GW1-2022-06952_Well Construction - GW1_20220722

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WELL CONSTRUCTION RECORD FprlicentnlUscONLY:
Tlris for use m can be d fin single ar maltipk wcUs
1.Well.Contractor lnfortitat(on:
=14 1let'CriR'I.ONESS
Stefan Smith FROM ITD P"CRIMON
Well orwaclorNantc 18.71R. 26 ft. Groundwater
3576 ft- fL
NC Well Contractor Ccnifterhtion Namlier tS OUTER CASING tfbe stutii easeil'rie[Is OR LiNER(tf a BcaGk
rrto,r To DVAMETER THtcKNsss \rATERrAL
SAEDACCO Inc 0 f4 16 ft, 2" ' '1a SCH-40 PVC
coatrvtyName 16INNER.CASING ORTUBiNG' eolkerm3E'efnuddoo
YROM TO DLL'11ETER TMCKNQSS IIATEML
2,Weil Ganstruction fcfiuit#; WM0301210; 70003022
1-istallrMilliuke wropca`ririts(Le:Coaatty.Stone,Arariamce,Infirdet1 cur.i
3.WOI.Usc(chccliwdl use): 17:sCR1 F N
Water Supply WeIL. FROM TO WA.MM. K ,scorst THtCKNtNS MATRRiAt.
Clrlgrkultuml CI1M1<ttn[cip;aUPttb9ic 16 R. 26 R. 2" ► i .010 Sclt-40 PVC
®Geothenmi(Heatingtooling Supply) Mestdential Water Supply(single) fL R_ ins
®lndusti(a1lContntercial Olkesideatial Water Supply(spitted) -lS GROUT - -
FROM 10. MAT'ER1AL EMPLAC IUM\lEMOD S AAIOUNT
❑hii lion tt. ft. li '
Non_Water Supply W11:
®1Nonitoring Mccot'cry 6•
InJectlon}Vest: tt, tt,
EJArtuiferReclaatge' 00touMvs-atcrRenicdistion :19:'SANDIGPAtVEL,PACKtif i ilicidife)`" -
'FROM To MATMAL RAM A(:FMENT METHOD
[7Agnifcr"Storfgc aixl Rcco�'ct}' 175alinity Harder FROM
R. 26 ft. Sand #2 Pour
17Aqu fcrTcst. ❑5tomnr1tef i} 1 .
riin�gc ft. Its
17lsxpcdtncnlal Tvchnoto ' 17 ull5idcnCC CoMtol •16.DRILLit1 G LOG(attack additiothl'sheddif wcrosaml
hGkodiennul(Closed Loop) OTrater FRO.rl TO DESCRIMON mbr.haMnc++wR'mcktr to walk 1
OGeodiennal(HeatinyCooliug Return) DOdier(explain under 921 Reuad s) 0 ft. 1.2 R, Concrete
1.2 ft:. 13.5 fL Clay iVh
4.Date Wells)Ca'utplcaed: 6-10-2022 We'll ID#TMK=2 t
13.5 ft. 26 tL Silt i,
r
5a,Well Uwatinu: tL ft
NRP Holdings, LLC N/A t4 ft, )n(ptm sWn ProcawAV UM
Facility"PivncrTlame Facilit?IDk(ifapplicable) R. ft,
DWQINOU-
3934 Raleigh St., Charlotte, NC, .28206
Plh*ica9,44dccss City_and Zip 21_REMARKS..
Mecklenburg 09107202 3 foot bentonite seal from 11 to 14 feet
i
Cctuula Marcel IJA:mliftciillonNo,(PIN)
511.1„'ttitnde'and Longitude in de'It"A inutr dk6nds or dccitital d iscs: 22.Certification:
(If iieU rleld orte.la(llptig is ttdflckla) j,
35.150496674 N 80.474942107 �`i � i 7/1/2022
Si eYilad{YellCamaof` Date
(►.IS(are)the-wCli(gy: ❑PCrrltaltcnt or $I CCmporary' By 411hig lkhe farm,l hereby rerfify tl!i ke oath's%MY(Mains ewrntnrdfed hr..ac dnImiie
with)Sit K6W 02C•0100 or 15A a1TAC,Q2C.02M Well t:onstPaer(oar Sraalh rds avid fiku a
7.L+thbia repair toam existing we1L 97Ves or Ntio rcyvyoi(1111, erAnjaiGienprorirtctrb')Wti'rlimcirer,
664s'Is a repdIn fallow Ai vifaa nve1l crnurnrcdara brforowfirm iunf ea(i(ahi the 1wrare of the
n/mirardcr8 l remarksserj"carat thn bad-afthh'fprAL 23:Site",r•atn or additional twdl'details:
You tuap use(lie back of this page t6 provide additional ic'ell site details-or well
S.Nnluherof wells constructed: 1 coustiuctimi deiails: You m4y aism.auach additional pages if necessary.
For murrlple lafecr)aVi ar ara i-unrer sitpAr we(lrQNLY idih Me same constricd1on,wu cgn
sabmitaviejvrin. SLTBM TTAL WSTUCTi©NS i
4.Totailwell depth befoic land surface 26 (p,) 24a. For All Well..:. Subinit'dais foim within 30 days,of conipletipn of yvell
For vnalllivle wells-list aItdeprks ll''dwerani(exampfe-3@209'avid 2@ 1lHf} construction to tlec follow0g; i
10.Static water[evil below top of casing: 18.71 (ft.) Division of Water Resat rrgs,Information Paucessiug Unit,
lfituler level i,akov cwfas,vase"+" 1617 Mail Service Ccntcrr Raleigh,vC 27,699-1617
"
il,.finrchofc diam 8.25
eter, (tax,) 24b.For IniCCdDrr'WcEta.®NLY: In addition to seudirjg'tire fomt to slue address in
246 a Dot .also submit a copy of tfiisI fonts Avithin_330 days'of completion of wdl.t
12.%N'Cll cottstme-timl method:HSA construction to the following:
(Le.augrr.tWar}•.-cable direct panic eta.)
Division(i£Water Resources,U d',-'ground Injecllen Control rrograln,
FOR WATER SUPPLY WELLS OLY- 1f636 Moll Ser eicC Ce I te
N r,Raleigh,N1C 27699-1636
24c.For Water Su�tlt&Inicetion Welke:
13a.Yield(gpm) \�Ictirad of test:
Also subinit one copy Iof this f6id cl:ithin:0,days of coiupletion of
I.A.. Minfect(an type:-. Amount:_- __ - - - «'cll.construction to the county hcalth�dcpanmcni of the counly where
constructed.
Fann GR'-I North Camllna Elepadrt ent of Emdromma wd Nararsl Resources-Division of Water Resmi Revised ALgust_10M