GW1-2022-07204_Well Construction - GW1_20220804

r Wh" C0NSTRU'C1'10N.RECORD For-tkcnmlUsc ONLY;
This miicanh;owd.fo"ia£Icor:multipksells-:
l;*dfib ntracidi•.lnformationc.
John Eisenman FRUM .TO I DILSCRIPTION
iVill6.tirte ot?4rfw- rl• fr.
4439A
NC Well ContrrctorCmificalioaNtimber IS:;Ol1TER CASING drocmultit"'Wi d-44slORI IhPR(ifu "tic,tDkl
FROM. TO DIAMETER.• TIIICF.NESS -MATERTAL
SAEDACCO Inc
4i+ttRi+�. +tt� =1ti':INNERCASING'Ott7IIBINC'.I eotticmaleWseddai'�
FROM I TO I DIAMETER I TIIIMN SS '"ATCRIAL Y
2.1Ycll,ConSt1'uctionpCnnit#: 70001826 0 ,ft. 37 ft. •1" ti SCH-40 PVC
14if t(V al.)irablc+ic1�prinnili(i:c.C,minry?Stec kariar;,4 II71ECt7t/f'ch)
58 4.' 1" ' •.1O• SCH-40 PVC
3:��cil ITsc(chocl:lvc11 use): T7.SCRLLK. ':. y:.
NV ter Supple Well:, FROM TO PTA.% rt;R FIAT"C17J . TIII(K1FN5 I NIATERI AI
Cti1'giiculturaC t Jbtunic ipaVPu l�Iic'. 60 ?:,1° .010 SCH40 PVC
37 ft: 39 rt:-. 1" ! 010 SCH40 { PVC
❑Geotlielmal(Ileatingtooling-Supply)' DResidcniial Water Supply(single): J- . 1
L7lndustriaUConlnicnial C7Rtsidcntial�VaterSuppt (Shared) 1WGROUT :` __
FROM TO NIATLRIAL 1,ENIPIACENIENT NIMIOD&AMOUNT;
❑lin^ttion: 0 fi:: 32 f4 Portland Pour
Non-\hater Su pjAy NV.cih
bMonitoritg . bItccowly
Injection.Well:
QAc]tufcr IZCCirirSC gGi011t►da lief IZCnii<lialipn `19:SAND/GR,CVEL PAC i'dNabtel';_' 3
OrLttDffciSlortgeandRctiblrq ❑Salimn Barncr FROM
m" NArF;RIAf. ENIPLAct,�uarNUTuon
55 'ft., 60 rt. Sand #2
❑Atl6ifcr76i ❑Stomt«;ttcrpialnaac 35 ft. 40 It.
OENPcrimcnial TcOnologv C7Slihsiitcncc Coi4nl1 -
o pRILbIKG[OG'fallich'adilitionnl3hecfs if nccees'n"'nl
EiGwdielnul(Closed Loopy ❑Tracer FRONT• VTO DESCR1FilON kobr.hnrilnc+�,v d'nukh` . un vrr.ttm
❑Cr otlieru>ai(Hea[in iCooliDe Retofit)' mOilier(explain under k2l:Reinatl ) 0 ti., 60 ff. san3y clay
4 Date;WcU(s)Canytletedf 7-14-22 �d,IED#BS-11
5a,AVi91 Lf)c:ithi'm
ii r, 0 A
LYondell Environmental Custodial Trust tt._ fL
Fact7iyeO+cf Lr Nana Facility IDm(if appliablo)
3926 Glenwood.Drive, Charlotte, NC, 28208.-
p4sientrlddr^sk:C. andZlp 2l RL'D11Rh5
Mecklenburg 06510128 Bentonite seal from 40-55, and 32-35'
(ciru+ty` I wel ld rdit`co:diun go,(PIN)
Sb I If tutic Ind i on ltudc in tl<�mes/minutcskccon,s or decimal dcgrecsi: 22 ("crtiTic3tiiln:
I:tlnot>3$tistitlfood) j
7/24/2022
J v
t�culni^of .Date
G.Is"(am)thceell(a):".YiPcnuant nt ':ur" -❑Temlforan .
�,+,f•ti .. / J-.+F.. tlN'_i'Inlcfe+l bF QCCOft1Gr)Ce
• �•++•ith lS+l+VChCO�C �tl+�� t'7 rc:�i� 'ti:4?011;iVe1l CnicsrrKriaiiStaiadRrilsrriuf denr,l
7.:IathisanpefrtD`dncxistiD{;1iell: :. t7Y .-iir ENq " c6p o;rriirrPcn;)lr,mb.ri;pmtrrT+trivthe+t+rlinr,tcr,
1jcFals xs n/a1>irlr jiff r�u;`nat+•a it•rllca+ui/ircrlan Frfforrruiilvfrm;r!idl+lalrf rlic�i>afrrue njr(u! ` ` �' �` '
rtltcrP ta•rlrYb?/nadirks artrtue os iu,tLc baclt affLls f,rru, '23.Sitle diagram or atlditfonai�tttill.rictaiLi: .
1'ou'ma .tlse'd back of tlua N•tge to provide addUignal cell:site details"or..�tell
8.1Wulilbcr of i4lls i�oitstrueted• 2 cottstluelion derails: You•ii ats o attaell
adi iiiolial pages if n.,_ess;n'.
Ferratai7iJFlrTglrri)nitorr.neNr+inrrrn+ppf�trilGOa17,Y,srirh'rhvsmnecmrs►rarclloit,,}o;icore !
I to A f_511 ITONS`
9:Total"ItOl.deptlt bclo� -land 5tlrfifici 60 ([t) 2�i 1 of atl ��'c1IsL Subiifit ilitis fon' it lhi f.3U'd ns of-coiupteiioti of Well
Farrntffflplc iit 11s 4sf;h1l,lcl?rhr 0t7/ i (i7 exi+r>�Tc-?�?On'nra(.2 1( 1 consfmcnonto iltc fo liming-".,
14.Sta.de watcr.k%vi helow top of casing, (L t-) biriatofi of��At, Re iourccw`Infortnation Pr�ut cy+in�Unit,:;
)jti+wr,v fev+l G nt or�ti iti l+f�:";" 1G17 Afail Sa»fee Ccntcr:R tlei�l'NC 27G99=1G 17
-
.14-96rehole diamctci.8 25" (in) 24b.&.1 TO lee ion MIN ONI Yc In addition to'sending dl form to ilm address-in
2 aabo�t al:o.sUbmit.a COPY" lht 0111l within; tl daps'of-C611 letton:of.MI:
12,$`ell constntction mftbotf;-HSA eonsftuctim fn t iit lolti e folng:"
(i.cen rroian cnbtr 'dfrcctpisficfc:) nil ision`of��`Itci;Rc,our'cei,UndogronudJnjectionContt»11'ingran,;,..
FOR WAT£R.SUPPLYWELLSONLY.' We,MASci ic'eGentcr,-Raleigli;•NC27699=1G3G
23c.Tor Water Subnly dt:Injection Wellk
13!.Yfctrl:=nt)- Nkiliod o test:
e�lso spbnut,on, copy`,of this fors]i0hin (r. dii• 4,6m ktion W
" WclFcolisinfction lo.tltc'count: ticatib dcp�rtmeni_otAlic.cotmlV:icitcr>;.
33h'Dfsinf�Ytiunh`pc:. _ _____.. ._ 'Amount:•
• constnutrit..
Fonn01%14 North CsfnlinaDcp inixutofEncirannicttt and lValuralRcmtuces-vircionoiwllcr�Re:ogLkes Revscd:AugustV- 1.3