GW1--06085_Well Construction - GW1_20241014

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WELL CONSTRUCTION RECORD Farlige real Use ONLY: -
This fain can be uscd far single Or nwltipk wells• -
1.Well Contractor Information: ,
• ta:-WATER ZONES- . .- • i..
John.Eisenman • roots - .T0 . -DESCRIPTION
•Welk Contractor Name ft.. ft. I .
4439-A it. tt. I . . .
NC Well ContmciorCcilificntioiiMaher `I5.OtITER'CASING'(foreull1-eiied eflsl'ORLINERtifanencabk)s
FROM To DIAMETER ' • TIrICKNESS Il] MATERIALSAEDACCO ft.- ft.. I ia.• -
Onnpaity Nomo 16:INNER CASING.OR TI]BING(Reeeturm etosedaonp) .' -
-,FROM- • TO DGMETER TRIMNESS MATERIAL
' 2.We11 Construction Ccr'init ti; 70003229 _ -R. fa Err.
140 all opplicr$le well penults,li_r.County.State,.Yariain,.Irt,°ada&etr.l
-fG fit,. i,In'
3:Well.Use Scheel:roll use): .-17 SCRI.EN •
WaterSupph'Wc1L FRO`I. - TO .•DrAME;Tt:R st.OTSIM THICKNESS I MATERIAL.
CJAgticultutal DMunieipaUFublic . It' •
•ft. •in.
®Geothermal(Heating(Caoling Supply} ®Residential Water Supply(single) . It In _ •
in.
G rm
©ludustriaUConuttercial 1 DRcsidcntial Water Supply(spired) ,.10 GROUT- . .. -,- .. -
YAOSI TO MATERIAL EMPLACEMENT METHOD&AmonNT
' 01tiipntion .ft.. • It,
Non-Water Supply Well::
. ®Monitoring -. . CIRecotet}•- R fit
Inject low Weil; !4. ft.
QAgnifcrRcchargc • DGrouridwttcrRcncdiation -'19:SANDIGRAVEL•PACK(if applie5Me)• - -
;FROM • TO' - • SRTP.RLM. ENIPLtCFAI1:NTNITNOD
DAquiferStoragc and Rccoyetie • DSalinity Hamer_ R.. ft..
ID knitter.Test.. • EIStommatcr l}rauta • It fit
0.E_g/trinicninl Technology DSubsidence Control - - .. - '
1111DRILLING'LOG'(altacb-additional sheetsilucccssan9
UGeotliennal(Closed Loop) DTracer .FROM•. TO . - : PFSCRWIIOX rotor.lraWnca.wR4tkkh1.pytnAie.del
. OGeothennal(Heating/Cabling Return) •1:10dter te t:lain under 42I Retuarlss) •tt. fit..
f6 - it 1r-= .r�.v
.t.Date Weil(s)Conipli letl: 9/23/24 .Well pDg111-1, •
ft. ft. • t1
54.Well Llcatbin: fL ft. 0 C T 1 4 2024
W&T Carlisle Properties LLC 'ft.- F. - 1 Uhl
Factlit),'UivncrlJantc Facilit)•IDktifapplicable) 1Cr3:rTti t�:fy t."C•C, xry„ ,fy
R. • ft. ' - • - - Lr, i:.i2l:,`?
3136 May St., Charlotte, NC, 28217 . . . • R, ft..- I,
• Phsssiaal;dduns.Pty.andZlp; 'it REnlARK:S':, - - - ; .
Mecklenburg 14505306 Groundwater sample collected through augers.
County tatter Itkytiflcaunn No,(PIN)
51i.!:atitade and Lringitude in dcgreniminuteslseconds Or decimal degrees: - r Ccrdfiration:
(trineu field,rnr tntn®us is tadncicol) . . .
N W {Y _--• 9/30/2024
• Sigaitnrccf�:✓��ii )f� ����r.2,44s---7. -_'�Date
6.Is(are)the tYell(S):.l7Fermallent. or %ITerntIorar lip eigngre thir Alms...". .—6:W.,,ifo r' ;r!` • as i6 a rratructed im mmnnhoice
with 15A NCAC 02C.'x l,s- :tr t.�6 ZAC.0200 Well Coustractioir Sraikfarda and riur or
7.Is this a repair toanexistingwell• 17Ye: or KIND ccyieof this r. oirlhosfirmprrmiderltollr'MI Owner. •
l(ttrf,La a kook;fill oar knnirir trill corutnrcr(on lnfomttulon and explain rhe rrnrore of the .
repair tit' t'1 retnarL.s:ier.•iiart or on the bark of this form. 23.Site diagram or additional well;deptus;
You may use the hack of this page to.proside additional well site details or.ti•elt
8.Number of wells constructed: 1 eonstiuction details. You may also.aitachadditional pages if necessary. -
For mnlriple IrOecrlon Or nnvr-waver supply rer(Is pmx iridi the same consiruition,you tqn
saitotie form. St1BM11 TAL[NSTI)CTIONS
bm . i
1:
9.Total well depth below land surfacer 30 • ' - (fit.) 24a..Fir All Wells; •Submit this•form.-within 30-days of completion of Well
For midi*a'ellsl srof!ATMs lfdlfjerem(example-J@r2IM'ood.2@-I0tl) Sonsln,ction to the foltgssiow,• I'
110.Static water level below lap of casing {R,) Division of Water Re.KotirceS,Information Prtietessing Unit,
Aylmer level is above rnsfig:are"+" 1617 Mail Service Center,Raleigh,NC 27699.1617
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11.Borellnte-diametcr.8.25" (in.) 2•lb.For injeetiop WellcONLY: in addition to sending the font to the address in
24a above.also-subdtit a copy of this fomi within 30 days'of_completionof well
12.Well construction method:NSA cottslmcttoti ib the following: I' .
(i.c.auger.rotary,cable.direct pith.etc:} 1 _I .
'Division of Water Resources,Underground Injection Control Program;
FOR WATER SUPPLY WELLS ONLY: 1636 Moll Service Ceirtcr.Rnleigh,NC 277;559-1636
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i3;t Yield(gpnr) Method of test: 21e.•For-Water Supply&Injection netts:
ALSO-subtiit one copy-of this form,ithin 30 days ofcampletioaof
13b.Dlsinfietian tile Amount: well construction to the county health'depamncnt of ibc.connty.whcre
constructed.
Farm GW-I Noah Carotin•(Department of Envuonan rit and Hanna]Resources-Division of Water Rem roes Revised Algust2013