GW1-2023-02977_Well Construction - GW1_20230425

WELL CONSTRUCTION RECORD For Cntcruid Use ONLY:
This h+rm cant be used for single of multililc wcHs
1.Well.Contractatrluforniation:
'ALAVATI RZONFS
Scott Hunt', Jr FROM 10 0MICIUMON
1``ellCorgtadorNaOie 9 R. 15 ft, silty,!' sandy
73 % 74 fr sand layer
4561-A
NC.tVellComraclarCcnifttationNntdact tS.OUTER-CASING itue'uulliewer➢eeFlsl'NW-9
R-LIIYEftf[ta'i facabkF
FROMTo MAI%EVER• TTtiC S4 hTATERtAt,
SAEDACCO Inc 0 (t..1 67 ft. 1" 7a. I SCH-40 . ' PVC
Congt uy h'anw i6.:iNA1ER'CASiNG 0_ _BING' aa1kennal clased400
FROM To DWEETER TMCKNM MA MAL
2.VNcIGon3ttuctenn:E!etuiit#:WM03 012 60 ft, ft tl,
P-i$ IT"Stable Mill P a KIS fit Cnrrntt'..Shrh ,V(JriaMV0.11*dC4 rrr.)
R. ft. in.
3.Wctt.(isc fehcdrieflasc): 17 SCttkEN.
WaterSuppl�v Well: FROST To nr.•MET R StcTS17W TnrCrWtSS MATRRTAT.
C1Agtku.Iturtl 0Nfunicipal ttblic 67 ft. 77 R. 1" iq• .010 SCH-40 PVC
®Geolhetmat(Iieatin&tOoling Supplyl ®Residential Water Supply(single) ft< R:
Oludustdal/CoDuneicial ®Rcsidential Water Su -IN.-GROUT ._
ppl}'(Sl)l[Cd) FROM
TO . lIAT13RtAL EMPLACEhTiM1ThTEiiIOD&AMOUNr
0ka,ition
Nort Water Supply Well:
NMonitodng pltccotirry tt., ft
miecllon Wilt: fa n.
E3Agt6fcrRCeh'trgo 00tw6d{{tto Rcntcdiatibn -,N:SAWDPt;I€A4EL PACK(if' r iWAN
FROM To _ MALTRIUAT: HNIPt•,{C{:�tENT INO-r ton
[]Aquifer-StoragcaodRccitwzy i75ilinity13'lr`icr 65 R, 77 R. Filter sand #z
13Agtiifcr T6t ClStvmmPtcr brti6ge
R.. tt.
0ExP4'wCntal Tcchnot©gy ASuhsidcticc GorNTol
"211:1bRILL1NG'COG7attacli addHionalsliects'if itcccssarr•1
DG>othemml(Closed Loop) ❑Tracer FROM To DESCRIPTION irohr,urrdficc+wmYnek tr*, n Ate,ck:i
I7Gwiltennal(ffeatingtCoolIugReturn), Gotlter(explain under#21Retow s) 0 ft. is ft, silty sand red
15 fL 68 ti PWR with chunl�+o argc�c
4.Date WeQ(s)Coalpieted: 3/21/23 . . W&lID#PDI-SB-1 T" f' R=
68 fL 77 (t. purple pwr r 0 L_
S;q,Vtirdl Liieatlonh �� �," A P .
CNA Holdings; LLC
EactlitybtvocrNartu Facility M'Gifgpiicable)
R. ft • :G
2525 Blacksburg Rd.. Grover, NC, 28073 R, -
MOM
PjpkA Addi.ss.City,.wd Zip 72Iz BEhthBKS
Cleveland Bentonite seal from 60-65'
Crlriul}' Parcel Ick:IMM;,9liuuNo.(PIN)
Sh,I. Jtirde grid Longitude in dint ecshnlnutrsJscconds or decimal itc pvcs: 22:Cectitic�ti+on:
(ifinelt field,one:alnonsis slrh'icka)
N w �C.d 4/8/2023
slipatusicefCcittficdNellCa. [ar Dmic
6.IS(area ttbe{vell(s): ElPetrmanene Or Iemltorar}' ar pin tans.faim.f hereky cerfi Char die vtiPl sl twx wan twarirucred 6ra4 orddnce
lffrt NCAC O3C.0ltIU or lSei rYGrIC U�C.i].OP1 i4i+1P Cwrsfarictiaa Sraiadards arniP ifuri a
7.Is things re1latrto an 6d.xtmwell, Me* ..or KINo carsofeINT nvoi-04.ybern pmrifk4iiosirr 1iV11 muncr•
if ihls Is a mpulr,fili+xri krtniivi rie1P.earutiarcr7ara X�rjprrrurr:ai arerP'c�Plalar ilro-r>r�reee of rfia '
re,aurr ivalcr8r31 rernitrJLs�xr7tun ar ar rPie brxk.af drU jaruc 23.Site diagram Or additional well details-
You.may use the back of this page Wproil&additiotial icell site details.or tiell
8.l4umberof{sells consimewd: 1 cousituction deiaik You.may also attach-additional pad if twti ssaty.
For imaUlple hd.&rlun or n(vi1-iid.rer sup#y wilds ONLY it-Ith die.srtmi c4inwim imr,ynit eem
stunt ane fans. SUIINUML iNSTETCTTONS
9.'Totalwelldepth beto{r:land surface 77 24a• Fur Alt Mllellp;" Subiidt this faari within 30 days of completion of wieR
For aeaihtpPr*ii•V14listalPdipihs'Ifdi*erwtt(sr<rrvptc-30200'aed2C•eld ), eonstntctiontothc.foltoul'.g8;
10.Static water lee{ l below tap Of casing 12. (ft.) Division of Water Rernurces,Information Pnieessing Unit,
Pf treater level.ls above casing,use"+" 1617 Mail Service Center,Italci-,h,NC 27699-1617
I1,iforchotc diaunctcl;6" (in.) nab.Fur[uiceai ri VGe1iv ONLY."In addition to.sending the fomi to the addrm.in
244 aboi'e,also submit,a-Copy of this form within A day's'of completion of Dell .
12.Welteoustmetiontttethod,Sonic construction toihe640%ving
(Lie.o: ner..re r}',cahiG direci,pasli etn:) Divisloit of Water Resoutres,-Underground Infection Control Prograin,
FOR WATER SUPPLY WEt;LLS ONLY: 1636 Mali Service Center,Raleigh,NC 276994636
134L Vidd(Mnt1 hlcthod of fist: zie._For.%Vatcc Supply&1!jeetion Neils:
Also subroit one copy of this form within,30 days of completion of
13b.Diatinfititiun type:, -"_ Amnuat: wC11 constriction to the county health dcRornew of the county.whcrc
constructed.
Fonts G{F-L G:orih Carolina E?epsulmcnt oC Et avirortauent dad 5damrsl Re9ourccs-Divi ion of 1VatcrtteSattYps Revised August 1i113