GW1-2022-06959_Well Construction - GW1_20220722

WELL.CONSTRUCTION RECORD For[tKsrml Usc ONLY:
This fortncanbe used Cur siaglcor mmltiplo wells
1.Wal.Coutradorluformatiou: t
=:I-I.W.&TERZON ES t
Stefan Smith FROM TO OFSCRIM0114
Well Comractartsanw 22.02M 33 ft. Groundwater
3576 ft. ft.
NC Well ComactorCcniftcationNumbir CIS.'OUTER CASING(fortnutti=eased;iselLc ORtiNER(ifo'"flcabk
FROM 1 TO I DIAM'TER THICICAESS hiATEAtAL.
SAEDACCO Inc 0 f1t 1 23 ft 2" 'hL I SCH-40 PVC
Cortap,ut}Name I6INNERCASiNG'OR'TI18➢NG` eaibertniletasedauu'
FROhl TO I DIMIETER I T11ic"Ess 1 hiATLRIAt
2.Well Construction Perrot L: WM0301210; 70003022 R. ft;
list allapplirable anl1 prrmirs lea Cbunq,Stare,Variamr.14aV64.7".)
Ft. it, ua
3.Well.Use(chcelc well use): 17.SCREEN
WatcrSupply Well: FROM TO DrAntsXt R SLOTSIM TnrCKNFa5 I MATRR1Ar,
0A9xicultutal- ClhfttnicipaVPublic 23 ft. 33 ft. 2^ i� 010 SCH-40 PVC
©Geothermal(Hea(ing,'1Cooling Supply) ®Residential Voter Supply(single) R. fL in
[3iudusMil/Conintercial ®Residential Water Supply(sbarcd) 18:GROUT,
FROM • TO MITERLYL EXPUCEHEVT]kWMQD&AMOMW
❑irri' tipn 0 ft, 18 ft. Portland Cel�ent Tremie
NonAV'ater Supply NYell;
®Monitoring .131iccovcry
injection Well: at. it. 1
AAquiferRcchirge 00irouriduutcrRctnediation ''I9:SANDJGRAVELVACK(if r rlie bk)
Fnoh1 TO stnrRRnAr, E<srrt„YCFxttt:Vrirertron
17A q'uifcr talagc anti Rccovcry []Salinity Barticr 21 R. 33 ft, Sand #2 Pour
m A q,A ter test. QS(ormim,(cr lhrt pat c
'R. ft.
❑l3gacdn1cn0.ITcchnotoff ❑Snbsidcocc Cotdrol
20::DRILL111GaiAG7aitach:addiiionat sficefsifamesmrv}
❑Geothenud(Closed Loop) ElTPdcer FROM TO DESCRIPTION tutor.uardnemv son'rhekte 'osim.d:n
❑Geotltennal(Fleatiug(Cooliug Retum}- ❑ORrcr(plain under 921 Remarks) 0 ft. 0.5 ft. Grave,'1
0:5 ft.. 5.5 fL Clayey Silt
4.Date Well(s)Completed: 6-7-2022 well iD#MW-1
5.5 ft, 33 ft. Silt i`
5a.Well Liicatiaol . L fL
NRP Holdings, LLC N/A ft, ft
19
Factlit}•,`OwnerNumc Factt1hy iN(iCappikablc)
R, ft. fOCtN611tg UttA
3934 Raleigh St., Charlotte, NC, 28206 o
Plryskid.Addisss.City.and Zip :21.REIIAMe,
Mecklenburg 09107202 3 foot bentonite seal from 18 to 21 feet
I
Cslanly tram.]idenlifiaalion No..(PIN)
Sb.L46tirdc aril i ongitude in degrces/minutcsAc6fids or decimal dog-rces: 32.Certification:
(Ifti41 l'teld,ob,l;tlilougls Srcfticierd}
35.150741521 N 80.474785856 W 7/l/2022
5ietwcd well Coruractor i Date
6.is(are)the-n'ell(s); SlflCrmatlCttt or, .171em[Ii1Cat}' sr nbi jk4 arm,1 hereb cerfi Idior 1he irefi sl vvs mi-M aYrwinreW in wevrd6cr
�'.'s i; f 3' Yy . t'. (.
with I&I NOW 02C.010l or 1JA NCAC d2C.02Pn R'ell Conumcdon srawfards mid rMr a
7.L1 this a ire r to au cristin NYelli 17S'es or 1DNn Cali}P}fh 4 flY01rJ1A7c�irn pia�rir&d to-itH'rirll menu,
l�rlrls'is n ri Jxrin fill�vr krroirvr icell earurrarerrarrJrrforrrirrrloir mad r.tlilaJir rJ�u nrrarr of rim ji
repair ravlcr#21 remarkv.srec1hin or rm th!b"k-of iris faun 23.Site diagir'an t or additional well lletaibu
You nay use die back of this page to pr6vids additional well site details or well
S.Numberaf wells constructed: 1 consituction details. You imy also attach idditionai pages if necessary.
For muiripfe 1rt(era19+1 or na'r-purer supply wells ONLY wirh din smrre corrstrrrrllorr,_vareena
asbwiitorrcforiv. SU MIMILINSTUCTiONS I,
9.Total ivell depth below land surface., 33 ((>t, 24a. Fdr:ill R'ells: Submit this farm within 30 days of completion of hell
For'lif0ipre iveWfurrlldprlarffdl,Birrreid(cxmnple-3@ 00'awl2@/Vol ) eonstntetionto the folhanipg: '
10.Static water Iewl below top of casing: 22.02 A) WN-ision of Water Rerourwi,information Processing Unit,
1lnt ltr rlepel is mGuye cnsirrg,'ase "�" 1617 Mail Semice Center.Raleigh,NC 271699-1617
I.I.Borehole diameter,8.25° (in.) tab.F_nX[lntection Welly ONLY• In addition to sending the forni to the addrm in
246above.also subndt a cppv of this form within-30 days'of completion of w0l
12,NVcll construction method; HSA construction 10 the following_
(i.e.aager.aatar}•.cab1F di=t push etc.}
Division of Water Resources,Underground Injection Control Progratu,
1636 Mail Service tenter,Raleigh,N
FOR�VATERSUPPLItrR'ELL$ONLY � IC 27699-1636
13a.Vicid(gpm) Method of test: 24c.For W:Itcr Sn ely.k 15jectioa MCIN:
Also submit one cop}' of this futni icithin 30 days ofcompletionof
13h.Dislafiction type: Amount: anti,construction to the cotmty he�Wh dcpmtment of the county where
FonOW-1 tN'nrth Catalina D Vanmem of EwiroRwLt and Namral Resources-Divislon oMratcr Resou- Revised August M 13
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