one COM of this forlb 01thin`.10 days of completion of
13b.DiAintmdan type: Amount �teli COastniCJian to the cotinry hei ith dcp>vitntcnt of the cddrn y wh=
Constructed.
Form GW-t North Carolina Deportment of€wfmtm zmr and Mimal Resources-Dh*Jon of oyster R66LM fts%iced Atetlst 2013

I
WELL CONSglti:3C'1'ION RECORD FerltsomnittwONLY:
lUs form can be owd[ar sib or rrultk*socft
I.Wdl Contractor Infortuatlon:
t4.S�§t4ltit%n _
Dylan Fierst R M D OY
!nett Cor*vciorN*w 0. ft, PWR
4507-A �
NC WeRComrsctorCci1Jrw ljm?6ir*et S.r)i}7RR a. bYiirutit�ttlr?d.i$p OR3 �Crrtik'a° '
FROM TO DTAMirmli. TfttC1 MSS 74AMTAL
SAEDACCO Inc 0 n. 10 ft, 1" hu SCE-40 PVC
Y�zs`rllls rltl a
callwiny Nsm
R
TO DMAIJUM RnC9CNt{SS MA7SRIAL
2,Weil C,0nativetino permit#: 70002870 ft.
tiu kll rrpplirwlile xrll�rmiN tier..CnamN.5&ee,•VorinnCr,.11�eCtfDl etr,J
3.Wdi.Usc(check well trse}:Water Supply Well: D1AAtY.UR t7}} rM11t CAStCSS IMATRRtA1DAgricultural CSMEIIIitip7UTt4bfiC 25 ft.rt 1" t� .010 SCa-40 PrepackDGeotlieErlgt(Heatin$(Cooling StiWy) OResi&Mial Water Sgpply(sin& � �
01ndustiWICnmtm°rciat OResidendal Water Supply(slxtred) tr CR01)T
FROM 170 arA•E•oRrAt: Tat�tttOD RAMOURT.
❑irri tion n. n,
Non-Water Supply Weil:
mgnitonn t7Rt cm
injection Well:
OAquifcr`Rcch:irp wroundnittcritcMediaticm t
QAquifct•Stw4c And Rcoawry asalinily Flarricr 8 r9 tit► e at A, t!Yf n
8 R. 25 f6 gravravell/sand #2
0Aillorcr'TC9 0Stormmtcri3raimg:
e. rt,
D xperimartal Tcclrnology OSrrb6 licrrcc Control
�tA��)'ItlfilA'r3 ill "tieliii�dtRtltinrilat►e+`d33f .� �w--.,, „ � .,�., .>,.
❑Geothermal(Closet Loop) OTraoer vRom 170 Dim"I ON abr;berin ronttuck dire
OGrothertmti Return) 00ther(eglain under 021 Remaft) n. n. PWA
n, A.
4.Date Well(s)Completed, 5/9/2021 W4llniteTMW-1
Sp.Well JAcilti n: (L A,
BIN-GRAHAM LLC ft. (L a
Fe;fl tyxw,wrl fi= Fast WO(ir kable) n. n.
4823 N. Graham St., Charlotte, NC, 28269 ft h, iRI Al
PkOnlAAdr—cilp,airdZap 2CRTAM R!7777777777 777777777777 777 77777c,qqln
g Bentonite seal from 6-8!
Mecklenburg 04519101 �•4r;lOf1
on"dry Aired WHIMMIforl NO,(Ptv) ^
Sh.La#ititdcanif#onfilttrricinSmrtcsJndsardt'eitrtatttegrecs: ZZ.Cetti}-xtinat
(itwell Seta,om Wort issrdfitkat)
35.282619 N -80.806394 W" 5/16/2021
Sigmitwc'ofCatified Wdl Ccritwor Daft
6.-is(a*)the ndi(Q: 13POmment or oTemporary
4•+18o*rt8 this frrnp,J berrbp rrrrrjJv rkal rhr uWJ(If)WW(»*r)cxrntrnrrrrd br axrearrAarihr
wirh]U NCAC 02C„01W nr 154 A'CAC 02C.020i Wefl Comtrowdorr Strlwtards and chata
7.Ls this a repair to an itd Wag»e11i 01 es or ONO sti r pfrhFr rrruerll irrbrrn pmrldrd to lAs rn limrsrrr.
If ri41a Ix rr trpciir fiN msr k+tor4rt uvll raarrrtrrrfmtlrtfamtarion�etPtoin rhhp nernrre rditrr
retwirdndrr621 rm*rks xft-*n or on die Uwl;of chic form. 23.Site diagram or additional v I detalis:
You mitt'use the va&of dlis page;to prm'ideaddidonal naell site ddails ar'welt
8,Number of~veils oansttn Idea: 1 constnirtlon details. you may a)so t7tt9ch additional pages if necessary.
Forarrurrf�kJ�r/erainrrofIWJ»erers pdFxefl3ON""rh-the WMrCVrrsftWtlbrr,YOU rnry CCTRhiiTTAt'
xxbn�it erne jorrr+
9.Totaisrdltleptb belatr iantl snrfae 25 24a. For Atl Wells: Submit this t'otm witbin 30 dayt.of corMletion of nr:11
FarmwftWei lsGtrrPllitrj r con5tnOctianto the folloviing:
10.Static Witter lewl barns top of taint: (R:} Division of Water k0oureea,IrtfortnAtion Ptneessing Unit,
ry"w"burl isdbMT cadn'g,ratr"a" 167man Ser,icc Center.Raiaor KC 276 16f3
i ;
11 l3oteltnM diameter 3.25" (in) 24h.&I I91 920 Weu§ONLY: In addition t0 sending the fornl to the address'in
24o above.alto subuth a oopy of this ibrrn uithia 30 dues of completion of'oval
IL Well construction ntetbod DPT cC41st etion to the 1tliloming:
(ie:txrSerraaa).rubletlirecrprtshac:) DhisionofWaterResourcm!Undetpmund Injection Control rogram,
OR WATER SUPPLYAVELLS ONLY: 1636 Mali Sti ice Center.RAW0,NC 274"-1636
t3a Yidld(gpm} l4iSthOd of test
tie.for Water sormix&to jeettoni Wells:
Also submit one copy of this form Athin 1,30 dins of completion of
13b.Disiabotinn type. Amount: well construction to the county lrcalth depah, mart of the counh tt•hm
constructed.
Farm GW-t North Carolina DgwtrwW of Etn3iormtcro and Nanual RL•wwws—Dhisbn of lftlerkMir t5 Re0qui Atoist*13

i
WELL CONSTRUCTION RECORD For trarmlukeorny; �
Tt05,rorm call be ased.for'SIA&ormdtli*1kills
1:Well Contrstetorinfort allow:
Dylan Fierst 'FROM b C-sup oN
lltrtE:CnntratWrT�•ame 1. ft. PWR
4507-A
li.tfU9&RG t3• oi* niftti5clltlrtlt ORS~ rif� rti
Nc Wcli cormsaorccntftaniDnNnitbrr FROM TO nUlMErTRttTRIDOMM I MATUTAL
SASDACCO Inc 0 tt. 10 tt. 1" in. SCE-40 PVC
Cetspsan•Nowt 16.: Ni:A11C TIV ,",tl�r9mr9 r" `�$ti
FROM. ro DIJLI%tET •rrirCACwF MAi1»RIAL
2:Writ Cdn#Mctinn Permit*: 70002870 IL ft. hi.
lur all.pplimu le wrfl permits lip..C u lfy.SwF.lbriomrr,14e[don onq
3.Well hose(chock well nsc):
Witter Supply Well: FROM TO ' Drt,nirM� fl? TAiCx MS I MA17tirrAt,
OftTkUhurai G7M0niCiixiiltrrtbtic 10 ft. 25 ft. 1" tea. .010 SCH 40 Prepack
❑G eothermal(Hetttingtooling Supply) ❑Residemiat Water Supply(single) ft it. in
E31ndustriail0 mmacial ❑Residential Water Supply(ftTe+d) t 1 t:Rt)trY. if '
FROM 170 MATrltd" lWRACr.MF\'T1%WMOD&AMOUNT
❑hri' tion ft. fL
Non-Water Supply.Well:
mmonhori ORaco.
l.nJect on well: ry•
13AgniferRc6nl;e QGrout dtrnterftaloditltion .M
GlAgnifcrSto�candRexotr�}' t2Salibit}>3arricr FROM 7 rA RIAL FntrrA ,rwYTMi, r n"
8 0. 25 M gravel/sand #2
❑Agaifcr Test O$torirmitrr Dmmgr
❑>VcAmcntal Tcchnolof ❑ftsideacc Cour of
., Rtl;it'ti° G°.. s'ca" • tidmd't"htu�f °" -
❑Geodretuud:(Closed Loop) ❑Tracer :FROM TO br rmox(ftur'lifted"m►nalrask ' , n*m a'J
❑Geathennal Fero Remo ❑Oihet in under#21 Remarks) h. PWR
.DAtc`F'elt(s)Compleicd: 5/9/2021 We1IM#TMW-2
So.Well Location: ry, ry
BIN-GRAHAM LLC ft. M
Fuc0h)Xh scrNuc FecrflityIDN0(uppikable)
4823 N. Graham St., Charlotte, NC, 28269 It, ry• 0 E
law
P12•swAddtass city-an'Tap 2tiiltrrtii
Mecklenburg 04519101 Bentonite seal from+6-8' IvItAl
Cat W fttea ldr-M111=101I N6.(PIN) t: Process it.
{ r L1 � rG�„�stng
Sh.Latitude and Longitude in dcgrocstuiloutestecconds.or decimal ftrem 2L Certification: D�V rZ 68�aj,,on
0twelt frrWoit Wore is sidtitierd)
35.282053 N -80.805436 W 5/16/2021
3iga t merctittiiodi4rltcontamor Daft
6.Is(Arc)the wcll(s): Oftntianent or aTemporar}
*Wnr tkh foam,t At-by err*that the x,d)(s)-s 1 nit,tl @d{rntrttrd k&on m er
u-0 IJU XCAC 02C..VIM or.154 NC'AC'02C•U30n Nett C.aacmult m Samdarras and that a
7.Is this arepairtosnftk- rig well: ❑Vcr or ENO rv+peel+jih[rmrvynikasLwMptmbfritrntlirainlfa+rrrcr.
if olds 1s a repok.f li Darr Amolm a+ro comet»redo"i fiunaetiM wW exptain die nowre of dw
nwirwder8'21 nwwrks srcti+x,Oran the bmi of this form. 23.Sift diagram or additional well dttatk.,
You r*use the back of this passe iopnnide addidmtoi well site deta b or well
8.Nnmbcr of wells constt ur reel: 1 constiuetion details. You may .also ctiacb additional pages if nemsaty.
For mu d#e injrrkm ONLY Meth tlm rrtnre t onsdtirrlfarr,wwr rgn
xubm t am form S M [ �t^TIONC
9.Total well depth below land.stirfac= 25 ((t•) 24s. For All Welli• SabmU this'lo"nvithin 30 divt of c"lesion of well
For rrrabiple w*Us list all drprbr{JdWerrm kyan+nia 30200'stud?@ OV) Construction to the folton inb.
10.Static water level below top of casinm (t1,) Division of Water Rctdnrtts.infannattonFtec'es ing Unit,
#wamp live i Isaliory edling„tve"+ 1617 Mall Service C mter,Raleigh,NC 276994617
11.l;orehoM distnCtor:3.25" (in.) 24b.&X iniocflon Welts ONLY: in addition to:coding the form to the atdd=In
24a above. also subtuit a copy of dds form within 30 da3i of completion of ttell
12.Well construction.mdbod:DPT construction to lire fbtlowing f
(r&aver.musy-doble diW push cto.)
Dh'isionof Water ReaourcesiiUiMergrnnndtnJetliooControlProgram.
FOR.N'VATER SfIt�.PLYWELLS ONLY: 1636 MAR Service daltr,Releiht"C 276"4636
133L Vidd Win) method of tt� 2 tc for Water Sahplr l4c tnjcriror Wells.
Also submit one Copy of this.form hither-. (daySofCompletion'of
13b..Disinfeetion tr'yre: Arnotint: well construction to the coimly bcMth dclki"icut of the county whert
eonslmctod.
FarmGVRt NoAbCamlinsDgvdmadofP.miron=rumotNnnnnl Resources-Dhisionet'VlratcrR.4ediroes Rci-bcde 44M2013