GW1-2022-00222_Well Construction - GW1_20221216

HVIIj CONSTRiXTi®N RECORD(GW-11 : :'for intcrnul Use Only:
1
1.Well Connnctar lnfort intion:
14.WATER ZONES � ----
FNOM." TO, OF8Cn1PTt ON.
_
Well Conir„ereryyArfw
I
NCB%veil 4:nnirutor certification Nutuber IS,OU1E:(t CASING far.mniti caeca\sells<)RLiNF.R ifn llcnblc �'
CDSC](iB i�r1111Rg'I IM FROMN. TO fL I71Af17F7F.lt!n, TIIICI(NF.55 ' atATKItLU.
('nmpmty Norco :: . 1
It.INNER CASING t '11111NG balbcrmnl clmd•lan _i
2.Well Cnuslrnctinn Pcrmlt il: FROM -'rO OIAMETFR TInCNNrSs a)nnannl.
ft. ft. In,
l ikf all nplrli�nhlr nt Arnrrina dun jmrraas(fir:IIiC„Cm,nry,Slatr..variance.etc,) _
ft fib In.
•1.Well Ilse(check well use): �3
7•Su YI Welk 128LTtEBN
Wmte
PI y Fno>). ...TO - 'nrnr<IF;r):R .r sr,nTslrx rnln:NFss IInT)aun%�;
ClAgrrcullunt E3MunicipRUl'ublii; f6 fir. In•
G)Cirvnl7emrrl(Nairing/Cnnlirt{ Supply) OResidential Witter Stipply(single] 1n
)t)5
t ltndiivtriatlCommcrciui 13Rrsidential;Wnler Supply(shared) 18:GROUT -
nlrrimticn ❑Welts>..100,000 GPD_ . FROM Tn _- -- _MIATI?RIAL EMtPLACtIMP.NT All r)IQU k AMIOUN't}'
Nun-Water Supply Well: R' fir. fy�f ]ll
. e
�?lfonitmriu) i7Recovery 0• ft. _
10;jectfon Well: R• ft.
17Aquifer Recharge L1Gtliundwalcr Rani tliotimn 19.SAND/GRAVE LPACK f a dlcahlo
(:iAgIU1CC:lfnrilgC fiat%RlCQVeiy, '[l$IIhnlly Bnrrior - FROM% ' TO 'MIA71111JA1; - - PNP7a10Ea,7E.\r M1ETuon` _
'MquilcrTest• UStornimaler Drainage 103 .r" t fi' '1 A,S'9+ a
C31 xper7mcnud Tccirnnlogy (]Subsidence Control - fL
Uckolbermal(Clasen limp) f:ITracer 20.DRILLiNG LOG faturch additiomll eheeis If necessary) Y3
11I40M7 I TO D"-CRIMON cnlnr,iisr.hvii.withad,111111i..grain fire.err, J
L1CiitiitlizKn7stl0It:a6nPJ(;ot7lingReturn) 00ther(explain under111.I:)Remorks)
d.ftate,1Ye11(s)C'nnrpleterl:� �'I '" �` Well 11)I! d R' ri' _ •^ ��< g-Y
5ni 1Vc11 I.ocnflou: .__�: ° �'� `I"-<""'• •-
' Itt)enr<nll)'Co({)i)ralion •, .- ., ._
f+arili:g!(lnncrNnnto Fticifitytan(irulrytgoabld)
.1481�Inn[)rive Kings Mountain;NC 28086
l ul.T4 �'
Phricet Addrecs,City,nrid'lip N' R-
21.REMARKS
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_.CI - -
t'mta'y' Paree1111cinilicatiotNo.(PIN)
Sir.lall)uile and longitude In tlegri cs/ndnutos/scrnads or decimal dogrccs: -
'fif well rrdtl,one lawong it sI1lNcionl) - 22.Certlflention:
6.i9(are)file Icell(s): 1,76-crtndlleut or ElTeMpo'ary Sigirauiro of CcnlNad, I J ontrndor Date
llFsignlaq thtr,farnl,!ltc�•cf!r crrfljr Ihn1�!lyd;nr!!(.rJ uas li;rvoJ ranrinicrad/fi accnrdnnrr.n•£r1
7.is psis n repair to nit existing Ivrllt UYcs or
1°1No I:fA NCAC 01C:0100 or 15A NCIC OX.0100 ue11 Gonib+rrrrnn Smrdardr and drar a ra
n!
1l rinviv a fvpair.JNf nut hnn}vr urlJcmix7tiri rinn inCa)nmrGid(Ind erpidin:rhe unsure njlhe
i�fhls rravd liar been provirlrrl iu nc�icrli mnirr,
rtpdirurtlu'rl3l rrmarlasecltnnarnri 0)chuckoOhis(drm. 13.Site dingruin ur srdditlonul'Tell deialln:
S.l or(:wprnhc/t)ft 1 or o oscrkGoop Geothermal Walls haviog.lhc some You 7nny uee the-back of this page to provide additional well constmctinn'infa.
t nns►n,clion,only11 GW-I is ni:eded. In(icatc'1 YfAL NUMM11 of welt; (ndd'See Ovice in
Remarks Ilus),iYou may arse aldli h additional pages if ncccssmy
24.8118MI'rrALINSTRUCf104S
9.70101 Weil jell Ill 1)elow land surface: w 3 (ft.)
Suhtitit_this C.Vb'-1 within 30 days of\yell i.•on7pletion per the fnllmsing:
Ffir 0uilliple o•i9tr.lisr fill depdit'if di(1i:rrni(vrumplc•Jn100'nrtd 1(a)1001)
24n. for All WON: Original form-it)-Divit;ion of Water ltesoiin:cc (DWRI-
10.St;diewater level belaly top Of calling: 00 'Information Pmcassiilg Unit,1617•MSC,Rnicigh•NC 27699-1617.
'll un(er lcvdl is above easing:147c "
cr- 24b:for Injcction Well:Golly Uri 1)Wlt,Underground injection Control(IUG)
I1,-Horohuled)nmetcr.- U (in•) Program,1636MSC,Rnlcigh,NC27G99-I(i36
I2:Well cnnsfruetlon-melhatl: 5�'"'1 f G 24C For.Water So' I and 0 end-Imo Geothermal Return Wells:Copy to 0c
(I d.nugcr,salary.cable,ditto puchrme.) - county unv ronmcntal (call, cpunmcnt of the County where Instal cd
Ff)11 WATER,gjjrPLY WF.i;LS ONIX: 24d,For Water Wells proilticin oiler 100.000 GPM Copy to pWtt.CCS't l;rt
Ptrmtt't lirugrmn,1611 MS(C..Italcigh,'NC 27099.1611
13n.Yirld(gpni) Method of test:
d
13h:DislnfecUon type: Amtitlnt: 1' I
North Carolina Ihpartnient of fiiivirunnIcntel 9gality-I)ivisinn of Watar it6sourccs i Revised[r6.2tt11
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