GW1-2021-04177_Well Construction - GW1_20210827

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WELL CONSTRUCTION RECORD For lntcnial Use ONLY:
Ws rom can beawd fir ftle ar mo1liple uvtls
1.Well Contractor Information:
1Q k►A at.?A E;5
Rich Lemire 11R h1 To I DRSC-TtIFTTO
W41 Carrhanaor Itarnne it. rt,
rL ft.
2593A
NCwd)cotnuumt-catirkmionNuntra IS,Otn*Mt CASINfi trorinatt *VITA1 tleatik
PROM TO DTAMt — MAI"TAL
SAEDACCO Inc 0 M 5 n, 2" 16. SCH-40 PVC
CoftVa ny Name i614M, 'O 'JTJ81iYG attt{sed lino
FROM TO I VI&MFTER I TninCR11vm ]MATEMAL
2,Weil Construction Permit# ft. ft. Iin.
ust all atpp/iraaNd.well pramits{fir.county.stop,Varirawc It;F ef"fir.)
n. n. to.
3.well Use(chock well asc): t � -
Water Supply Well: VROM I TO 101AD IMP i SlOt$t7X. TnTC-UNM- 3MATO] L
oAgricultund C5lvitinicipai74lic 5 M 15 ft. 2- In. .010 SCE-40 PVC
OGoothermal(HeatinCooiing Supply) DResidel tial Water Supply(sifmle) B' R' hL
Olndusaial{Comnxtcial OResideTltial WaterStrpply(s_bated) i$:GROI)7
17ROM TO MATERUiL IMMACEMM MEMOD&AMOUW
Ohn lion fL (L
Non-grater Supply Well: n. n.
lWonitorin ORecor
Injection well: ft. fL
0AquiferRccMtge OGmuTTdlTaterl2cmcdiation t .S`. ,T
Ra kt" 1AT1:ttTAr NJMP �1 �rrr7T.tl r{t D-
OAgoifcr Storage and Rcw%, y 13Salinityl3arricc 4 (L 15 ft. SAND #2
OAgtdfcr Test OStornmatcr Drairtjgc
rt.
OFxprimcntal Tcchnotog ❑Subsidcocc Control
111 btR1lA.ti� I', t�tti.I:b tan )r '
OGeodienn al(Closed Loop) OTracer $ROM TD otscn MON n etc.
OGeotlienual tReati oli Rewm) OOihet. lain under#21 Remaly o ft. 15 (1. RED CLAY SILT
4.))ateWeil(s)Completed: 6-29-2021 Wd)M#TMta-2 rl. �
U.Well Location:
YADRINVILLE REFUSE DISPOSAL SITE (L j (L
Facitii A)wrraNamc Facilk IDk(ifoppir:abte)
r? \
U1. 1A
707 Tennessee St., YADRINVILLE, NC, 27055 fL
Plgaiwl Address'.Cis,,and Zip
YADRIN BENTONITE FROM 01TO 41. '
t 4ra[ny Nteet idsm tacnrtgni'Na.(pLVy
Sb.Latitude and tmngitodc in degmalmloutestse6nds or decimal degrees: 2L Certification:
{1f wetl held.one Wong is sidtltlefd)
•``r
]� W .,Q/j- t ..t. 7/4/2021
SiPAI a of Ccrt WellComtacmr Date
6.Is( re)the tTtll(s): Mamanent or $!Temporary
By sigttiirgr tldt farone._Ihrreib),elrtlfq that the uw41(c7 ewer{tepee)ecrostrurted let aen'atdEmce
with ISA NCAC.02C 1000 or f.14 NCAC Re 020P itM Cautarmtat m sranAwdsanrl that a
7.Is this arrepoirtoantAitingwell: OVos or MNo copy oftherrrrtntlhobrmpim-kWtoOwavllamwr:
if ihta[ttt relxrl+;�i nett ksteir.va uell cYonrintevioo lrtfortsndaar mid�arHfoin the netnre r�rllr
rnwirmtderI31 rrrnurft sre7im or can du bad!Of thin farm 23.Site di4mm or additional well details:
You may we the back of this page xo L pw%,I&additional wa site details or reel!
S.Number of wells constrnet il: 1 construction details. You way also attach additional.pages if necessaq.
Farintahlnle lnjertkm.a rwan•uwe?swfd.r tvdh ONLY nitb the Witte ronsdarerllm4 uor elm
=bMftone/arm. SUBBIMA .INST--tCTIONS
9.TtTtwl well depth bett►1c land alrfac 15 (cL) 24s. Fbr All Well Soblmt this;!brio within 30 days of completion of well
FormedfWe,hells list a ll drpitaa(f dl/(rrRw(eximipte-J+E?0V'ewQ@10ff) eon5tnrction to the1g1toning;
10.Statk Uvater Intl below top of Casinr 7 (g,) 11ivislon of Water Resources,Information Processing Relit,
11water MW isaraovi!(Villog atte"+" 1617 Mail Service Center,Rste:igh.NC 276"9 1617
It.Borehole diameter:8.25° (1n) 24b.EOE inloetton We1La ONLY jn addition to sending the form to The address in
24a above, also submit a copy of rids form within 30 days of completion of%veil
I7-'A'all construction method:AUGERS construction to the folluyving:
ti.a WWn cr;totaw.cebtsy dined push cto.) Dh ision of Water Reno mes,.Tirdeirvand Injectiob Control Y1opram.
FOR WATER SUPPi.Y'%W.LLLS ONLY. 1636 Mali Sen9ee C&tcr,Raleigh,NC 276"4630
132.Yitid(Rpm) Method of test 24c.For Water Sap)sll&idoctim%Wells:
Also submit one copy of this forth nithin,S0 days of completion of
13b.Disinfec-tinn h"pe: Amount- well constriction to the coTmty hc�lth dep drot2ft of the county where
constnlcted, i
Farm G%V.t gosh Carolina Dcpannrent of EnvitD ire--n a and bbtural Re9aums-Division of\Vane Resovass Revised ALOM 2013