HomeMy WebLinkAboutGW1-2021-04618_Well Construction - GW1_20210510 WELL CONSTRUCTION .
�LL CONSTRUCTION RECORD ForFrtemal Use ONLY:
This fang con be aced fa shlgk or multiple mils
f.Well Contrmor Information:
tx>ti'Sf
Zach Thompson a FRAM URSCRIFT10!t
NMI Coy ,7dm NantC y. ` n• fi
4478A
NC Well Cormcior-CenilfcaiionNtmbcr AY 1 202 15.17tFM, ti MoratrM1-ft 70*11 4Rf a tFc.b
ur�l1 FROM TO MAMM111 TMCKNFM MATCRIAL
SABDACCO Inc 1 `�C�SI � 0 h. 6' it 1" In. Schedule OPVC
- -- t�s-�rts'L--c
cetnplrrp Nam i is:irizve�CASM M r AMO i tl o�elowd4o r
FROM TO DIA.+rMit THICKNF,ss MAWRiAL
2.Well Constr action Permit# n. h.
list all amurahle Weft perr"lts Oxe caunrv'swe,trariarare,[*W art err.) R• n im
3.VFdl Use(check well use): t.:S °N
♦ aterSupply Well: FR M Tt1 :DiAMMIR: $MOTSM. '"II KATRRIAt,
DAgricultural G)MunicipallAtbiiC 6' R, 11' fr. 1" h 0.010 Schedule 4opvc
hcrmal(Heatin olio Supply) DResidential Water Su ft. ft. f"
DGeol ,NCo g:Su)Ip ppl}•{single)
Otndustrial/Commercial ®Residential Water Supply(shared) 8'tTROT7T
FROM 110 MATURLAL I EMELACEHJtMT1kWMOD A AMOLWr
01n tion n, n.
lloo•Water Supply Well: ft. n.
®Nianitorin ClRccm
injeMon Well: n. n-
DAcitliferitccharge 00mindnaterRemodiation 19.$AND/GJkAVZLfl diCidt
FROM
fArn.RrAt.. �S9ADIjA- . crtnarMr " D
CQAquiter Storage lord Rccol�ery Mnlinity°13anici 4' R. li' ft Filtered #2
❑Aquiter Tt5t ostom"'kalcr i]minagc
06wrimental Technolo • OSubsi&-mc Cttrtrral
14,DRtGM-0 LOti atisch athllti 'a1 stredritftT"ra 3
❑Geotbetn al(Closed loop) OTra►er moat To DFscRIF"ON Deb.aard4m malftk ru
❑Geodienual(Heath lCooli Remm) OOther(explain under#21 Remwks) n (-
R. ft.
3.Aate Welf(s)Completed: 4/8/2021 We41iD#TPI-5
n. n,
$4.Well UCRtirra: R fi
Alcoa n. to
Fac7ity+ vrcrNorm Facility iDO(it apphuble) ft. n.
293 NC-74, Badin, NC, 28009 ft. R.
P100sical Address.City.and Zip 21 tttlitA1t1:5
Stanly Bentonite from 0-4'
Ckmm,, Parcel Jdealttiaitioa No.(PIN)
.%.iAtitude and lAngtMdc in dcgrecslmimttes4cconds or decimal dcgrocs. 22,Certirwatinn:
(if ctell field,pare lions is tatfletenn)
35.309407 N -80.119054 W 4/9/2021
Sigartam of cenHicd Well caaneto ar Date —
6.Is(are)the well(s): OPermanent or zTemporary fry AArniar rki fmat,1 hrtrMy ivro-that flu arlpx)wm fMrrr!)rowinwied i"amnrdmnre
wiA 15A MCAC MAIM ar IiA ArCAC A:C A2M Well Con.0wWon 5tam4dr*and Aar a
7.1s this a repair to on existing well: OYt s or NNo CMy n/thtr rrrnml W been lrntrldrd to hr sail ownrr.
if Ala is rrxdr.fill are komm well coom t akm lfffonwrirram d r%ptaia Or mrare r?r1w
repair arrderd?I nenmrks satin:,or ran the hark of this form. 23.Site diagranrar additional well details:
You am,use the back of this page to provide additional well site details or well
S.I\umber of wells eonstrneted: 1 construction details. You am also attach additional pages if tMessaty.
Four tutdl a lnntkvi or ffm-+:sorer jWrdy xeth ONLY w1rh the tarot enrrsfrerctlmr yox can , 6111'I A iJ OPIS
form ���
9.Total well depth below land surface: 11 {({,) 24a. Par All Well iz Submit this form within 30 days of completion of nrfl
For mat,owle ts'e*14r all rlrp*s frdfd`eR'rtr{exatyrte-30-U Ml'trud 2e@)l y eontlntetion to the folloning:
10.Static water Imel below top of casing: M) Division of Water Resources,Information Processing Unit,
1/11utrr 100 is above cdAjr.wr"+ 1617 Mall Service Beat w.Ralciph,NC 276994617
tt.l3otrhntc diameter 2.25" (in.) tab.For Tnl&iin Wells ONLY: In addition to standing the form to the addlrss in
24aabove. also submit a copy of1this form within 10 days of completion Of%T11
12.♦Veil alnstrDetlon method: DPT construction to the thilowilw
(i.e.aapr,rotary.cahla direct push etc.j
ftblon of Water Resou rcesb Underground Injection Control Program,
FOR 1VATER SbPPLY WELLS OiIM 1636 Mail St nice Center.Raleigh,NC 27699.1636
13a.Yield(Apm) Method of test: 23e.For\hater.Svp t &tnjattoti Wilts:
Also submit one copy of this fotin'mithin 30 days of completion of
13b.Disinfection q•pe: Amount: 'knell constmction to the county hcaith deMitmrart of the cotmly where
constmctcd.
i
Form G%V-t North Carolina Degmtnrrnof Em-itonnra and Namnal Resomms-Division of Watcr aemrm Revised AtguSt 2013