GW1-2021-04622_Well Construction - GW1_20210510

WELL CONSTRUCTION RECORD for irftnoiftONLY:
ni3 fortncan be amd.fer sftlt or nnull lc Ivan
1.Well Contractor Information. oZ
Zach Thompson 'MOM
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94dt:Cgrthadctly`4r� Ir'IN1.
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4478A f
NCB ellComractorCenifetationkli�rr ��tf^vil�,�i'v�`r�CuCu`S1Nf��Yl .#&pQU QA ti r-*mH.Jow*i: c OR1WIM bla9
FROM 7D DtAMET6tR TH1CIMFM 1 MAMTAL
SABDACCO Inc 0 fu 6' 1t 1" n, Schedule OPVC
tt+rrtpatnt�EFanrcB.i ft O -t +tedtab
FROM I TOI DtAlftr'r8R TflrCKNIM MA7F.AtAL
2.W41 Gtinsttmrion permit t:: ft,
ft.
listallaopiirahlrxeettpermlrr tKc.Crnrnry.Sttmr,Lnriraierr,Ti�e:Yial err._)
il. ft. ixa.
3.Well rise(check well use): 1 SCJft
Water supply-' FRAM TO i niA QM SLOrSf7X ttttCtf $ 1 4AittRfAt,
OAgticaltural 13MIMitiplavidbtiL 6' n, 11' ft, 1" ice 0.010 Schedule 40PVC
OCklo l anal(lientingCooliing Supply) DResidential Water Supply,(single) n' n' to
c3mustrialfi ommorcial OResideaftl Water Supply(shared) t7RtilTf
FROM TD MATIMAJ -9 MrVRGD&AMO#M
Obligation tt. It.
No"-water Supply Well: � IL
mmonitoripg 4izecor
Injection Well: n-
OAgni(crRccharge l3Groundvmterit wediatioat l . 1(:4tA., ':
OAt(trifcr Stottrgc and]tcccnr:t} !S riinit}°Ronicr Fa M inrc trik+t, ttn#rr A. t�rT: tn n
4 ft. ill it. Filtered Sand #2
❑Aquifer`l`est OSto m-atcrl mimge
It.
OEXpt«rimcntal 114xltnotogy OSubsidence Control
0.O'RRMAJ�KC G oqmchit6dittreridt"licels ve sn+rr!t >
OGEoftmal(Closed Loop) O'Tram FROM Iro a rrttPTto�to7mr.l�itr ae 4,aNrosrs b eGn e�rt
OGeothennal{Fieatiu KC-a Rettnti) ODthEt( iii usdEr#Z l Retnaii ft. ff.
ft. IL
4.Date Weli(s)Completed: 4/8/2021 le Yell ID#Tt't-1
h. tt.
So.Well Location: (L tt.
Alcoa A. ti.
Facffipy'vncrNemo Fosii'rty IDN(fapplicible)
tT, ft.
293 NC-740, Badin, NC, 28009
Physical Addmss City.stud Zip 3tt i(A
Stanly Bentonite from 0-4'
emery Pawd ldemitIxallon No,(14N)
Sit.Latitude and Longitude in dcgm vvJvnlrmtc0j,wmnds or decimal degrewsr 12„Certifteation:
Wadi field,one 161i78rs is sedilttetn)
35.309407 ty -80.119054 W T � 4/9/2021
Si#mtate ofCsnifimd W'dl C'oatmcmr hate
fi.Is(are)the well(#): 13PLy nanent or WTemporary By iigWnp Alt talm,i hr e r thtu thr mill k9 wts Mare)cxenxrrstrted hr ea"Ma nce
with 1 SA NCAC 02C,01R)or 7SA NCAC 02C.02M WWI C-r nh°tinn Stardanis ernd.rlaast a
7.Is thLi a repair to an t sting well: OVes or ONo mpp of hilr re OM ihns*Mn Prrrr'idtd to AC r'rt1 smater.
tfr$fx 1 x sr rrpatr,fiN axur rrettskaa xrrff o xwntafm i tftirrmw#vn mod expo t the m anwe of fhc
repair anderv-1 na wAs sw1iene ornn ntu brft-k of this farm. 23.Site diagram or additional well deta ls:
You May use the back of this page�to.pw%ide additional%Wl Site details of well
S.Number of wells eonstrticted: 1 constnictiou detaits: You maw also attach additional pates if twci ssaty.
For:n hiple injeerkAtor arar•»wier A'F1y urlix O LY mfth die wme consowedmt.j%wa ean BA�ITTAL IN i fT�t)
submit<uie form tC
NS
9.Total wit depth below Land surface: 11 {n,) 24a. For rltl W.01%. Submit this fond i%Htin 30 dst i of completion of well
t't rartattANe KWU fist RlitkfAs�fd*rent(anWfe 3@200'ot+t1MlMr) conaruction to the following:
10.Static water lovi belmv top of zasing: {ft.) Divhlon of Water Re rourre r.Information Procening Unit,
tftevrrer try!U ahoee mists*..we^+" 1617 MA Service C�nt¢r,Ralcigh,NC 27699-1611
tl.Borehole diameter.2.25" (it,) 24b.Rnr lljk an NYellc ONLY.,fin addition to standing the form to ft addnw in
24aabove. also submit a copy of this foms within 10 dais of completion of tteii
12.N1°Cll e0o5 t4tMf0H Method.DPT construction to the following,
(i.e.aupr,ides]•,wbte direct push,ems)
Dh'ision of Witter Resources.Zhilerground IDjection Control Program,
FOR:WATER SUPPLY 1N'RLLS ONLY. 1636 Mail Service Ctnter,Raldog NC 276"4636
13a.11#4d(gpm) 1"emod of tech 24c.for Water Sv[VX&twoction Nydls:
Also submit one copy of this forhi Mthin it)dM of complaion of
13la,1lit3nfixtion tfytr: Amount: rtcil constnsctson to ft county health deManrcan of the county whin
rnnstrtrctexi,
Farm GW-t North and lyatunal Re#onurxs-Dh sioa of Neater Itesnem Rer•iwd At%ust 2011