GW1-2021-02102_Well Construction - GW1_20210706

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Donald Warren InFiNED 14.WATERZONEs -
C FROM TO, I DESCRUMON
Well Contractor Name ft. ft.
3581-A JUL 0 2021 ft. ft.
NC Well Corihador Certification Number ,atlQlt Crjfe g►f1Q Uvl 15"OUTER CASING fo`r mutt eaied wells OR':LINER'if a treble
Mid South Environmental!! i)�ty1R Section FRORi, TO: DIAMETER TUICKNESS MATERIAL
ft. ft.
in.
Corn
panyName 16.MMR:CASING'OR.TUBING eothetmil°clos&466 _
2.Well Construction Permit 0- FROM. - TO DIAMETER TRICKNESS MATERIAL..
List all applicable well construction:permits 0.e.UIC County.Slate,:Variance,etc.) ft.
ft.
3.Well Use(check.well use):
1 17.SCREEN
Water Su ! ;
PP y Well: FROM TO . DIAMETER SLOTSI2E TRiC(aVESS MATERIAL _
:)Agricultural []Municipal/Public ft.. it. in.
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ft. ft. in.
lndustrial/Commerciai Residential Water Supply(shared) itI iGROUT
'Irrigation FROM TO MATERIAL EMPLACEMENTMETROD&AMOUNT
Non-Water Supply Well: ft' ft
it Monitoring DRecovery h. ft.
Injection Well: ft. ft.
Aquifer Recharge OGroundwater Remediation >.
19F:SANDIGRAVEL-PACK'(if a 'Gable.
:-)Aquifer Storage and Recovery Salinity'Barrier FROM. -TO _I MATERIAL EMPLACEMENT METHOD
Aquifer Test DStormwaterDrainage ft
Experimental Technology [3Subsidence'Control ft. ft.
Geothermal(Closed Loop) OTracer 2k-DRILLINGLOG attach. dditioinal`sheeetsifriecessa'
BGeothermal(Heating/Cooling Return) Other(explain under#21 Remarks) FROM To DESCRFF+noN eotor,herdnas aolllroek in siu eta
ft. it.
4.Date Well(s)Completed:3/26/2021 Well ID9MN-11 ft ft.
ft. ft.
5a.Well Location:
Radiator Specialty Company ft. ft.
Facility/Owner Name Facility'ID#(ifapplicable) ft. ft.
6.00 Radiator Road, Indian Trail, 'NC 28079 ft- ft-
Physical Address,City;and Zip ft, ft.
Union 2LREMARKsa,'
County Parcel identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
( 4 b i ) 22.Certification:
Ifwe11 feel oneaaf/1on+Is sufficient
35 03' 45.28i1 N 80 39' 01.24" W ����� 4i6i2021
6.Is(are)the wells)(gPermanent or [3Temporary Signalme.ofCertiSed Well Contractor Date
By sighing this form,I hereby certify that the urell(s)was(were)constructed in accordance
7.Is this a repair to an existing well 0—Yes or QNo with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well C'otistnrction Standards and that a
1f this is a repair,fill out Imotm well construction information and explain the nature of the copy of this record has been provided to tire well owner.
repair wider s21 remarks section or on the hack of this form.
23.Site'diagram or additional well details:
8.For Geoprobe/DPT.or Close&Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only 1 GW-I is needed. indicate TOTAL NUMBER of wells
construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft) 24a. For All WO Is: Submit this form ui thin 30 days of completion of well
For multiple wells Am all depths if d ferent(example-3@200'and 2Qa 100') constriction fo the following:
10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit,
If uuterlevel is above casing,rise"=" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-106
13a.Yield(gpm) Method of test: 24c.For Water Supply&Iniecton Wells: In addition to sending the form to
the address(es);above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
I
Form GW-1 North Carolina Department of Environmental Quality-Division of water Resources Revised 2-22-2016
I

r
r RSC
Chemical Solutions
a division of Radiator Specialty Company
July 2,2021
North Carolina Department of
Environmental Quality
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh,North Carolina 27699
RE: Well Abandonment Records
Radiator Specialty Company
Indian Trail,North Carolina
Dear Sirs:
Attached please find one copy of Well Construction Records and one copy of Well
Abandonment Records for Radiator Specialty Company.
The following monitor wells were repaired on March 26, 2021.
MW-11 MW-13
The following monitor wells were abandoned on March 26, 2021:
ETE-6 MW-12A
HT-2 MW-14
MW-10 TFC-1
MW-l0A TFC-3
The following wells were abandoned on May 3, 2021:
MR-1 VE-2
MR-2 VE-3
MW-9 VE-4
TFC-2 VE-5
VE-1 VE-6
Radiator Specialty Company appreciates the Division of Water Resources' cooperation
and assistance in this matter. Should you have any questions or require additional information,
please feel free to contact me at(704) 684-1815.
Thank you.
600 Radiator Road — Indian Trail, NC 28079-5225— Telephone: [phone]— Fax: [phone]-- www.rscbrands.com

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Division of Water Resources
July 2, 2021
Page 2
Sincerely,
Radiator Specialty Company
Stuart Kerkhoff, CHMM
General Manager, Ops
PARTB/WELABANDONMENT2021.DOCX
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