GW1-2022-06964_Well Construction - GW1_20220722

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WELL CONSTRUCTION RECORI?
For itacrmllJsc ONLY: {
This fonu can be used fur single or rnultiplc uxtls 1
1.Well Ctintrtctor Intorulation:
a4z,WATER ZONE
Robert Miller FROM TO I DFSCRIPT1ON
WiellCor4rdclorNamy 17.43ft. 27 It. Groundwater
I I
2675 ti fL
NCWclICon=orCcft1ftcationWwnber iS.OMR CASING(rdrtnurileastdnellslOR:GiNERitfa' flcabkt
FROM TO DRALMETER 7fltt'ti 9 MATERTAL
SAEDACCO Inc 0 ft., 17 rL 1 21, l ! 1p, SCH-40-- PVC
Conk ut}.Namp INNER CASING OR'TURING' "Lodwrmat deseddoo
FROM TO Drh1NETER THICKNESS MATERIAL
2.Well Construction Permit ar: WM0301210; 70003022
List 411 fi a.Cara+ht Stvm':trariarrre Tty-ac rnt err,:J'
3,W01,IJ5c(chat,"oil 059J: t7:SCR>tJ N
Water Supply Welh. FROM, TO I DtAS19TrR SLOTstyx I TnICUNINS I MAT1711 T,
C1ASTicitih([al CII4tunicipaUPrtblic 17 ft. 27 R. 2° i '.010 SCH-40 PVC
Meollwmial(lieatingflCooliug Supply}, Mesideutial Water Supply(single) tL ft.
01ndustiial/Conmien:ial ®Residentiat Water Supply(stared) -18:GROUT.
FROM TO MATERUL EMPLACMENT 3E1110D S AMOUNT
❑hit' kian tL (L
Non-Water Supply Well:
mhlonitoung pRocovcTg �'
Injection Welt: f4 ft;. I.
0AquiferRcc6arre PGrouridviulcrRgrucdiation -;19 SANDIGRAVEE-PACfC(if t,cableYc--
HOM TO ,1 NSPRtAL R51Pt'It"At�NT M171"a
[AquiferStorage and Rccovct}' ❑Salinity Hamer 15 R.: 27 rt. Sand #2 Pour
pAiloifcr Test. 17S1ormwatcc Drain,=
ft.. ri
❑I y>camcnhtl Tochnolo 17Snb5idcDCC Coritiol '20 DRILLiNG LOG isnach-additional sheets if-mceswrvl
Meothermat(ClusedLoop) DTr.rcer FRoar Tr} D�seRtrmO�cobr.hnMacrt xnnKta nSaiti�1[T
OGeollieunal(FlealiDgfCooliug Return}. OOtiter{eltplain muter#21 Remarks) 0 ft. 0.5 ft. Concrete
0.5 ft.. 14.5 fL Clay t
4.Date.Wetl(s)Canlploled: 6-13-2022 Well iD#TMW-1
14.5 rt. 27 ft. Silt
Sa.We 1 tte rtionr to rt W
NRP Holdings, LLC N/A (t, fl,.
Faciliry10nncrNamc Faciilit•tD#ei appli nb1eD {t1f01 t1Ii0{7 PrOCS�!!M{q u
R. ft, DWW
3934 Raleigh St., Charlotte, NC, 28206 fL %
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Plgsical rldd[pss.City.nttd Zip 7,21.HE6IARILS'
Mecklenburg 09107202 3 foot bentonite seal from 12 to 15 feet
Crmuty' 1?arcol lder+lirxCjilonNo.(PIN)
Sb.,LAtitiidc acid 1.6.ng1tbdc in tligreiesslminutesAcctiuds or decimal dCrccsi 21 Certification,
(Itrieil field,uaa titrloaS is sud7clemQ
35.150424260 N 80.474973764 W �. 7/6/2022
4'4 Date
6.Is(ate).lbC-\1'ctt(S}: Elpennanent or MTelnporlry tty sign ig rh r fana.thereby rerrify char Yhr ire11i]'i I5Y]'iNl?leJ CYJTS'lNCfCY11R.,8 LY'OIYIRntt
Wth W NOW 02C,0100 or 15et NCr1C.02C,0200 IWIT Co,Dtrucrion§ran deirds mill rhiii d
7.Is'thisarep4irfoanexistiggivelk 01'es or 'N&II COY f(UTnV0,41 hay Giet+'nrovidi'drnifrrm:ll(iurer.
if rhis'is a t'epr A fill an ARUI IW reeld rnrutnrcrtaa hrfonrurr cvr mu1 raplahr Mle norare of rha j
rtpairamlerd2l remarkvr-:crian or on the hack'offld]•farne 23.Site diagram or additional wetl,details:
YOU uiay:use the bacb of this page.to'proclide additional well'site details or well
8.Numberef trolls constmeted: 1 construction desalts. You may also aita6 t'additional paps if ttecessaty.
For)rcpf 1pre htdeerlon or arai-ioirgr sappl teetfs ONLY v'irh ncv,state,coustrui"r,Ms eila
xondf ww fara. SCiBMI7"PA<"iNSTUCUONS
9.Total well:dep1h below land surface 27 ((it,) 24a For All VVetlsr Submit this-faun a ilhin 30 datAs of completion of r'ell
For itudriple isellslisr alldepths ildWre*fcsmi+ple-3@2W'aru120 rvo y constniption to Iltc fpito ittg-,-
10.Ststtie water level below tap of easing: 17.43 ( ) Division of Water ReiaurccK,Infotmntian I'tnceysing Unit,
lfu�rierlrgel'!s rrl+ave emigg,am"+" 167 R1ail Servicc Ce A ter!Ralcigh}NC 27699-1617
11..Borehole(liameter,8.2511
(in,) tab.Ent Glle,1100 Weth ONLY: in f ddition to sending the folnt to the addrr s in
24aabo� also submit a copy of Iris faun within 30 days of completion of uOt
12.Well construction method:HSA construction to the following:
(i o.pffgcr,rotary,cab1G direct push etc.)
Division of Water Resources,Uudegground Injection Control Program,
FOR WATERSUPPLY WELLS ONLY: 1636 hfuil Service Cettler,Raleigli,NC 27699-1636
i
13a.Yield ftm) \lcrytnd'af test; 24c.ForWatcr'SuyPIv&latection Netts:
Also submit one copy of this fonn'�within 30 days of cotnoletion of
13h.Disinfection toper Amounts_ - _ _ well consO rction do the county hca Ith department of the ccnrrth where
eo
Fenu,G%V-t Nonh Carollna Depaom-rn.of Em irontuem and Namur Resources-Divhlon of Water Retour Revised August 2013