GW1-2022-06954_Well Construction - GW1_20220722

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WELL CONSTRUCTION RECORD FarintcpwluscONLY:
Ths form can be used for single or multiple ivclls
1.Well.Cdntractnp Ittformatlow..
\Vd21:R ZONES-
Stefan Smith FROM TO DRSCRIPtION
)tc)lcontrsctorNam 16.77R, 27 R. Groundwiater
3576 ft. th
NC Well CorumclorCcnifrcntionNutdtcr 15.OUTEFfCASING'rbasuitli isedR'cTlsORIrNERltf:a"fkabk)'<
FROM 'TO DFAIDIF.TER. Tt1ICKMM NIATERiAL
SAEDACCO Inc 0 (L 17 (L 2" ta. SCH-40 PVC
Coirgrury Nanrc '16 1NNER CASING OR77IBING "eoibermat chase 46e' :._
FROM I TO DL+Itt1ETER. TIUMNNESS MATERIAL
2.MeVI Comtruction No tait A,: WM0301210; 70003022 R, ft:
1.4t,41 applicable iedf pr mits 0 c.co-op,stt w..Varialr,fly-oIcn c )
R. rL ir.•
3,NVdI S0(check;wrj.l usc): 11:5Ctt>EN
WaterSnpplg WcIL - FROM TO I MA\TvTriR 8t.0TSt7T: TNIMOSS I MATRRIAL
CIAglirultutal: QmunkipctU•Prlblic 17 ft. 27 R. 2" 16 010 SCH-40 PVC
Meotheimat(HeatinglCooling Suppty) ®Residential Water Supply(single) (L ff. fill
®hldustfiallConmtercial ©Residential Water Supply(shared) 18'"GRQ
trr
FROM TO ALITERLtL EAPLACEStENT]tMMODSAMOM
ElkriOmtian
lean-Water SupptY��ci6:
®1v4onitoring Mccoi.cry
Injection%Veit:
MAquifertic6irgc Olbnot idRutcrltemcdiation 319.'SAND1GRAVElrrAcxTir' rtllcyti[rl
ilAintifcr-StoTagcaitdltsco�'cry' C]SalinityHaiiicf FRONT To atATHRwr. RaTat.ACMVNTwtatian
15 R. 27 R. Sand #2 Pour
CIA i ifcrTest 175tonnnatci i?r t n.9�c
ft. ff. 1
❑Exptimcutal Technotogy Mubsidcncc Cowrol
s'20 DR1LC1l1G:IAG:7>itlacb:sddlliorinl stieel3if necessan)
dGeoiltgmml(Closed Loop) '13%Cer FRONT- .70 119SCRIPMN h»br,t,anlneci eoR'nrcRtr rimdr.T
DGeothemial(ITeatinti Caofiug Return) Roder(explain udder 921-.Remarks) 0 M 0.7 R,, Conciete
0.7 ft... 6.5 (L Clay
d.Date WeU(s)C0 plctcd: 6-10-2022 Well jD#TMW-4.
6.5 R, 27 (t Silt J.
ia.Well I.ITCattMH (L i
NRP Holdings, LLC N/P; UMFactlit},bunc[Nama Factliq•IDkGfappli abbij R. ft. ���
3934 Raleigh St., Charlotte., "NC, 28206 ft. fL
Ptoiicul.Address city.and Zip =.21:REMARKS'
Mecklenburg 09107202 3 foot bentonite seal from 12 to 15 feet
Gcmuiy Nrcel hkiiiifecailou No,(PIN)
Sk l<atitirtie and Longitude in tle9Mcs/mirtuteslaccondS or decimal dc$T•ees: 22,Certification:
(IrwAl field,air Ia47oi+S 1s SurtiCicid)
35.150566952 T 80.474850645 NV .[J'� 7/1/2022
Sigmcleificd t4'c1t Cannactor! Date
6.Is(are)thewell(s)t DPe nnanent -or zTempordry '
Ll}•afgrtuig char form,l herrb}•certify dear the ivrMs•1 vnas(}aiicJ tvnrrtruttevl iii.arranlmicr
retch I5A NCAC 02C NO or.ISA NCiIC OIC•(1200 Well Constrrmerloir Srandanfs a,ul alxir a
7.Lc this A Repair to an esi tiair rich: Mee or NNo ropy bfd1h rtroitl has. ri pmvirled ro ihr'vrl!muner.
lJO Is,o repdin fill ankrroiivi hell con anrerlon bifpgiwdwt aril explain die rurrare ofilia ' 1, '
repairwrder6»1,rrrnunCr srctraii ar an the bark of rldr jnrnr 23.Site dtty;ro m or additional wCtl dC(alli:
You may-use the bact of this page to prmide additional well site dulls or well
8.Number.of wells co''nstrueted: 1 eoustiuctiorl details: You utay also attach udditionrtd pages if amessaty.
For nrnlalpJ'e 1i0'oral�in or nrNr-wirer sapplr rvrlls.ONLY mldr(fie:srate cunstr+rirloar,,ve�r cvtn
sabu«twiefami. SCl13AfI7'TALiN57'UCTiONS I,
9.Total itcitileptb below land surfuc�. 27 (It.) 24a. Far AIL Well Submit this fpnn ttdtbin 30 days of eomptelion of Ttietl
FoPtunttlplawcllrllsraBdc7ulrslJd{(rice'nt(erarnyle-J�20O'aaud26ifO(+�' con51nictionto tile
fo{[on�og:
1(1.Static Hater level below(op of casings 16.77 (R.) Divisian of Water Recouixes Inrormatiun Ptocessin;Unit,
i/water legal h,above oddlig,ate"+" Id17 Mai[Serf ice teuter,Raleigh,NC 27699-I617
11.BmcholCdiamcfcr:8.25" (in) 24b.Ln � on WCt1a.ONLY, )n addition to sending the fort to the addtess in
24a abo'Ve.also submit a copy of i its fanu within 30-da}'s of completion of well
12,Well construction method:HSA cousametiontotltefallotviug: `f
(i.e.augcm raim):'cable�direct push etc:)
Division-of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:' 1636 Afail Service k eIater,Raleigh,NC 27699.1636
13a.Vied(g(tm) Mahod"of test:
24c.For Water S�IIIc&LIP Cettnn WCRs:
Also submit one copy of this fami within 330.days of completion of
131T.DisinFixkian type: Amount:-- _ WCtI CQn51r1rCI[piI to ti1C CotmtY I .Ith dcpanment of tlu county xvhcra
- - Constructed.
Farm G%V-.t NorthCara]Lma Resources-DivWonor%%121crReS0uCr s Revisrd August-2013