GW1-2022-06962_Well Construction - GW1_20220722

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WELL CONSTRUCTION RECORD For internal uso:t)N1v:
Thfs form can be used for single or onitiplc%Ms:
1.�Vel@.Contrtetotrlilforuratiocr.
14c1VetTI?R-2.ONES• h
Stefan Smith FROM 7t➢ Dmic"IMON
vvel:ColmmigorNanie, 14.92ft. 24 ft. Groundwater
4 i
3576 fl. fL I
NCWdlCommctorCcniftcationNwnber A&'0t1TERCA8ING ORLiI�ER91,S' flc`a6k
FROM 70 DTA31 rER• TLtiCKivE5S 1VIAlEHIAl.
SAEDACCO Inc o fL 14 fL 2" I. I in.. SCH-40 PVC
CcJngeuryNaar< 161ANNER"CASING"OR7 -BIND'Am.
• l6erfnal'efoscd loa' ..
FROM O D1A.IL ER. I THIC&NEss I MATFRUL
2.Wct1 Constl•ttetign Pet�rait lr: WM0301210; 70003022
U04.rlf rjya7ica6fe •-uprniaits fi c Calm'.% t le,Varies re I1*dC4 ere..).
tt. ft. im
3.iYclt,I)sc(chcci:well Dscl: t�5CRYr:1:N: I.
Water SuiiplgWelt- FROM' I TO Drv.ri;TER' sLorsrrl; THICcwscs I NTATmmt.
C1rLgtieul[utat, CII6funieipuiU[ iic 14 ft, 24 fti 2" 461 010 SCH-40 PVC
®Geothermal(Iieatingt7CootiogSupply) Mesidendat Water-Suppll•(siugie) rt fG in
0 fildusuiaYcoluntercial ®ResidentialNater Supply(slxioed) Y:t:GRo[ft .-
FRONT 7t] I—AT RtAL ENti'LACEfiIL4ThtEMOD SAhIOQt ,
❑irii tiara . fL ft.
Iken_Watcr Supply.}Volt:. iB. to
®1vlonitnring 17Rcc4�rlg
Rection Welt:
r
0Agtiifcr`I;cc6arge A9.`SANn1G10LVEL 'ACKiif Iiceabte-Y': '
FnO151 10 1 !fA'rt;'ntAl, K�iM1(F1f1:YT�f►rrl(In
QAtldifar.Stara�eaW Rcco )3ai ice 12 R . 24 ft. Sand ii2' Pour
t7 rtiitpifer.7cs# [7S1vrm�atcr llriieia L
brivcrii icati.0 TCC116(ttogy17Srtflsidcncc Co»dra4
2odDR1LLiNC'lAG'lailxb additiamal Beets if acccssanl
OG�rthentvil(Cldsett Coop) L1Trttor FRoSi- Tt} DF„SGR41T14\1nbr.ItarUucti uaumctt ' 'n wr.ckt
DGeatitennat(ReatinyfCooligg Mum) t70tller(plain under ReitwtT.$) 0 fL 0.75 fL concrete
.075 fL. 24 fL Silt
4.'Date.Welt(q)Cdnrpleted: 6-10-2022 Well IDfiTMW-5
ft." fL
• M ft. I.
5a Wd11 t)cation7 I
NRP Holdings, LLC N/A fL 114- I; Dn-P1`00040in4 U"'
Fucilityr4uocrWnnuc FacditylD (r3ppliulbJc}
[t. ft.
3934 Raleigh St., Charlotte, NC, .28206
P1Wysi AAdd[pssL-Cit}•.and Zip =21:REIIIARICS:
Mecklenburg 09107202 3 foot bentonite seal froin 9 to 12 feet
Gchmlp' Parcel ld'.ritiCr�rylipu Ne,Ig>�17 �,
ltitirdc'2641 i gingittrtoc•in iRq'grmqninuteslsccands or d'cci nA ftr test
22:Certification:
(iftelt 1`ield iu�:_I1ttldnS ifi firc:l7eiC:d) I^
35.150507181 h 80.474609383 N 7/1/2022
Sic}flied Wcll Contrtctar I'• Date
6.Is(are).phe-well(s)t 13PeTnrancnt or ZTemporarg I
By:ergpiiig.ihi.faam;1 hcreLy i'rrfijp'1hW f1w nTll(i•)wm-(IAmei cimi7mew)n reiz-ar Ace
ieith 11%NClC 02C 01Q0 or ISA Me 6k.0200-Well CoirsfrrrcNar Sraarltrreis acid rlkri a
7.h-this aivpolrfuadtAiwtingwell: ElYes .'or _KN1! 0.Y�7�:OfflNSfeear111�175 Cap�i�i'idctrdiLV flCif(neWler,
if rdats'b'a nepolr,fill are krf uvu ti'rP!cwrtsriueNara l rjamu flwr arul caplabr i){c trrrrnre of i)ie I`'
re pair itrrdcr$3P mnrtr&ssretmia nP rM!be bark of rhfa Jame 23:Site dliet;ram or additio ant well details:
Yau may use U bac;bf this Nge';to}pr djde'additianat%%A site deails or ti'ell
8.Nuiftberof welts constructed: 1 cousttuctioif deiails: You tray atso.iittach udi itiottd *V's if imessarp.
Fortrfalrlple.fry fex'it��nvr rtrNl-linter s>,pplr Ivrfla EIiM'LY orlrJi tJir sgriae ranatrurtioir.vaar rno
sa6ulef onefari". SUBMITTAL DMUCTiONS
9.Total welt depth below land surface: 24 ((1,) ,24w For Alt Wetl.m. Subrnh lltisi!ham within.30 days of Completion Of hell
For mAiMFle iMMist ail deprlts ifdtj iW vlf,jex;ip fe-3@200'amf 2 IM7 to'lhcfpttottina:'
I,
10.Static water 1rvelbelow top of casings 14.92 Ov-) fibt`6iun of Water Res ureei,Information Processing Unit,
ljirater Irvel Is altorl'cbdks;rue"+" 1di!Afa it service 6nier!IL•ricig r.NC 27 699-16 17
11.Borehole diameter:8.25" (�I 24[. ote�►icctior➢WeIIc,ONLY; in addition to sending the fomt to the addtess in _
24a above.alsomit sub A copy of this.fonu within 30 dnys'of Coinpletidu of wdlI
12,Well conAnictiou method,HSA to the follo%ving;
(Lc.�uper..nAmy,cable.'dircet jtuslt eta.)
Division of Water Resources,Uudetground Inj'cdatt Conttnl Qrogralil,
FOIE WATER SbPPI Y WELLS ONLY:'' 4636 Mail Semite Cen er,Raleigh,NC276".61636
I3;1.Ydd(gpm) hlc0lrod tlf test: '4c.For Watcr'Sunnt_v&tnlection Wells:
Also submit one copy of this form iFtthin 30•day� ofcotupletionof
13b.Disinf-ctioq le Amount: hell con5tniction to dtc county hcaltfi dcpartmcrn of tfic cormti st'hcre
coastfrti:tcd. I!
Fang G%V4 North Ca3mH=Ll,paft=m of Environ=in altd Naiwul Resources—Diiiilomof Water ReaLrom Revised August 1_013
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