GW1-2022-02956_Well Construction - GW1_20220301

WELL CONSTRUCTION RECORD For Imcmil Use ONLY:
nis,fonrican h.used roysingkor multiple wills
1.Well Contractor Information:
-14i UAlMR ZQNtS-`� "Y
Brian Ewing FROM TO I ORSCRIP119N
Well CorwrUclot NAtm fl. to
4240-B
NC NXIell Contactor Cenifical ion Number A_'&OUTER CAStN1G:(For-vkultk*sW Wilts)` UNM if§_Mfkab1c)L_
FROM TO DIA1*1 M, .R THICNiVE 111_ A--TTRIAL
SAEDACCO Inc 0 fi. 15 ft. I" !a. SCH-40 PVC
-_16.INNER CASING OR TUBING.4vto rvn2lckjwd4*0-,1,",-.
TO I DLANIFTFW I THICKNESS I MAITRIAL
'FROM
2.Well Construction Permit 70002970
Lin oil applirable wrlt pMnits(Le.rosoiry.Swre.Varionre,11 f&6aJ ete.)
3.Wc Illis c(checlewell usc):
7.S(.
Water Supply Well: FROM 70 DIANIF.Trit .1571 AT S 1711 TlHCk'W.1% I 'MATF,141AL
bAgricultural 0municipall7hiblic 15 tL 25 fly 1. • .010 SCH-40 PVC
OGeothilimal(fricitingfCooling Supply) ©Residential Wiler Suppkv(single)
Oindustrial/Conuncrciii 011csidential Water Suppl-(shared) XRO . 7
FROM TO MATERIAL I E31PLACUMERTMMIOD&AMOU,-ff
olffiguian ft. ft.
Non-Water Supply Weil: ft. ft.
mmonitoriqg oRccovvy
Injection Well:
OAriniferAccharge 06roundn-ater Itcowdimion '19.SANDIGRAVEL PACK Of uludksble)
OAquikr StornSc and Recovery ClSilinitv Birricr FROM TO MAURIAL C%MrNT.Mf_r"oD
13 ff. 25 ft. SAND #2
0Aquifcr Test O.Stomivatcr Druoagc ft. ff.
OExprrinictual Technology OSubsificticc Control I -
120.'DRH.UNG LOG.'(sifach addilionimislim4-ifilect%.1-ar-0
ElGoothennal(Closed Loop) otracet FROM TO 0FSCR1rTlON'ft*Wr.hNr4net*,so,Wnwk tvpt.py16,&e.tk.1
oGeothenual(HeatingiCooling Reuino 001her(ex lain under 921 Remarks) 0 ft. 25 It. See Geologist's log
4.Date Well(%)Completed: 1/18/22 WeIlID#TW-3, TM-5, TM-7 NW 8
ff. ft.
Sa Well Uwation: ft. F_�F7 L47 If 1�71
Southern Resources Facilities h. ft.
Facility/OwncrNtunc Facility 100(if ajtpltahk) ff.
3826 Raleigh St., Charlotte, NC, 28206 ft. fl.
Pinskid Addrrsk Cit}'.and Zip
PI M
: I I
" TUE MR MCC,.),
Mecklenburg Bentonite seal from 11-131
Catilliv Parcel Idelitirk-11ionNo,(PIN)
5b.Latitude and Longitude in dr.grrcs/minutc-4wc6nds,nr decimal f1mms: 22.Certification:
(if well field,one lailotV isgufrtckna)
N W Ewing 2/3/2022
Sigratur,of Certified Well Confraclor Date
6.IS(Are)the well(s): OPermanent or ZTemporary
b)-signing this fimn,I herrhv ivrtik-thro Me wellfs)trots(mrrr)twaritneied in wcordftn re
7.Js this a repair ff)An exiong well: Oyes fir ENo oropy nfrhk rprotv/hav berij litorfeled ro;hr w1l corner,
If this is a Jepfil r,fill rate k0(;iJV1 Well ropisma-don istforowdon anti r.k-plain the mi rote of rhr
rel-wir soxier 021 winarAwseefion or on flip htwA-afthtsfont. 23.Site diagnun or additional well details:
You may use fit-back of this page to pfovidt additional well site deiails or well
S.Number of wells constructed: 4 collstfuclionde(ails. You may also attach additionlil pages ifowessary.
For'"4411lPle 10J&4011 Oe IWAPI-Iorer sifpp y'velh OjVI.V 101th dir same construdiwif You con
xiii,mit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land Surface. 25 -(ft.) 24a. For All Well :_Stibittif this form within-.Ill days of completion of well
For A",ultiple welly lin all de,10%ffdij,'rrew le.ymole-302tWootil 20 100') construction to the following;
10.Static water level below top of casing; (ft.) Division of Water Resources,Information Processing(Unit.
Ifivoiet level is al-ove ojaing,tose 1617 Mail Service('enter.Raleigh.NC 276"4617
11.Borehole diameter.2.25" (in.) 24b.Ur JnLvSIJS![1 MIL,ONLY:'
V- fit addition to sending the form to the addrm in
24a above. also submit a copy oil this fbitil within 330 days of Completion of well
12.Well en"gruction Method: DRIVEN construction to the following.
(i.e.auger.rntafy,cable.direct puskctc.)
Dis-6ion of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Senice Center.Raleigh,NC 276"-1636
24c.For Water Supply&Injection Wells:
.13a;.Vield(gpm). Method of test: Also submit of*-cop),of this fbion within.10 d,-,q,s of comolet ion of
13b.Disinfection tvpe: Amount: .veil construction to the count) 11c.111th 6pinnicul of the counh,.wherc
conmictcd.
Resources-Dixtion of%%later Resotftes Revised August N-1 13