GW1-2022-07256_Well Construction - GW1_20220805

I
t
WELL CON$TRUCTiOmRECORD For lrremrlUsc,ONLY: i
This fbao can lx uscd.for$ini lc or multipk x'clls-:
l fi'clCCiiritr5ctor7nYormation: �
is��=A7YR�LOKISr�_`. s'
Stefan Smith FROM .10 DMSGRIPitON -
1ti'c)iCiiitirrClatiiilns. N. U:
ft. rt.
3576A
NC\Nell Contrscioi Ccnification Nrimber '15 OUTER:C SING((oi`u6l11 c i'sed iie11s1 OR GIhFR 1if a"Ilca�Ml
FROM TO DI METER.• THICRNE.I•S. MATERIAL.
0 f+., 30 fL 1" in. SCH-40 PVC
SAEDACCO Inc
Ccliigtan?f�9nw WANNER' ING:OR`TUBiI3G'4`-talhernsal closed:toii
FROM• W1.TO - DUMETF.R TIHCKNES4 m.TER+AL'
2.We.116nsti'ut thin.Pci nit
Usrtrfl al pil cubJ'rsrlf p,:?riitr fi:c.Cminn:Shan;Tarfaftr4.jjer6M rlt:)
3.Well tlsc(chccl:t4c1)a3c): 17 SCREEN
Water SupplgWell: FROM ..1'Tlt DI k1 TFR SIOTSIrs I TttrCx\FNS V NIATERIAT,
Clr)gtiCultural bMutic)paVi'ultlmi 30 .It. 35 A. 1^ ;lo, O10 SCIi 40 Pvc'
b6cothemtal(Witingkooling Supply) l]Rcsidennail Water Snpplj (single);
Oindustdal(Coutnicieiat 011csidemial ARiter Supply(sbaied) FRO 1RO� TO JtATr R[A+. T P.MPIACEME\T 1TCrllOn.cAslouNT.
Olin"alien 'it,'. Y+.
Non-Water Supply Wcll:,
6moniWing QRcco+'crp
Injection.Well; rt: to
DAgnifcrRcchargi: 13Groundll;iicii16,1Wiation 19 SANDIGMVELPACt,(d "iil)cablel "
FROM TO, M,EfF: , ItMPI"ICtNEYT\11TIIOn
QAgntfcrSiorlgcaixlR�colci}' C15a1(ntn f3�mc""[ 28 ft:. 35 ft. , Sand #2
IJAgtnfi:Tcst ❑Siomntatcr.ni iina�c ft. ft.
Mperiincnt,ll Tcchnolog) QSahsidctr`c"Comn�l _
-
'20 DRIhLING'1OG`(:itt�chaddi9ionolshed3:ifnccrsfnnl . =' ^
(76eolhetlttal(ClosedLoop) E7Tracer %FRRO11 TO Dt CRIPTIONfcobr.hanfnca•ir.irnMkN+rr�sin.im.ctcl
Meotitenual 616 ini lCooling Return)' []Other(cYplaiii j d r#1 i:%marks) 0 ii,- 16 it.' Silts
16 fl.'' 26 ft: Sandy silt
t:AatuNctl(s)Conlplitcil! 6/22/22 ::WcIIIDg13-301 .
26 ft: 35 it; Saprolite
5a..,%VC41,Uicition: ft. it: " a
ALCOA r1.. rL
Faoilily?ot�'mr Ianr Facilill:ID {iCapplsiblc), �Jr�Q"� 22
293 NC-740, Badin, NC, 28009 rl. ft. C' r `•cu`'mg
Phj's>tid i�d jmis:Clts Ind Zip - toP91-
stTREAIARI:S _ .
Stanly Temporary well f
linntty',: I�nald:ntiCsciltunNp:,(Ptzo
Sh.1 1tltutic,lud ho tb�tudc in degi ics/InlnutcsYsccnnds or+leciinal dcgires: 22:Certifteation•
(ifsreU 1ic41,Mw 1a47pct81;5ulliaiall '
35.410697 1\. 80.119653 ryy'" _I�,;�/dr�j 7v'v"`^" 7/21/2022
Si*ib�ab—rcC)fredWellContiaet6r Date
6.Is(iie)the well :.OPcnnanent :'or''•5tlTemporan•'
M sr�natb Wtfiim 1 herrbv carrefv rhar,1, iic144 tuts{F7Yh)rurtrlarrlrrl Gt atrOrrlariee
;+oitlt ISA NCAC 02C.0109 or;15A''NC .'02C X20911 Well Corisrrr,'ioil crirnteirdi trouf limto
7.Lc thr�a itipatr ti►an cr fisting troll :.. ©1'e, 'iir ®No`. cc��?a;This r1r'V;41 ac(h'-ci,lifts►lr'vl iW ihr ar ll mm r.
1f t1•is u n rej�lr fill r�+:anbnm xrlt eaumrcr7at Jttforwktiiutr mul C.ililahi lbr.iurntre njrbc - - � '� ! ''
rr)hxvm drrf731 r.•mnrkssrttiim onun die back bf rLct fpriu.• 23.Sitc diagrain'or additional-I►'taLdetaIt%. .-
Vou in•13 use(lamb 1ck of Ufis.p Igz to prol;7de adiliiitit>JI nel4stie details or.Icell
8.]\uinbFr'uf Itclls constrlletcd 1 cotistmction'iieta+ts You+u7i also atlaelraddilional,pions if nece mly.
Fgftnat{JpTeiaJt�crinnornctii na,crTlrpplj'1i�irlf30t1'L)'rvrlt'rhe.urmecorislraeiioit,yn;icun -
sai+niirgnrfotin. Stf�11TTA .fR_rC_TITt�IOlVS"
9.Tot 11 arch depth below land stiritirc: 35 (ft.) 24a. 1 nr'III ft�ells:. Chbnnl ithis form'tiithili-3t1'd•tys.af'Coluplelioti of~yell
Farirreihlnlcicillsllsralid6pOntf4lf.riiti4em7ple 2W vulvul2,co1M) consfnletiotvtoilic,fo(louing::
19 St. atic water level 6eluly top of cast, n;j Uit i+mn bCRet�r Re aurres;Infnrtnation Pnuccxiclmr Qnit.',
if rtmci level 6 aLore'cusJa:use'" "' 1617 Mii1 Scrviec#cnicr Rjlcigti.iC 27G99;.I417
l I:116rcho le.itiimctcr 8.25° (In) 2�b ►' , V c ONL Y: h►addition to' u tlic foml to'ihe add in
24;abot'c also subn►ir a cop} of this form tI ithin.al daps of coniplchol►of:iveh
12.Well construction method:-HSA co»stntchotl to the folloiving,
(i.`a an�,r,rdian cnbli-itveclpushcic') ! - � ,
Division of W1tcr Resources,Undcr�rouuil(ejection Control Program,,
FORAVATER.SUP.PLY WELLS ONLY': 163E Alen Sr
rUT ce Center;Raleigh;?i C 27697=163r,:
I3a Yreld.(gpmj Ncthott of tCSt• 21c Ftir Wafer Sunnh''dc Injection AVOW
Also'subiniton. copy'of tWfoitn nithin: �.dajsbf.conipletionof
YJh Disinfitiinin h'pu, __ ___ amnunt:. .well conslnlction tollic cotunty licalth-dc{mAmcm of the cotritty Ilia:
constnictrd..
Fong Division of R:ntei Rewtrtes Etcl ised'August?O I l