GW1--06642_Well Construction - GW1_20231006

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WELL.CONSTRUCTION RECORD Far trtenwl Lisc DNLI':. •
•This fond cnn be used(or Single or nwh p)c welts'
1.Well.Ciiuftactor Ltfornration: V '
'1Ji:WATERZONRS .• .
Rich Lemire FROU. ' TO _ Dt+Sf;RIP rlOr •
Well Cortrdelor h;amo •- ft. it.. [
2593A ft, ft; I, i • '
NC Weil ColdiaciarCcnifrcitlonNun cr 'IS:OUTER.CASING'Itoeiautil-€isiedwdlsl'OR LINERiifaU-dcabIc). I
.
FR0I1 - TO DIAMETER' IMCKSESS MATEntAr.
SAEDACCO ' fL- fL' 'In. , •
Con4uura-t in . - ":I6:_1NNER:CASING'OR-TUBING:(Liail eim:d'cluicddo8i►);,-. _ • -
FROM TO DIAMETER TRICILNESS. MATERIAL
2.'W II Constructitin Permit-: • 0 ft. 30. ft. 2 'hL SCx740 PVC
L Err 011 gpillirabIc v:rll peimit.�(i:r:County.Sta r.,!variant,Irf et ial err._) n,, tL in
3:Welt Use(vh.ecl:Weil tic): ' . . .17:seitt:.EN
Water Supply Will: _ — FROM• TO otAItr.TRR St.OTSIn: T11ICICNIIS I IiATRRrpL
®Aglicllltitral . uM►inieipallPublic• 30 ft.' 40 'ft.- 2 i 010 sex-ao PVC
•
❑Geatllennat(iieating/Cooliug Supply) .❑Residential\ViterSoppl}•(single) tt' •t� in, I
❑IndustrialfConmtercial_ ©Rcstdential Water.Supply fsienedi 18:GROUT:.._ - ..-
FROM TO. MATERIAL i EI,PLACEII TIIErI1ODA.AIOtI T
❑irrigation - .- . . - . . 0 'ft. 28 ft. BENTONITE Cx>t®BRED
Non-1Vater Supply Well: ., .
!Monitoring EIRce, let}• • R.. lit.
Injection Well: . ft, ft. .
CIPituifcrRecliarge. • • laGloufid,l:ilerRcirudiallon • ',19:'SAND/GRAVELPACK(iflipplieat[e''- - _.. .::: ' ..- - _--=- •
'FROM - TO MATERIAL , .F:\IPIACI MEET MLTIInn
AA iolfcr.Storagc and Reeotcty ,i]Salinity Harriet' . 28. • ft.• 40 ft. SAND #2
❑Aquifer Tcst ❑Slonitfwatcrfrainagc
l71 acp nnierfal Tc tinoto f75Rbsidctocc.(androl u:DRILLINGLOG'(aUadi additional sheds 11 neccssan•1'• - '
❑Geothennal(Closed Loop). . OTracer FROM••• TO DESCRIPTION(m 4'm(color. viek 0pc.goon we.do 1
. ❑Geotliemtal(Ileatin&Coollne'Retuin) ❑Other(etplain underl#2I Retnattis) 0 .fL 30 ft RED SILT
30 •fL. 40 ft ORANGE SANDY SILT
.L Date Well(s)Completed: 9-7-2023 Well 1D#GTA-1 ft: ft. .
54:Well Location: :fL• tt, .;' o 1 . . ,
WIX FILTRATION . . • ft.. ft.• i I-. .:,•
•'- Faciliiy,±Ow•ncrNmuc Facility 1Dk OCapplieablc)., • R. (1,, JTC1,0.6 2023
1301 E,. Airline 'Ave., GASTONIA, NC, 28054 - - ft, ft. • 1' '
• . PlTiienlAildies •s,City_iidZip• ,,2LREmnRKs '^� �- =fa:.,J
• GASTON i�'.`.a:T�Vci
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County • • , Fred ldentifl*z iicu No,(PLN)
Sti:I:atiludcanilLongittiulein degrees/Minn tcs/secondsrirdecimal degrees:' 22.Certificatio n '
Ofifell Add,one latflorig i$snllliic14)
h Ar = t. t --Pr. a
,.0 .C� 9/16/2023
SigmlurrrofCc,t Wei -11 c0i,' Date
• 6.Is(ttke)(In. ell(s):•DPennanuit or •XITentmratti' .signing thdi Jm..l keret rCft!p rl at thg u•eill's)War kLra)LWtstiner fd Mc gc,•co'If 7CY 11}' 8 t' � 3' ,f�1 {
'•With'154 NC,IC 02C,0100 or 154VCAC.02C..0200 Ri•1l Cnnstristio,r Srarkdart1S qnd thin a
7.Is this a repair to an existing well:. ❑Vcr or No 'copp-ofthir oconl Nils$gran p.in forgo Io tlic%n*dlrnraer,
Ifthis.itarepilr.fillcarkuoiinWellmatnrcNatiH(ftrrurttinnmu!crplainthetwrareofrue • - • I
rgiaircarlrrP?1 remarts sirision grim the back r,f this fore 23:S(te.diagrnn or.additional well details: . •
•' You may use die'back of this page Co procidr:"additioual well site detailsortitell
. 8.'Nuntherof wells constructed: 1 ' . •construction derails. You inay iilso attach additional pages if necessary.
For,imlalpk injection err arm-water supply u.r'11s,O,YtY frith rhe.satrecotrstr'Etiw+,-gun a io
• submit form:. - SUBMITTAL INSTCTCTIONS'
9.Total well depth below land stitface: . 40 (lt.) 24a. For All Wells: Submit this fonn within 30 days of compteliori'of well •
For Tuhlpk ivi lls'lisr all drprhs ifdlffi're,U(expiate-3@200'rmr1 2 @ l(1rr) -consul:Won to the following; 1 '
•
1U:Static Water level below topi of e sing:''34,5 - 00' Division of Water Reseurcea,Information Processing Unit,
/looter leaf is aboV'c casing,rue"4." • 1617 Mail.Scn ice1Centcr,Raleigh,NC 27699-t617'
11.Borehole diameter:8'.25". . . (in.) 24h;For Infection Well!ONLY: :In•addition to•sending tho fomrto the address in
24a above,.also submit a•copy of this font: svitttin 30 days•of completion of Well.
12:Well construction method:'AUGER , cot,sunctfonto•Ntefollowiiie;• ;
(Lc,augci rotary,cable;direct posh c[c) Divlsinir of Water Res ourccs,,Undergr'ound Injection Control.Program,
FOR WATER SUPPLY WELLS ONLY:' 1636 Mall Service'Center,Raleigh,NC 276991636
• 13;t'Yicld((�{m) VfcEltoil of test: •
24e.For Water'Supulr tittniteitori Wells:.
Also submit one'copy of this-;fariil Within 30:day's of'completiott.of
13b:Disinfection hpe:_ Amount: welt eohstmetion.to the county health department of the county where-
constricted.
Form GW-L Nonlr Carolina IApan,nent of Eoviranrucrn and Natural Resources-Dlvi;Ion of Wafer Recatr Rexiscd.,August 1013