GW1-2021-04620_Well Construction - GW1_20210510

WELL CONSTRUCTION RECORD For lmemal Use ONLY:
"this form can be used for sittdk or multiple evils
1.Well Contractor information:
r,. tWA't`"ZD
Zach Thompson cy YROM DPSCRnPiI
t1'etlCbnlmtrorNantt
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4478A
NC Well ContindorCertifkation Nrunber Qrh AY 1 � 202 5..O(fM CASMMG rRsutti-mwd-"7 OR iJNTA f v'Aeab
i, r�tGC�cglll�Unli O FROM f. 61 ft. 1"AMUM ��TM MATERIAL
te. a OPVC
SAEDACCO Inc r,3` 10(1
Conar Naetr VY t6 CA51NG'OR B1itC tlera+aletaixdtoa
FROM I TO DLOkMFTFR TtFIC9.RO MMMAL
2.WdI Con.ttracdon Permit
List,all appliraNe urru pratnlra(i-e.Gaunh.stwe,Vadoaore.h fa d on or;.) fl h. in
3.Well Use(check WRII Use):
Water Supply Well: FROM To DIA31ETM 'SIATS171. TrnttcnM I HATFRIA4
OAglicuttural OMtmicii avmlic 6 ft. 11 OPVC fL 1" I� 0.010 Schedule
OGeothemmi(HeatinglCooling Supply) OResideri ial Water Stipp(}'(single) fi. tL 11L
DindustrialIComlteercial OResidentiai Water Sappy'(shared) 8:CiROttT
FROM TO MA7 P1tUL E1/PI.I T OD fi AMOTJ•iT
Oirri Lion fl. fL
Non:Water Supply Well:
A. fL.
MMonitorin ORec m
Injection L11:
OAtaaiferRecharge Oarminlrni ter Itcnxtliation f TR A 'fi '
rR at alrr Rr r w.:aer,n, :'ST M"11 o
0Aquifcr Storage and Rccovery OSalinity Harrier 41 ft. 111 ft. Filtered Sand #2
OAgaifcr Trsl OStorrllwmcr DminBgc
fl, fL
❑E,,rerimcntal Tcchnolog OSnbsidc;=Con"I
20. R[1 AWG eddtltottatsttrtislfnecctcsar,
17Gmtknim!(Close!Loop) ❑Tracer FROM TO ►R5CRrPl lOs eata+eAsnta ezoarock Hr►
OGeothernral(Heath Cali a Remm) DOtber( under#21 Renla/iss) ItL ft.
R. ft.
4.Date Wens)Completed: 4/8/2021 WelI ID#TW-3
It. fr.
set,well taneation: n. n.
Alcoa A. fL
Facilit)•+Y vmrbiantc Fecihi)•lDk(Owpi able) ft. 0.
293 NC-740, Badin, NC, 28009 ft. A.
P)tr'siW Adds.0tv.and Zip 2t. fA KS
Stanly Bentonite from 0-4'
('&Dmv parttl Idemifrcauun No,(Filet)
Sh.Latitude and Longitude in degrecslmimtteslsceninds or decimal degmes: 2L Certification:
Of xelt kid,one h0otV is sidfle4aid)
35.309407 N -80.119054 W 4/9/2021
SipaWrc ofC46fiied Well Conuattor Dare
6.1s(are)the wcll(s): »Permanent or OTemporary ga.;,garbs Ab fi"M t hrrrby rero(hit the wrfi(.rl wits(ward ct*artrueted to atcnrd ore
w idt 1 SA NCAC MAIM or I sA NCAC NCR=well Constrnctlon Sonddrds ond:rhdt d
7.to this a repair to an existing well: OVee or ONu twit puaerr.
tl ihis it a repair,fill out Ammw%rA coarwntmion i4om prim mad expfoln rbe trtarr of the
rvlWir craterV-1 mmorks xrrtim or as dm bark ojthis/orm. 23.Site diagram or additional well detallc:
You may use the bacl,of this page to pro%ide additional well site details or iveil
8.Number of wells constructed: 1 cmist uetiarl details. YOU n1a�'also aivach adtfititlna!p,t�es if tlectssan.
For mdalple lnferrlart or mon-waarer s rrA wYllr ONLYWrlt der rarmr eutrsamrlort,voH twra
o dmit oar faro,. 'SUBMITTAL.iNSTUCTIONS
9.Total well delvdi below land surface: 11 24a, For All Weis: Submit this fonn oithin 30 days of completion of well
Forawlip4rxvf1s4srnfldepafiajfdf)}erentforpmapfe 3 :lJft'eraA? ilk)} consinmlionto the fbtkming;
10.Static water Intl below top Of casing: ((t,) Divislon of Water Resources,Informatian Processinp Unit.
if wdier 1twel is above tvufng,rase"+" 1617 Mai Service CCntcr,Raleigh,NYC 27649-2617
11.Borehole diameter:2.25^ (in 1 24h.Fftr Init to Welk ONLY,t In addition to sending the fomi to the address in
24a above. also submit a oopy of this form within 30 days of completion of well
f L Wei!construction troettnod:DPT cmisinlctien to the fallowattg:
(i.e.wipr.mrnr}•,cable,ditto cash,ex:)
Dh'islon of Water R.esan ree�17ederiroond TnjctYlan Control Pragram,
FOR WATER SUPPLY WELLS ONLY: 1636 Mai)Strn'ice Ctnter.Ratelo.NC 27699-1636
13A.vid it(WD) l►Scthod of test: 24c.1`or Water Supply&tnlcctlah Wells:
Also submit one copy of this form l%%Ithin 30 eta},sofcomplaton of
13b.Disinfection h pee Amount: wall constnaction to the coimh hsnd(b drpaAmdn of the county when:
covamctod.
Fans Gwt-t Nonh Carolina Mpmfmrnl of£mimnaem and NatunJ Rcsoumcs-Dhisloo of Water Resoirc2s Roiwd Atgusi 2013