GW1-2022-09192_Well Construction - GW1_20220930

WELL CONgRUCTION RECORD For Imenuil Usc ONLY:
"this form can be used for single or ntultipk wells
1.Well Contractor information:
14.WATER ZONES
Zach Thompson FROM 1 ll) OF-SCR iP1TOV
Well Cotsnicu r Nanic
4478A
NC%tell Contructor Ccnifiewion Nunbcr IS.OUTER C&IONG'(for multttasnl i v9s),OR LiNFR`if a "lkabk
FROM TO r!A\tETFR T1nCKINIr MATERIAL
SAEDACCO Inc 0 ft. 41+ ft, 2" in. I Sch-40 PVC
Congcug Nang 16:IKv�(t GASING OR 711Bt1�4';'eadsernia)cb+ed-Ibup.
I FROM TO 01A1151Full TniCKNESS MATERLeL
2.Well Construction Permit>;: tt. It. 0t
Lifr cell rryrlirnhlr oral tvrrnuts 0-r.Cmmr,.ante.4�uirurcr,1jara44 ne. - -
ft. tt. in
3.Well 1.'asc(cheek well use): 47:1.CREEN
WaterSupptV Well: FR41M I TO DIA11ETER !;fDTSl7,V TnICKXt14.6 ; MATERIAL
41 a A. 51 r ff. 2 n in. .010 Sch-40 PVC
IJ Agricniturtt f l>Lluuicip.'+1:7'ttblic
IJGco(hetltwl Meatine cooting Supply) 011csidcntial heater Supph'(single) It. I (L in.
glndustrill,Comntcrcial OResidcntial Water Supph'(shared) 10.GROUT
FROM I TO MATFRIAt. 1 EMPIACKIMENT MFTnOD A AM01:N'T
01ni cation 0 ft. 37, ft. Portland Cemanfection
t
Non-Water SuppiS•R'cll: A. n. �
Whlonitorin g ORccovrt)` 1
injection tF`dh
ft. fl.
QAquifer Recharge n6roundivatcr Rcnicdiation 19 5AIVbKWAVEL PAC K61' ri di able
FROM to MATI;RLA1. V.MPI.4XN1►%T"MHT"0D
gAgaifcr Sloragc and Rcto�cr►' g5alinity Harrier 39° ft. 1 51 r n. Filtered Sand #2
DAquifcrTcst OStormwatcrDmina c ft. ft.
OExp;rimcntal Technology ❑Subsidcncc Control I
2k DRII:LING;LOG-(uhnch sdditioiiatitice(s if rleccsssi&)
❑Geotitennal(Closed Loopi q•fr ccr I FROM To t)Vi(*RIPT1ONkubr.Fr.t4hr.+pde'nn7kh , ti Wr,dc.l
OG othell"al(14eatine+Coolitie Return) OOther(,explain under 021 Remarks) 1 0 It. 15, ft. 1 Brown silty sand
15, it. 51, it. . Rock !
4.Date WellesI Completcd: 8-4-2022 Well jDIINW-209 I
ft. ft.
ia.Well 1,uvathm: n. ff.
Alcoa fl. ft.
Faeilitl Oscr><.r Nan>l Facility ITV(if rzWI a7b1c) ;
293 NC-740 Badin, NC 28009 Stanly County, n. n.
Plmsi;0 Address.Cit%.and Zip 21.REMARiK1
3 Bentonite seal from 37'-39' ✓'':ii2r; A
Cnenots ► rtclld nbfecttinnNo 1PIN't
5b.Latitude and Longitude in degrees/minutm/scconds or decimal dcgrm� 22.C&tificaliutt:
(if aell fond,now L•Vh1%r%is tsttirkw)
35.407354 N -80.117846 W 59 8/6/2022
e4,r idM of ni d i 'cll Contn�of f r Y Date
6.6(arc)IIIC wcll(s): SiPcrnancnt Of ElTC1111gIrRtY' Rr�:g+tinr thn lone+,i he'rehr certify Aun the ruck''.')w'ar tw'etel t oultucied or awty dance
with!4.1 aV('AC i)'HC,.nIfYi,er!S;t A`C+SC 11.'.0,i/*tk)11e'rl C1t:wih7i ,1$tn+r<hr+plc taui rlxtr 6
7.1%this a repair to an existing well: OVes or Enka 3 t r+f rllir ree`o,11 he.s layer 1mwide,l ro the otrN owner.
If rlit Era rep dr.filf t l tat,tw+nrri lolwitr lr+rr)hrl+r+t xrieat tr»A et(+lwo 01'.n+trlre'of th,
rr,:ati!mntrr tr'i remurkv.o`rc-riurr or an thr ftek of this form. 23.Site diagram or additional well details:
You tn:W use due back of this pajtx to provide additional well site details or well
S.Number of wells coealructed: 1 constluction details. You m:t�alsv anach additiortat p ibks if,rtiessaq.
I::.r mAlrllttr lr(j<Y rlc+tr yr r+ixt-etwtar t1(rin's t•r/(5 O:VL}'truth r!)e some ronstr'u<•tirlr,t er rr++
..%uhjnir ever fi-ra+. S U BM I D AL INSTUCTIONS
9.Total well depth below land surface: 51 (fi.) 24a. For All Wells: Submit this form within 30 (htvs of completion of well
For derlhe i(&J.'ivenl textirp( 0-.7f 9'n+k12G_r Ift)) construction to the Collowin.g;
In.Static water level below top of caving: (It.) Division of Water Resources,tnftlrmation Prucessing Unit.
if n-wer level ii ahnrr+risia,Y,asp`"+" 1617 Mall SCVViCC(:enter,Ra1Ciot.NC:27699-1617
11.Ilorc.hotc diameter:6° (in.) 24h.For iniectinn Welk%xN1, `: in addition to sending the forut to the address in
24aabove. also submit a cop) of this form within 10 days of of well
12.Nrcil construction method:Air Rotary construction to Ilte following:
(i_c.aogm redar)%cable.direct push.etc..
Division of Water Resource's.llndrrgtvnn,d injection Glnttt►I Pltigranl,
FOR WATER Sll'PPLV WEi.LS ONLV: 1636 Mail Service.Center.Raleigh,NC 276"-1636
13a.Vidd(gpm) Method of test• 24c,For Water Supply&Injection WCILc:
Also submit oil,* copy of this fu'nit Ivithin ?0 dal,s of completion of
13b.DiAnfection type: Amount',_ well construction to tau county hcafth dcpaenienl of Ilic county whcrc
conslructcd
Fono GIt-t Nonh Caiotitu M-1xmiiuut of Em imnnwut and I:aural Resource%-Ui% nni of waaCr..mources Rcs iwd AuSUSt 2r)I I