GW1-2022-07522_Well Construction - GW1_20220811

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
M i ke Tynan 14.'WATERzorri s
p� � FROM TO fDESCRIPT ION
Well Contractor Name —' 9`a h 15 ft 2 j ft. DES
2725-A a--.- �° pwr
ft. rt•
NC Well Contractor Certification Number ' `
A. Is,OUTER'CAS1NG,formulti caseditvcas ORLIIVER'iC ' icgbt rv:
ETA u,q FROM TO DIAMETER rm THICKNESS MATERIAL
ft. ft.
Company Name tntvf �opj
C• "16.INPTEK CASliVC�.OR T171111vG epthermalclused-lob '
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL H
List all applicable well construction permits(i.e.UIC,Counn'.State, Variance,etc.) 0 rt. 6 ft- 4 im Seh40 PVC
3.Well Use(check well use): ft ft. in.
Water Supply Well:
FROM TO DIAMETER, .SLOT SIZE THICKNESS- MATERIAL
Agricultural DMunicipaLPublic 6 ft- 21 ft- 4 in 0.020 Sch40 JPVC
Geothermal(Heating/Cooling Supply) 13Residential Water Supply(single) ft ft.
Industrial/Commercial Residential Water Supply(shared) i8 G120BT.
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
Monitoring .%Recovery 2.5 ft- 4 ft. neat cement pour
Injection Well:
Aquifer Recharge Groundwater Remediation 4 ft 5 ft, bentonite pour through augers
19:SAiVl)/GR�t`E17ir,AC�if�"`li�ii'ble �,.�
Aquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test DStormwater Drainage 5 fL 21 ft- #2 silica sand pour through augers
Experimental Technology Subsidence Control ft. ft.
11 Geothermal(Closed Loop) Tracer 2QCDRI7 L119G;L1}C� att�ehiiaaitioitial jh�ets.,fnecess�r
FROM TO DESCRIPTION color,hardness,soittrock type, rain size,etc.)
Geothermal(Heating/Cooling Coolin Return) Other(ex lain under#�1 Remaris) ft. ft.
See Consultant's log
4.Date Well(s)Completed:6I1 4/2022 Well ID#RW 14
5a.Well Location:
Charlotte Douglas Int'l Airport
Facility/Owner Name Facility ID#(if applicable) ft. ft.
Airport Drive, Charlotte 28208 ft. ft.
Physical Address,City,and Zip ft. ft.
Mecklenburg ,'2L RL71fA1ZIfS
County Parcel Identification No.tPIN) Well vaults te be by anetheF eefitmeete,,.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one ladlong is sufficient) 22.Certification:
35 12 28.22 N 80 55 43.32 W 7/8/2022
6.Is(are)the well(s)oX Permanent or OTemporary SiLtiamre ofCer ed Well Contractor I Date
By signing this fort,I hereby certijv that the n•ell(s)was(here)constnrcted in accordance
7.Is this a repair to an existing well: DYes or XDNo with 15,4 NCRC 02C.0100 or 15.4 kk 02C.0200 8'ell Construction Standards and that a
1(this is a repair:fill out known well constriction information and explain the nature of the copy of this record has been pim•ided to the well owner.
repair tinder#21 remarks section or on die back oj'fl is form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 21 (ft-) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if dij)'erent(example-3C 00'and 2C100) construction to the following:
10.Static water level below top of casing: 15 Division of Water Reso'w ces,Information Processing Unit,I/' ater level is above casurg,use "+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 1 0.25 rn•
( ) 24b.For Infection Wells: in addition to sending the form to the address in 24a
a Auger above,also submit one copy of this form within 30 days of completion of well
12. uger,construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,'Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Supply& Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed. I
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22 2016