GW1-2022-00221_Well Construction - GW1_20221216

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WELSH CONSTRUCTION RECORD(GW-1) Por liitcmat Usc Only: ! i ~l
It.well co samcfor,Tnformntion: 1 ll
{ 1t y fi Id:NV fFl X)NFS 1
rum .TO. Mcgicalp-rum
1t!c])G'aa:matnr tiarrnw - Yi.: - �' �ft.
.t141 ft.
-
3-e 4 erctontroalar arlificatidn Nrimhar lS,oUTER CASING'forraulti-cased,vclls Oft LINER life Urnblc . i
unnat •rri mntnrn•etl T'lntTcvtss aiATsn+ni. �? ~
C,ast•.ndb bdllirlp LP rt, n. h1.
Cnrai+:ny Name 161 INN ER CA91NG OR TUD1tVG en lh I Mal closed loop'
2.Well Construction ircrnilt N: MOM .To niaa+srt;tt —C Tutcxvrss MATEIIIAL
rift all applGah/r will cnnitrndton prrmhs fi.e.(I1C Coun(V.Sfnlc,thn7nnct x1c:). ft• F-
I Weil M&(Cheek weU Ilse):
17.8CI1FEW
WntcrSupplyliVcll: 'Ti)' p1A81E1'►at ' 31.b'1S1%6 Tulclfvess sinTrmni._:
EJApricuhninl' CIMAmicipaUPu6lic ifr. C n: in. .r 016
.1ticruhcTmal(I tt atingJCnolint;Supply) t lRraidcatinl Wnfcr Supply(sii+glo) A. �L nn.._
s7industrial/Colnmereial C)ltesideijtihMaterSupply'(sharcd) . :(B.GROIf[
rlirri ciao C1Wcllc�'IOO;t100 G1'D' -Mom to, _ sin retuAt, sstrl lclSstEa7 attA lnn F.Aaa)USI
Eon[Pater Supply well: n ) a' r i YtI 4
f7MonitgtinQ ORecovery tt, n.
:•fn)eetion Welt; n. n.
f7Aguiro Ile charge JGronndwatcr[temediation 19,gpNDIGItAVRY;PACK If n Ifcoblc
?7ArlaifarSu,mgcandRcrnvcry �Salinilyl;ntricr FROMTo IN -I )u.a. s�lrincrsa:Nratetuon _
sMquifer Test UStotnnvatcr Drriinngc , , !:�Sr� ft• r (.� ��l�fL
'llreperiment it Tcehnolnry lsuhsidalca C:oniml' � Il. Yt.
rJGr illbrnrltal(Closed Lnoll) CT1'r;iiur' - 20;DRILLING LOG punch addliloual sheetr Ifdecessn
Thom 'tb.:...- n1"SC1rIPT10P(rolnr,hmrinem.A0111 mk tine.er.ln ela,e1d),,,,,;
Mycoiliermal(►IcattogiGooling itentrn)1 pother(explain under•ki Remharks)' h, rt.
•i.1)nfe Wcll(s)Completed: ��,�'�f/"� We�)1., �"`��y� n.' n. _
-So.:%,'Veil Location: .,.,�l�.��o
Ahumarle Ctorpornlion --
'Irusrihly/ftnaName Facility 110(ifn {�nplicalk) n it.. EC 1 e l'LL
• ter � il. �' M __ Jr.�.::,..,_r,> l-.
3,18 blbliday Inn brivo, Kings Mountain,NC 28086
Ph5ircai Addretts,City,cud•lip nt lf.
21.REMARKS
t✓ieVellfid '
Cm:nly PrucclldentificnNno Nu.(PIN)
5(r;Enfilade.and Longitude in degrecslminutes/sccauds m decirnnl degrees;-
(if Wall fir(d,nnc laJlnng k rnfficiknt) 22.CertliicnNml:
N i, tt r
r SignatureprCantliedWellCnntrnNor Date `
4.(stare)thewell(s):Vlermmtcnt or OTemporaiy
Ny.tigning f1dc form,thereby eeriify dint the tveN/r)110 0rre)cmanucicd in ntcnrvlmrt.r u i!t
7,1s thfut.repair to:an existing swell:,. OYes tit` Jo' 1st A'CAC 02C'.0)00 br 15.4 NCAC 02C.0100 Well Carrnrlt Don Srandnrds and that n cajrt!
lfibb rr a repair,fill tiarAnom;well eonrdurrimr informatian nrr_ .plain the nnnor o(fbe r!/'thlr rrcorrllrraLrtonYunuidetl In(!rt xrll rnen.v, -
A1140 uadcr 1131 remnrkisrelian ar cn ttm back nfAh f run. 23.Site diagramnr addll tonal well details:-
8.(rtir Ge6prohrfol"T or Closed-Limp Geother-ainl Wells havin(;the gal-via 'You-mayuse the brick of this pago;lo provide additional we11 wnstntc(inn inlo
cgnSlnt6tiat;aoly I GW-1 is needed, Indicate TOTAL NUM)3L'It of wells (atld'Sco Over'in Rclnarks Has).You may also attach Additional pages if ucccssar r.'
24.SUBM11TAL iNSTRUCTIONS.. .
9.Total well depth below land surface: 1!1�Lr - (ff) Submit.this GW-I within 30 clays of well completion per tile following:
1%or nmB(ple ne/fs list all depth it'diglen•n!ikample•3@200'.a!d 2@ 1 QOnI '
24a..Tor All Wells: Original farm to Division or Water Resources (1)Wit),
10.Slalie water level below toll of enslrlg: "tits) )n ronmition Pmca'ssing Unit,l61'7,\49(:,Raleigh;NC 27699-I617
' - I/arvttrrlmrli nlmrrtsrcing:nar„—•• :.-
24h..For InlcMion Wells:Copyto-DWR,Underground hljeriioti Conant 1111t':j
li.llorcholc dlmncter: - :?-------(iu•) Program,1636 MSC:,Raleigh,NC 217699.1636
12,Well construction method; _ 7�?��I fr 24c.'For Water Supply and t1 len-Left t Geothermal itelnrli 1VOIs1 Cnpy'to t1,4
0-of cupor,mtary,"Life,direct puck,etc.) catmly mvironmeninl hca th departrnc+it ol't+c cormty tvhola installed
1-oR W)xrlal St1FPLY WRLLS 0,NLYi 24d.)�nc Water CVells l►roducinc over IOO,OnO crli:Copy to"W' t=CPC[).1
Permit Program.1611 MSG:,Rnlelglt,NC 27699-1611
CIA.Yield(ppnr) Method of test: . .
1.111.mslnrectlon type: Amount:.'
Rcviscd 6.G-in l r,
Foral6 ,) No m th Caro Dcpattinolit a r Eaviroamotnl Quality-Division of Water Resnarecs{
y
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