GW1-2021-02697_Well Construction - GW1_20210527

WELL CONSTRUCTION RECORD Forlrtc ItkeaJNLy:
'this farm cur be owd far shtgk or mmtiyle s+rtls
t.Welt Contmctorinformation:
;Ixx V►�1l lt.
Dylan Fierst rN M: TO SPAMIP110N
NV4di Contr8dof tftme 3 fL 20 IL PWR
R, rh
4507-A
l Otty#'tt C er ni lr t ` t}R 6
NCWcllCarnnictnrCcrtifir ionNiunb R41t:cr FROM. To ntAMLTER. TiffEw.W ASATENtAL
SAEDACCO Inc 0 h. 5 (I, 1° in. SCE-40 PVC
Can>p;my�ttamc
oM , To DL%Swmk TinCimm MAIrSUAL
2.Wad!ConstrvrAon ferMjt#: 70002870 IL A. 6i.
fist all uppliroUr wrilprom is(i_r.County.Striae.trarianrcrr.Iiierdnrl ar.)
3.Well liceWWI;wellIpse):
Water Supply Well: verJst; To 01AN1R9Tt&.I st:OT OM I 71111CRNMI MAYRRiAL
�Agtculftrrtl C7MintitVl'Itblic 5 it. 20 A. 1° trd; .010 SCH-40 Prepack
OCreothermsl(HetitinglCooling'Supply) OResidential Water Supply(single) �` t
0hAUStdfl1V0on MVrciat DResidendai Water SupplyYtl f3KOi3T . h;
{511aiCd) PROM TO MATERIAL k�lf?1ACT'MMTMl3Mon&A)&om
❑ltii Lion it. ft.
Nora=Water Supply Wdl:
'rJ: rL
mmitoring OREatti
Injection well: tL (L
Mqutfer l cchmp admuMmiter:Remled ation
_ .pR 14 TO. - MATFUIAL.. . MFT n
1'3Atit$ter•SWmZc sod,Reco-my oWinhyBartier 3 li. 20 ft. gravel/sand #2
O qu*r Test ❑$#Orin mcr 11*1A c
0expetimcnial Tcclmoiogy OSldtsidcncc Control
30;13) j143 iiCclira ' Owe SIK*(,Vwf
aGeothermal(Closed Loop) 07racet FNOM- TO IOKSCRt !t a►br Rinet . ;e� net' n Y
t7Geotuenttal 0katiAgConlial Return) OOther in under 021 Reroaft h. fL PirR
f4 fL
4.Date Wgll(g)Complded: 5/9/2021 Weil tllAT -6
Q: tL
Sa.We"t ocatlon: (L n.
BIN-GRAHAM LLC lL 114
Focflk)0uwrNanv FwintyiD# riwiacabici
4823 N. Graham St., Charlotte, NC, 28269 g h,
111
PiOsimlAatdteaS Cily:andzip
Mecklenburg 04519101 Bentonite seal from 1-31,
County Farad Identifwt a®'No.(PIN)
Sh.t atitade:tltid#,ongitude in delprecfirnimitcslsetandsor decimal dtgicw' 22.Ctdtil'rcation:
tit"ell he ame lafila�is arvfnriafal
35.281589 -80.809399y 5/16/2021
sigrota a of Ceitilled Wen Cortmetor Dade
6.Is(are)tft well(s): 13Permanent or ZTemparary
By*nhts Air f6m I hrrrbp ern*thmttht xrll(&)war{►rhr!conthwted try aS;OMMre
idth 15A NCAC 02C,01iA9 or.ISA NCAC(11C.OIAI)1yeff CarrtrwWo t Smndarda arndOw a
7.h this a repair toIm existing wen: over or MN6 rc1i ihlsrrsrmrll sbeonprovhkdtoth+r.trti+mircr.
IfAlt Lett repdr,flit nor inn;*1 coownr Eton ktfnmafflan egad rig4in*e-natwe of Me
rrpnlr amdnrb2l remnr�[x xeetann or rat tht Mrrt o/rids jmm 23.Site dhigarn,r additional wdl details:
Yon may use the hack of this page 40,pw%ideadditional-well site details ortt�ll
8.Nufnberofwells constructed: 1 constmetion detalls. You may also attach add tiom1 pages if neeessmy.
Forntatr♦jltl errlontOfnrurasnm/rufplvwHs ONLY"Itli dip
amnGcansdwrtkry,tintclan
mbonit ate foam. SURNInMAL INSTUCTtONS
9.Total wdt dcpth beioir l#Dd stlrft w 20 {tt,) 24a Por All Wells;'Submit ih,Gnu-.viiirh130 doys.of convkdon of Ati!
Foor witiplr tolls f4r.o0 drlmla.t Jjdyjrrmt 1exmv{ptr tonstnntton to Or fotipirina:
10.Statle water lml below top of easing. {lt,) DiVislnn of Water Resourtes,Information Processing Unit,
11 n,nrer levrl 1.time Cidka, 1617 Maff Ser iee Cntcr.RnilcW Nit 27649-1617
1t.Borehole diameter 3.25° OIL) 24b.Flnr ini oail&a ONLY.rin addition to sending the forth to the Wress in
24aabove. also subtitil a copy of this tiorm within 70 days of completion of icrlt
12.Well torStMCtla"method:DPT consU credo t0 the following:
(i c supr.rotary.table.atvtdpesKctc:) DhImlon of WaterResaurm.!Uadetgruuad Injection Coatrtil Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Sorrier`Center,Raido.NC 276"4636
l3a Yittld(gpib) Method of tlx 24r_For Water SD &1n xtitrn Wells
Also submit one COM of this forlb 01thin`.10 days of completion of
13b.DiAintmdan type: Amount �teli COastniCJian to the cotinry hei ith dcp>vitntcnt of the cddrn y wh=
Constructed.
Form GW-t North Carolina Deportment of€wfmtm zmr and Mimal Resources-Dh*Jon of oyster R66LM fts%iced Atetlst 2013