GW1-2022-07519_Well Construction - GW1_20220811

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Mike Tynan ,a ,14 WATERZONFS ... Y
FROM TO DESCRIPTION
Well Contractor Name
2725-A ® ; ���� 9.5 ff 22 f: saprolite
NC Well Contractor Certification Number ura 1S.OUTERCASING for r ulti-cased"wets LINER,{if a' ltca¢le Y �,
ETC'1 Prt`C: 9 FROM TO DIAMETER THICKNESS MATERIAL
m4'°n �rtyt3 rt. rt. in.
Company Name
16.INNER'CASING OR TUBINC, eothermal tlosed=loo
,, yr
2.Well Construction Permit#• FROM TO DIAMETER I THICKNESS MATERIAL
List all applicable well construction permits(i.e.UiC,Counn.,State, Variance.etc.) 0 f4 7 ft. 4 to SCh40 I PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well:
FROM TO DIAMETER, SLOT SIZE I THICKNESS MATERIAL
Agricultural ®Municipat,'Public 7 rt. 22 tt 4 'ft 0.020 1 SCh40 JPVC
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ft. fL in
Industrial/Commercial [3Residettial Water Supply(shared) 18.-GROUT
Irri ation FROM TO MATERUL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: I. ft. I
Monitoring EIRecovery 2.5 ft. 4 rt. neat cement pour
Injection Well:
Aquifer Recharge E3GroundwaterRemediation 4 rt. 5 ft• bentonite pour through augers
19'SAi\D/GRAZG1'AGK tm liia6lr �
Aquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test [3StormwatcrDrainage 5 rL 22 ft- #2 silica sand pour through augers
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) Tracer ZO:pRILLTNGYOG-attuclatldiliotSals"he _s recessar
FROM TO DESCRIPTION color,hardness,soiltrock e, rain size,etc.)
Geothermal(Heating/Cooling Coolie Return) Other(explain under#21 Remarks) ft ft
See Consultant's log
4.Date Well(s)Completed:6/1 5/2022 Well ID#RW 17
5a.Well Location: ft. ft.
Charlotte Douglas Int'I Airport
Facility/Owner Name Facility ID#(if applicable) ft. ft.
Airport Drive, Charlotte 28208
Physical Address,City,and Zip ft. rt.
Mecklenburg °21.,REMARKS= "
County ParceI Identification No.iPIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latflong is sufficient) 22.Certification:
35 12 26.97 N 80 55 43.28 �,
�y�� /urr.�r� 7/8/2022
6.Is(are)the well(s)ox Permanent or OTemporary Signature ofCVEdWcl1 Contractor Date
By signing dris form,I hereby certlfi till the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: [3Yes or XJNo with 1 SA NCAC 02C.0100 or]SA NCAC 02C.0200 Well Construction Standards and that a
If this is a repair fill out known well construction information and explain the name of the copy of this record has been provided tolthe well owner.
repair under 921 remarks section or on Ore back of this form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages ifnecessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 22 (ft-) 24a. For All Wells: Submit this form vrithin 30 days of completion of well
For multiple wells list all depths if di ferent(example-3@200•and 2@100) construction to the following:
10.Static water level below top of casing:9.5 (ft.) Division of Water Resources,Information Processing Unit,
ij'water level is above casing,use "+" 1617 Mail Service enter,Raleigh,NC 27699-1617
25
11.Borehole diameter: 10. (in.) 24b.For Infection Wells: hi addition to sending the form to the address in 24a
Auger above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
6
13a.Yield(gpm) Method of test: 24c.For Water Supply& Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016