GW1-2022-09196_Well Construction - GW1_20220930

WELL CONSTRUCTION RECORD For ttpcmtatlfscONLY:
This(=cau tL ttscd for single or nmttipte«'ells
1.Well Contractor information:
14.WATER ZONES
RICKY LEMIRE FR<)M To DFSCRIP110V
Well Coneractor N.Inx
2593a
NC NVOI Comrtctot-Ccniftca ion Natrbcr 15.OUTER CAIRING tfo►mullkased xrRsI OR LINER it a 'l able
FROM I TO I I I MATERLAt.
SAEDACCO Inc 0 it. 35' ft. 1 28 in. I Sch-40 PVC
C;atttirut\'Nattt< 16 INVER'CASING-OR TURING�eol�rm&J ttoxd•iou0t
FROM . TO DLICI 'TER TillClsSF..CS NIATTRM.L
'2.Well Construction Permit N: fl it. im
lisr all uly1hrat'le wellprnri.,fix.Cntunr,Stole.Farianre,//cede=rig-,) - -- - °--
ft, ft. in.
3.Will list(check well use): 17.-5f,•RI m
Water Suppkv%Vell: FRCIst 1 TO 1 DIAMETER I S1.OTS17): I THICKJt1S 1 MATERIAI.
35+ ft. 40' ft. 2n in• .010 �Sch-40 PVC
t�rlgricutturtl t�1lVfunicip.Tl;T'ttblit:.
043cotheru>id(Heil hkivCootiug Supplt•) 011csidcntial water Supply(single) It' fL in. 9
I�h►dustrial'Cvnuucrcial 011csidential water 5upph•ish:ired) I&ROUT, 1 70 yATFA4\I. i EMPL\tZ\lf\T METIIOD fi A\IM:FT
Olrri" tion 0 ft. 311 ft. Portland Ce T= ection
Non-Water Supply Well: ft. tt.
®Monitoring ORccov cry
in eetlon Well: ft. ft.
QAquifcr Recharge QCimnndtsatcr Rcmtcdiation 19.SANDKiRAVEL PACK(tf a 'able
►ROM Tq �tAfi):Rn.At. E11PLAll'.\IE\fi:Nt:Tllpl/
OAqui(cr Sior gc and Rc1aycn' OSalinitc Harrier 33' ft. 1 40• it. Filtered Sand #2
OAquifcr Tcst OStort n atcr I)riinlrc
OF,'p;rimcniat Technology OSuhsidcncc Control �;DRII,LING"LOG(allach additinnefsfieNs it nntasnn
❑Geothemutl(Closed Loop) 0 rracer I FROM to DESCRIPTION'i(Obr,hnrdne 1.441"K-,lVtW.plin skit,tfc.1 1
❑Geothetmtal(HeatinelCuolitit!Relunt) OOther(explain older 4.11 Rema"s) t. ft.
ft. tt:
#.Date Wells)Completed: 8-9-2022 Will ID#MW-215
i ff. ff. i
5a �Y�tl Llrcatinn: tt. t.
ALCOA ft. 0. _ c v 2 L,__
Fuilits:tLltcrcr Nanx Factl0y 1lM(if.nTh:ah1c) fi. U.
1f1i1tr7rySv1 :3�": j tlnl
293 NC-740 Badin, NC 28009 Stanly County, BADIN, NC,
28009 Plmsr:d:lddrss.Cit..und7_ry1 a
21:REMARKS
STANLY Bentonite seal from 31' TO 331.
t'auntr Parcel ltkrrfiftGtiiun No.il"IN4
5h.Latitude and Longitude in de.tets/minut/,sJscconds or decimal devves: 22.C crtification
tifoclt fsVld,otc LitMt is;tdlii:nt►
35.401735 N -80.119548 p '`h Vl!, Q/rh�-tom 8/9/2022
Sig:nIll ofCtni :�'cllCon#1711. Dax
6.Is(ar'c)the eetl(s): EPermanent or OTemiarrar'y
Hr.r•'gning thi,form,1 he•rrhr crrtifr thul dtc nwRts!tt7n lnv°rr`1 r•ur_cLu<trrl in(crtrrrlrrnrr
n•ith 1 frl:VGtC 0X.010).ir I,Srt A'C.iC 11.X.010.)H."e'il C+bfett;n'7ims suaidt d,falllkw o
1.1%this a repair to an existing well: _IYc.% or I-C-No +trs r_.t'rAit r(imYf hr..l r.-n t,narii.::t%•th.•t+t•Il:+x•ru v.
If flri t tx a re ptir,ell fart IR).Bm 1Ydi e4toymf( o»J ext lok rhr ta'tft,lt,:f die
relmir under F21 minark%tiv)hm yr rm(lie hca:(nt flux fornt. 23.Site diagram or additional well details:
You may cost:due back of this pal c to ptovid additional n'ell site details or well
S.Number of wells constructed: 1 Coustruction detain. 1'vu Imay also.ntat h addition:d pitb+es if tizti essan.
Jvr fnuttil}4 irrirYdrat tTr vri+vt•b'ah'r.tnl+lilt tcrifS J�:�7,1'trill tin•Slant COttsh'uCIiML t•,rFe ff tit .
sd'volir fmle j:rmr. SU MITT E',INCTUCTiONS
9.Total ss'etl depth below land surface 40+ (ft.) 24a. For All Wells- Subotii this form within 30 days of completion of %veil
For ol"1tilde weth hu 1111.1"phs it dtJ,'i•rrnt(.:ronrptf•:.�� tbY,ut I20r AM construction to the folioninjq:
IO.Static eater ies-ci below top of casinw. 30' (It.) Division of Water Resiources,Information Processing Unit.
!f n•rthv le r,1 it ahrnY rcievr„tlS; 1617 Mail Service Center,Ralcigh,NC 27699-1617
11.Borehole diameter.8.25° (in.) 24h. Far joiMfing W Hh ONLY: in addition to sending the form to the address in
24a above. also submit a copy of this form wilhin ?(l data of Completion of well
12.Well construction method:AUGER cotisiniclion to the followillL:
(i.e.auger,totan'.:ah1c.direct push etc,)
Division of Water Remitrtes,Underground Injeetirrn Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Kill Sen`ice Center.Raleigh,'NC 27699-1636
13a.Vidd ft pm) Method of test: 24c.For Water Supply A Injection Welk:
Also submit one cope of this form wilhitt o days of completion of
EK
13b.Disinfection h Amount:_�_,• well construction to the comnty Health dci> ainc ii of the comet where
_ _ _
constnicicd i
Form GA'-t Non)[C3rntiret D'P:mmcnt of Ent uuattxnt atd Mitural Rcsources-i)i�uion of\\faxrjRootrces Re%ised August;V113
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