GW1-2021-02713_Well Construction - GW1_20210527

WELL CONSTRUCTION RECORD For InIetmltiscONLY:
Wa form son be itscd for-.singlc:ar anrltiVk i%4s
i
t.R"c!!Contrl�or lnlormetion:
yi. A'fti4t.ZbN�fi. .
Dylan Fierst R MTO I P IPt70
Writ Cofftcw N2ft 10 A. 30 f, PWR y
rt. n.
4507-A
NC Writ CotrlracfatCo»1ftmionNturba
&OUTIRR CAStATG or.'itliMt eisoti+r tt1R; rf 8ciib
FROM. TO ntAMETBR TtIiCRR'E.SS MATERIAL
SASDACCO Inc 0 fL 15 ft. 1^ 1b, SCH-40 PVC
FROM TO DiANIFUR I 71UM''F.SS I MATERIAL
2.[I<ellCtlnaitlionFclmit#: 70002870
I.W elf Omfirwr ww1 prrmfts fire,Ownnt swtc.Vrldawr.Nkftl etc.)
3.Wdt.U�(cbedt�►rJlasc): .z ', �;: ,,
Water Suppt+vWdi: FRorr TO I otANK.111R t T 7i. 1 7111t9fA MATRRTAI,
I�rlgt c#ttttlt8l Gll�1011iC1(xllflrit�ijC i5 ft 30 ft. 1^ 1% .010 SCH-40 Prepack
DGeotimnal(licatingCooling Suppv) L9Resideiuiat Water Supply tsingiv)
n, ft ra
C31ndustrlal/Gomntccriai OResidtnfial Water Suply 3L';CROf1T.. `L
��`���) TO PROM itrATBRtAL P1�fPt/1C7Ih1Pr�iTMF1ilODfiI1iHOURr
MTWtion ft. h..
Non Water Supply WeD,, ft. iti
mmonitori ORS
Tn eetion Weil- 0. IL
0AfluiforRecliarge QCirot ndmtcrRcovdiation t
DAdaifer gto a And Rtxovety` OSalinity Atlmer 12 R. 30 f1 gravel r. 17NPI ACF1tr1? rM n FROM— iATt' e
/sand #2
OAquifcr Test ❑Stommptcr Omiriags
ft: ft.
OEVcdmrmtalTximokW- OsosirfcrlccControl
"ORtlrlal ti'' tiEi aZtittfloriti! t a t r► r
OGeothenual(Closed Loop) OT=m. FROM= m nsscrlfPrrax cane aerti a*n�ca n
O;3wthemlai(Hein ' ttolit Return) OOthet(exylain under#2 t Remarks) fL tt.
ft. ft.
4.Date W+ell(s)Completed 5/8/2021 We11tD#TMW-5
ft.
So.%%'elt Lotatitn: (
BIN-GRAHAM LLC fl. ti. 7 02
Facility0m,mx;rName Fscllity 1DN cirmlicablt) ti. ft. 1
li
4823 N. Graham St., Charlotte, NC, 28269
PkjjW Addross:City.andbp 3ti1Et
Mecklenburg 04519101 Bentonite seal from 10-12,
Cotiroy pArtot idcMitieatirrn>fo,(Pi1V)
Sb.t ntitude'and it rinOtude in degltseatminutes/secontis or decimal degr". 22,Certifcation:
if»ttl t'i Wone talon it srdl kffi)
35.281178 N -80.808897 W 5/16/2021
Siglaldsc ofCeitifred WdtCoimactat DMe
6.Is(am)the tii ell( : t7PCrmanlnt or M!M$pOrat}' m.*niag iW f rqk f hereby twor th#r rhr x, kYj woo(trrr*l ivmrrurr d of 4veottdmtr+r
wlrb IM NCAC 0IC;nlM or 154 KCAL''J2C,02M14'rfi Carestm orlon Shin wds and mat a
7.161bb a repair to an dititing wdlt OVes or MNo ropy aftlift►void itpx ormpror 4*4 to 6 r iirti o%,jwr.
1/t h Is A reprtWr f7 rat lxtrirre uvV cart tma1a+a tltformarW wwf rspfatn the norwe of dte
repWr wKfor!?1 rerwrU rrdwo or an the bad of rMs form 23.Sftr d iagram pr additlonat weti dcralLg:.
You may use the bbck of Ails page 4o.proOde additional-well site details or itvll
8.Numbeirof%t1h cons'cnwtvd: 1 consttuction detafts. You thn}also attach udditimi pages if necessaty.
For nwMtde IRJeMANJ.er non-rtwee srgi*r W1j ONLY"frh-rhr amroe as Rsirurtlar,i act csp»
sxE etat rrx fora SI,jBj►. I7T L INSTUC740NC'
9,Total►ell depth bcbisriand surfaces 30 (1t.) 24a. k'tor All Well Stbinit this form within 30 days of compWoo.of rreil
1'a.m©rfriple wefdf fist ali drlra4a�11d4Qerrni tex#Wtr-3Cb2OW old 381(W) c onatuctinn to the folion ng:
10.Stink water icvel below top of rasing; 10 (ft.) i vision of Water Resonre",I01'artnntion Processing Unit.
If»rarrr W VO 1SObOVr Cddaj�AW"4^ 160 Mail Stri iec Center,Raldlot,NC.276"1617
i
It.Bordirtte diameter:3.25^ (in.) tab.Fnr inttxHttn Mdlc ONLY: to athtition 10 sending the form to theaddress-in
24aabmv also submit a oopy of ibis farm within 30 days of contpietion of well
12.'%Idl construction lmetbod:DPT co»stntctionto the Mowhig:
(Lt.auk ratW.table dine pmtL etc) Dttisian of Water Rcsotltom„(ilf6detViDand 10jecilon ConW Program,
FOR WATER SUPPLY WELLS ONLY: i636 Mail Sa viae Center.Ra'telgh.NC 276"4636
24c.For Water Sag&&fnj00006 Welts:
13a Yield(frpm) Method of tt Also submit one copy of;this form Vdthin-10 days of completion of,
13b.Disinfection types Amount-
well
th depallmart at fire turinfy 1vbcTe well constnicnon to ft county bccd
Farm O NF-t Nonh Cwohm Dq mUwo of Einimnnm and Nanual Resources-Wvkion ofUrster R motrees Rc%i!;W AtSUA 2013
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