GW1-2022-09195_Well Construction - GW1_20220930

WELL CONSTRUCTION RECORD For ittenial Use ONLY:
This Winatn tr,usad for sinrtc of Itithiple wells
1.Well Contractor Information:
14..WATER-ZONES
RICHY LEMIRE FROM "it) OFICRIPI/OV
\\'ell Cottrtrtnt Name
fit. fit.
fir. Q.
2593a
NC\tell ContrrctorCcilifkalion Number ° 15.OUTER CASING((oraml hcaird aellt OR LINER'if"a kahkl
FROM TO DIA1iF.TFR Tr11CKSr�5 M.ATERIAt,
SAEDACCO Inc 1 0 h, 49.5 ft. 2" in. I Schedule OPVC
(.omtmily Nanai 16 INVER CASIN,OR 7VBG�Yt,:�eo(Acrinal
FROM TO I DLA1tFTF.R THICK\ECS MAWRIAL
2.%veil Construction Permit k:
1Jrr all rlrf)lir rrhl.•er.•11,vrnri:r(I-V.C'moup,SAVY.I4Orirrrrr.fly"en ru.
3.Well I;sc(check well use):
17.SCREEN
Water Supply Well: FROM 1 70 91AMETER SIAIT�17E I THICKNtSF I MATF.RI.L
49.5(t. 59.5 (1. 2" is .010 I Schedule 40PVC
t7Agriculttint t llVlunicipal;T'(rbtic t
13Ge(nhcomil Mcatin5lCooling Supply) 011csidcntial Water Supph (single} fit• rL in.
1RlindustriaUComntercial i 11csidential Water Supply(shred) FROMGROUT TO I UATERtAI. . EaIPIA(T.mcm MFTnoD,&AMOUNT I11
❑ltri ation 0 ft. 35, fit. Portland Ce ilu ection
firm-Dater Supply Well:
Ohlonitoring ORcro\•cry
injection Well:
QAquifcr Rccbirgc 06ron dutatcr Rcntcdiation 19.SANDIGRAVEL PACN(if illkahk
VROM TO MATrR(AI. K.1f P1.A("V'.AIF\T Mr3mOn
QAquifcrStoragc and Rccn%-cn• QSaliniti.Banicr ( 40' h. 59.5 fit. Filtered Sand #2
QAquifcr Test ❑Storm\\atcr Dr:+ina;c
t
rt, rt.
Of xprrimcnial Technology OSuhsidcncc Control
1 20.DRt1:WNG LOG laitach additi6nal stiee(s if accessen-
❑Gcoitrcmial(()used Loop) oTmcct t FROM TO OF,SCRtPT10�iivbr,hardn,•�s.stnl'n.rk h a)a aivi.l(r.1
OGeothetntal(Ideatine+Cooliu2 Return) OOther(es lain under 921 Remati:s) 11 tt. ft.
tt. tt.
4.Date Well(%%Conr(lleted: 8-9-2022 W(ll I1)#MW-216
t ft. a. _
52.%%'oil Location:
ALCOA h. ft.
Faiilil„l3t\r�tN7n - Facilih'1006fappli:mhic)
293 NC-740 Badin, NC 28009 Stanly County, BADIN, NC, p 8- R'ivi'''SRe^^+M '1 ? i ^.2. ';:?
f:6;
28009 Plnsical Addrrsc Cith:and Zip 21.REMARKS
STANLY Bentonite seal from 35'' TO 401.
C'aunn Parcel ld AiftetliwtNo.IPINi
5b.Latitude and I.nnEitudc in d(o-ncslminutN- scconds or decimal dmrm,: 22•Certification•
Mt`L•(itncll fOd,, VitwaV k t.diiei:mo �}
35.401735 N -80.119548 Ww� Vi��J/:Q/Mc�.G� 8/9/2022
Si hole;OfCeni :�'cll Comrnaor Date
6.Is(are)the wcll(s): BtPennanent Or aoTemporar' Hs signinjr d6i fnnn,I he•rrhe•errtife fhm dw u,rlll•.e)ews ixy re)tysexIrur7ed in rre'arrlrrnrc
„iM)5,1 AVCdC OIC'el fv)fir 15A A`CaC n?C'I)Mp)n',y1 C,"wowr.mi farmlrude en,i rlanr n
7.&this a repair to an existing%ell: OYcs or M No eopr r;rlti+rrr...il has 1+'•rt Ivi>ridr.:fin I&-%wll ou iwc
If yh;,,iF rr n pr,ie,fill Ur tn,>"Ir n'rll rrl;tylq,7u,n hi fr..wunhmi two explain d".nnrr,r,•ref fhe-
rrinri,u.airr 921 remark sn-rion or rm thr hr.a.((If this fury. 23.Site diagram or additional well details:
Yon may use the back of this pagc to provide additional well site details or well
S.Number of welly en"mnt(-ted: 1 cotistruction details. You niav also attach addition:d pages if nwessan.
A,r ntabiple v,ieohm or nirorr,n;ev n,pfrlc wdh ONLY,rich the Wme ronstrut•ficat.v.-a con
.m9mliteme fomy. SlIBbII1IAL UNSTU .TIONS
9.Total well depth below land surfa►e: 59.5 (rt.) 24a. For All Wells: Subniil this lone within 30 days of completion of well
Fnr mnhipfe nelA lien fill depfhl ifdlfte•rf'm(prgllnple.30.fly)•and.101(.VY! eonsiniction to(hic follot\ing;
In.Static water level below top of casing: 431 (fit,! Division of Water Res iurces,Information Processing knit.
ifualer level is atone twiir;,rem•~." 1617 Slail Service C'cntcr,Raleigh.NC 27699-t6 t7
11.11orchole diameter 8.25" (in.) 24h. For infirm1_ WcltcONLV: to addition to sending the form to 41V address in
24a above. also submit it cope of this fo(nl widlin 30 days of completion of well
12.Well constntctitnl method:AUGER consinietion to the following;
ii.c.mipm miry.cihlc.direct post:cm.)
Division of Water Rcsnurecsr Underground Injection Contril Prrgranl,
FOR WATER SUIPPLY WELLS ONLY: 1636 Mail Set vice Center.Raleigh,NC 276"4636
13a.Vidd(gpm) Method of test: 24c.For Water Supph•n Iniectitin Wells:
Also submit one copy of this form wilhin 30 days of Completion of
13b.Disinfc(•tion type: Amnunl well constniclion to the coonly lteal(h depanmcm of the coirnn where
constrnctcd
FOnta OW-1 Nonh Caiolim DVanireit of Em itutuncnr aid Natnral Resources-Dig lion of Water Rmotrccs Rc%ised Augo9t 2(i1:1
i