GW1-2022-09184_Well Construction - GW1_20220930

WELL CONSTRUCTION RECORD For frrcntnlliseONLY:
This firm can be used fm sintt;k of rudliplc%yells
1.Well Contractor information:
14.WATER ZONES
John Eisenman I FROM TU nFscRlPno�
Well Corttricu r Na1114 ft. ft.
4439
R. ft.
NC%loll CommoorCenification Nombu 15.OUTER CASING tfor MIL11 ai V4*0s OR LINTER ifs ablilt
FROM TO r, FTF.R T►IIC'KVF95 MATFRIAI.
SAEDACCO Inc It. ft.
Congr:ury Natnc 16.INNER CASING OR 711B1NG'Jgialbermal elowd4do
FROM TO nLiMETCR THICKNESS MATT.RAI,
2. Well Construction Pcrrnit t:: � n. 32 n. 2 in. SCE40 PVC
Lrraflrlylbrrlhl.-+sr/larnni:r{i.r.Cnrote,Slrl:r.Pnrimrcr•/l-0'fYDWyrJr.j 11 --- .� -- -.. �,m.,•�
3.Well l se(check well uses: 1_7 R(,'RFBN
Water Supply Well: IFROM i TO nIAMFTFR SLOTS17Y, I Tl11Cksr_Ns I MATI:RIM.
IDAgticuhural DkInnicipal.- tblic 32 ft. 42 fl. 2 is .010 SCE40 PVC
IJGeothennal(tiemikw ooling Supple) ORcsidemial Water Supph•(siglc) U. rt �o.
17-1industrialfComtnerci:ll ClResideniial Water Snpph'(sll:lred) I&GFROM 70 1fATERlA1. EAtPL\CFAfE\T METt10DA.\MOI\T I
DIrfirmlion 24 It. 0 n. Portland Pour
NonAVater Supply Wc1l: � ft. A.
®hionitoring ORccow n
injection Well: H. IL
QAgnifcr Recharge 06ronnduntcr Rcntedialion J 19.SANDIGRAVEL PACK fif d(eable
MAtI:RIAI. V.MPLAC7:irFYT Mr:'fNOn
DAguifcr 5toragc and Recaven• OSa FROM TO
linity Barrier j 42 n. 29 ft. Sand #2
0AgnifcrTc51 OStormimicrDrsirLiX
❑Experimental Technology OSuhsidcacc Control
20.ARA:LENG:LOG'aitach additi6nalsheds if nem"n•
OGroiltemlal(Closed Loop) OTmect 1 FROM I TO InF•5('RIPTIO\t%ubr,hrrWacn.vnl'nMi h Ira 5drt.tM.t
0Q.0111conal(Heafinge!Cooling Return) OOther(explain 111WCr 021 Rema") 0 ft. 10 ft. Silt/sand/clay
10 ft. 42 ft. PiQR
4,Date Well(s)Completed: 8-5-22 Well 1pdMW-202
n. ft.
5a.Well Location:
ft. ft. Y. ,a
t
Facilils-(Owns Nasttc Facility Ibk i.if applimblct
SFP ZOZZ
293 NC-740 Badin, NC 28009 Stanly County, , H. ft.
Plns►:ad Addr.•ss.Cith'.and Zip ,2L REt1fARK4 - ..,
bentonite seal from 29=24ft
County Parcel ldrnlil'watinn No.IPINV I
Sh.Latinedc and Longitude in degmes/minutesiseconds or decimal degrecs: 22.Ccrtification•
(Wool fxid,ow latthuvz k mtlfwicm
N W 8/12/2022
Sigtuarrc �A:. Date ,-
6.Is(aryl the neff(s): EPennanent or OTernpor ar'y 8 ,;Aril lhil i 1.:err T F '��r/ f;,r•a < ;^ ; ,�i;nr_altu tea lrt rxs.rnie(nry
4-416)fA AVAC A3C,•y..c*��- i (;rim '.;l.ti?.O�l/i'II C.n vjitl rNvl st"t"'V.15 alui 11.11,
7.&this a repair to as existing well: JVcS or MNo ram+n!the.'revolt he>'J+v�:{v»wdra:rn qh,•null a rnr•r.
if lhi•+f a(l lepdr•fill f.r-,III(>N7r 0"./41fulr cif dor
uneven mrdrl 021 rmarks src-tim or fm thr hi '.(of this form. 23.Site diagram or additional well details:
You may use file back of this pale to provide additional%veil site details or well
S.Nnmber of wells amir'ncted: 1 consimclion details. Yon may also attach additional pales if nixessan.
fire rnsll7nlr irtirY ricnr l}r nrinPir'r4e•r lr(frle!s r.ells/I�'L1•n'iNi drc MrRe runsrraeliolt.�aa+sYKI
aainvrmrrJncl. SUBI1IX INiSTUCTION:S
9.Total n01 depth below land surface 42 (ft:) 24a. For All Wells: Submit this Cann within !0 days of completion of bell
Fr r nattliph.ua•:h hN rt!!d.rths if i Gr 10)) ConstmClion to the follmirk;:
to.Static water level below top of casing: (i1.) Division of Water Resources.Information Pnicessin-Unit.
If uatlty leer!it+7tir•rr ratan.;:afst •' 1617 Mall Sm•iee Center.Raleigh.NC:2 7699-1617
i
11.Borcfintc diamctcr.l0/6 (in) 24h. EUE flip Lion Well%ONI.Y: 'lit addition to sending the foot to the addim-in
pia alw%'e- also submit a cope of this form %yilhin i0 days of completion of %yell
12.Wcll construction method: HSA/AIR constmclion to the followimg.
(i.c.anger,rotary.cable.dirccl push ctc,i
Division of Water Resourecs,Tnder'Rrmuld Injection Control Pnngratn,
FOR!WATER SUTPPLV WELLS ONLY: 163611fall Service Center.Raleigh,:YC 27699-1636
21c.For Water Sunnh'aA Injection Wells:
13a.1'idd(L9►m1 Method of rest:
Also submit one copy of this form within 31) days of completion of
13b.Disitirmtion type: ., ,•,4 _ �. Amount:„ well constmction to the comas liAlth dclmanwm of the crnmh'whcrc
conslnicted
I
roan GW-t Nonh Catolma Depanmcnt of Em irommot and Naurral Res..ruccs-00%t0on of Milo Reno rces Rc%iwd Aoguyt 2013
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