GW1-2022-03577_Well Construction - GW1_20220328

WELL CONSTRUCTION RECORD For lw-nwl Use ONLY:
�- Ws form can be usud Car singlc or multipk arils
1.Well Contractor hifortnittlom
t4>HA'L8R3i1?IVES
Stefan Smith FROM TO owickip"ON
Wtfi Contmduvr Natin tt. IL
3576A R'
NC Well Canim-torCtttifnmiionNumber M,40UMRCAM X f-0 a h ViiWWeW --01tMER :..'.6eiihtt,
FROM I To ntutBr 'TElt TOtChNM MATERIAL
SAEDACCO Inc 0 ft, 6 ft.. 4" in. SCH-40 PVC
(;eaprm3'Naare is IN: Io r,e;9riireanle lea
FROM TO I DFAMILTRR I TEI(CIMSS I MATERIAL
2.Vl01 Construdli n Ptrwit(4; ft. ft, 1ae
fist 41 apn&UNP wrilµrnnits(i r.(nunf},Skrdr,Ynriartce,TI7�9C0�an;.)
3.WelVusc(ched.well usc); Z7 S41t>EE1V ,
Water Sn11iN'Well:
FROM TO nTANXTQR $tA1TSIM -rRRMNMj I MATMAL
DAgricultbral t]IvfinieipaVPTrblic 6 39 by 4" lit .010 SCH-40 PVC
DGeothemial(IleatingACooling Supply) ❑Residential Water Supply(single) ft. n
ndusmCorn-'WmerCial ❑Resiek2tial Water SST ttt Y7Rfl1iT
Ol
➢A15'fsf�t�l) .PROM ma ATERL&L 131RREti:�flMMUFROD AAtOtJZ T
❑ hmr 0 ft. 3 tL Portland Gravity
Non-Wafer Supply Well: R �
❑Monitorin haRexa� ..
rajedtiotE Welt: tr: k
❑Ag r*r"Recharge Gl iouridaatterRcnledioti°n 19 R .BI.@A4`�d Jcyb
raga and Rcca•vg' 17Salinity Harti7cr FROM hTK MnL RMM A twvr r rtH n
DAM fCr.Stb
5 ft, 39 ft, Silica Sand 20/30
pArlvrifer less AStomm Tkor DtatoaDc ft. ft.
❑Egvetimcrntal Technology ❑svdrsidrpd a Catttrol.
❑Geotheffiml.Closed Loop) ❑Tracer FROM. TO 0RSCWM0'.%wtsr,9artn¢n
1f1 DRILUN fsr1.Q(r intact+tlltivfl(iimAl. Reefs if ni
4 Irk
E343cod"nal(HeathrJCooy.2 Retutio ❑Ofhert in under#2-1 Remaft) 1 0 tt. 18 fti Tan Silt
18 (L 29 (L PWR
4.Date Well(p)Celnlpleted: 2-17-22 Well IDfRW-26
29 It. 39 fL. Bed Rock f
SM.Well IA)Minn: rt tt vm
Former GE Site ft R' MAR 2 8 2022
Ficililp0 nmi-Name Facility WN Cif applitzfilo] ft.
1223 Fairgrove Church Road Hickory, NC, 28602 (L
Pktsi d.Adds.City.andZip 2GR"
Catawba One foot bentonite seal from 3 to 5'
Couorl' Pamed IdcnjOk-Anon No,(MN)
Sh.1-aAti$ude and Lein(;M0c in'dcgTvWmintrtLst c6ndsurdairial de0m. aa.Cerlif'ec in@:
(dwell(kid,ouc hit loog is Rid it id)
35.708712 1j 81.260828 tW 2/27/2022
SigMel af+Gt,iitd Ple1l Cantmcbor Daec
6.IS(arC)f11e wells): aPcrntaneat or L7TCtIiltQC>tt}' �i nin�Ifrb tm;d herrhy cc \that the Hid rd mu Oti-mi cwMinrc-red imdcwA m ce
r 1'VA ArCA02C.0100
TC.0100 or 1.5A
s ACAC nTC,Olf�k�lYetd Gt�.Katrri,K(an Stctrrfcrrrta 4170 rJHrt e
7.Cv thi,s repair to an editing weft: oVes or NNo copy of dtis►mini leis been proriri4vt ro aw utird t piano:
(/ryta'da a iep<r(r,fitd,7�VI kR1n4W Nlld COIASlI7rti9IQA'FtdDIRdRdiCNI mud explahr r1w narnre of the
repair wider 921 nernarks srcihm ew an the hatk of th r fnmL 23.Site diagram or additional wdl dttaiLi4
You elL'l}'use ft bad,of this page t0 provide additional well she deWls of nett
8.Xuntbcr of,ATID coetMmcted: 1 construction deter: You inay also attach addifiondpages if necessen".
For nruftfple✓*Clem Of Arai-+i'alit l'sW#i uVefds d:VLr u'Ith the Same arusbtrrrdar,}4*n edin
Aubolit one for". sUlil1 rit L INS-riu T'FONS
9.Total well depth below land sftrfaet;. 39 fFf,) 24a. For Alt Well sa Sulnnit this fdrm wiffrin 30 days of cotnpfdi0u.of tell
Fnr eonsimcc on Co the fbitoning;
10.Statle water Ievvi below top of caslttg:. Di i_cion of Writer R6oprces,information Processing Unit,
djnnter kwd is ebn«e edlosr;am"+„ -- - — 11617 hfittit Sert'iee Center.Raleigh,KC 2769946f7
11.fi:orebolc diamder.10.625" 1rho 24b.ar JpWgta Wetly ONLY: In addition to sending the forni to live address in
24aabove. also's6iiiilii a copy of this fomi within 30 dayt of completion of istil
12.Weti conslm. Won method: 6.625" HSA / 6" roller cone construction to the foflowhke.,
(i.e..at#x.rotary.cnblc dittce posh cxc:)
Db-Ifilon of Water Rem macs,Underground Injection Contral Program,
FOR WATER SUPPLY WIZLI S'ONLY: 1636 Mail Service Center:Raleigh,NC 27699-1636
13A.Vidd tic.For Water SuM!j&fpjcctb n Wells:
(gpm) lllcdhod°fleet also subtntt one copy of this faun trithin 30 dag'sofc0n4AetiORof
13u.Dlsinfeellon type: Amount:, tvcll construction to the.Counly+ health dcprmd=it of the Comdn ,where.
cons ructcd.
Fenn GW-t t.YMdh d a�m]taa G}xtnnert:t.oE Emdmnnw iu"aMd Nlanaal ResnurCcs-f)n islon of tiValer',Resota t Rcv&d AugL9 2013