GW1-2022-01366_Well Construction - GW1_20220124

WELL CONSTRUCTION RECORD For irrcrrml Use ONLY:
Tics form con be used W tiftic or mtiltiplc walls
r 1.Wdl Contractroranfortuatian:
_ MA ATER 7.ONLS
Stefan Smith rROSI TO I DFseftrir"ON
r Wal corstian,trine ft, ft.
3576A ft. fL
NCWcllCommetorCScrtif=66nNtanber 1i.,0117ERCASIX 9't rhi-eikilvmtk OR1,1tlER.ffa fte9ldC
FROM TO Dri\MVTER TFJiCteNEGS MATERIAL
SAEDACCO Inc 0 fL 77 fL 2" ie. SCH-40 PVC
C all 1uS
°Atoms &I 1t 'An,g- 7t TLCRWC
DLL1t( ihe�iilst tlomd-I
T&R 7FiiCtCNE53 At.1'TL'RiAL
2,Widt Gomstractinn Permit 4; ft f1 irL
Llsr oilan'iliru&lr.wellprnKti tlx:L'rurmtn,SWIP,.Marione,lr*664 rr1r.)
ft, fL irL
3.Wdl:13sc(chock wrel)asc): i?SCRIi t N
Water Supply Well: - -- -- — - FRnst TO ;DtA,it'sxritt sr•,Orstar; I TtrClcw> s I MarRntAt.
OAgtit:rthiriai J1v unidipclV?dblic 77 ft. 87 (t 2" In O10 SCH-90 PVC
®Geothetrnal(Heatin oo St ❑itesidential Water Sit ft. ft.
in
llA� li�Supply) ikP�'{single)
❑industrial/Colmnicrcial ❑Reside-ndal grater Supply{s erred) IA° RoiFl ;
FROM TO MATERIAL 1111M ACEMENT Af6iil0A&AMOUNT
01rfipition 0 ft. 73 fL Portland/bei iTmeiite
�1v40tiitorinc Gl�eccs;r � rt:
Injection Welt: rL ft,
0AquWC'rAccharge o(Ilig odaater Rcwdiation 19.SANtt,1GRA�EL PA(Xtif - able)
_.. M1IAS`�tlAA1. �71f�7,Aif�iSSi V'r�11�'ft n
❑Agn`efcr Stortgc and Rc'caycty OSalinity Harrict PROM75 ft. 88 ft, Sand 2
❑Agnricr Tc5t ❑$toenm"Stcr Dminag
❑Expcnmcntal Too hnology ❑Sabsid€ncc Control
3t1.';DRII.i�lt•G1:OG-(o{iirek aiidii4aixt ahiYls if�ece�fnrv�3
❑Geadietmal('Closed Loop) []Tracer FROM TO PFSCRtFTtON mbr.naronen s�N6,�� a*c.etc
❑Geotltetnral ffleatit ofi!jReturn) ❑Other(. ainunder#21Retnarlsl 1 1 fL 7 fL silty sand with some gravel
7 fL 17 (L Silty sand
4.Date Well(s)Con rpleted: 12/2/2021 WejjjlD#MW-5 17 ft, 24 fL Silty sand trace clay
Stt.Well Locat om 24 ft, 87 it; Silty sand PWR
American Zinc Products ft, tt
FhcM1y)0Tv-WrName Fsctlity JD#�J(#pl coblc)
484 Hicks Grove Road, Mooresboro, NC, 28114 tt, fL
PlWskul Adilccss City.and Zip ;.2t.REItfAttKS
Rutherford 2 foot bentonite seal from 73 to 75 feet.
c{ropy Pawner Wfft;Cfc/tioa No,(pall)
5b; sa#ih,tlt anil.i.om ltilttic in[legrccs ftdnijtcsl5ccnnds or decimal dc(nvcs; 2L Cerfirmation.
{tf will fh ld„tie I;Anons is st¢ittckfd)
35.195468 if 81.847538 yF 12/14/2021
rr*a . fi, 5cd Wc8 C--b-ebrr Date
6.1s(arcl the well(# Permanent or ❑Tentporary
By signing finis fararr,!J'rereb}certtify(hril the urll�r)tsvr(tnrre).vmrnnrererl br,anrrrrlmrer
rt!&1 fA NCAC 02C.0100 or 15A NCAC-{n2G.0200 Well Constrtier air Srandarrls and dxrr e
7.Lc this a repair to,an exurting well: ❑I'ar• or ENo rape efrAh record tins bl6rn pm4 then r�tlac rrr11 i7rr'ner,
1f rhlsis o rmpddr.fill ourdrwitw wet emmrrmfmi ijg(orrmorlow crO exp(ohr the rurrrrre of Me
repair wr der 0l re mark-secllan or an the brxi of Ate fnrmi. 23.Site diWpnf or additional wC01 detach-.
Ycm may use tlie,ba&of;this page to pfovi�addilicntal well site details of well
S.Number of wells constrtticted• 1 construction details. YW 7la!'also atlach additional pages if necessary.
For rrr414Ke injeerhm or otwi-)twrer uAWy rvrlls Qi1'LY trdrh rhr m*e cosrstratflmr,yaw can
Aw&mlirome fQM. SUBbff7 YAL MItC_TIONC
9.Total welt depict below land aurae- 87 (tY.) 24iL Fbr All Will t. Submit this farm urithin''10 dse's of comptef on of well
For 0err111p1c xVcfJsllSradlyde a tl`d(Frrrrr;(eAMPfe- @200'ar„f 20100) construction to the ftiltoning;
I
10.Static water level below top of casiuW. (I ) Division of Water Re4oti rest,tafirrmsliba Protemaug Unit,
!f rnamf kvo is above Ming,am"+ 1617 Mail Service Center,Ratcit;h,NC 2769,04617
11.Barv:bole diameter:6" (ito 24b.DE lnhSfien,Weds ONLY' In addition to sending the form to lire address in
24a above. also sttbihit a copy of this foot within 30 days of completion of ua
12 Well const mulon fnetbod: Sonic construction to the fol1o*fiLe_
{i_e.srr r."rotnrq;cable.`d66t push ctc.)
Ph islon of Water Resources,Undergmond:tujecdon Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636]Flail Service Center:Raleigh.ETC 276"4636
13 a.1 idld(gpm) lNcNrnd of test 24c.For Water Snp&&Injection Wells:
Also submit one cap}'of this fo�rtn within 30 daysof comolet.ion of
131u.L)isaufe ion,h)ue: Amount wc11 construction to the county 11calth dcpartrocnt of the cminly tivh=
coastructod..
Rcrised Ate 2{tl3
Form GW-1 North Carolina DgkxAnxm ofEmrimunera and Vnrival Rc€ou ces-Dhliioa of Vdaler`l1MLrot%