GW1-2023-02074_Well Construction - GW1_20230307

i
WELL CONST1tuC'rm RECORD Fnr 1ptcnml Usc ONLY:
This rorm can Ltr used fox si nglc or intillip3c mils'
1.WO Contra for Information:
4L VrERZONFS
Stefan Smith FROM to DE-SCRtP110N
W01 Cormaom Mamc
ft. fl.
3576-A
NC tVcl3 ConimclorCcnificplion Nunber 1S•;OUTER CASING(fur uiultl cci�r+l nc[TsI OR LIPILftt'(lf.0 Ilcabkl
FROM I TO Dr IMETFR' Trrlcm.aS Nt.mnm.
SAEDACCO Inc 0 (1.- 2 ft. V" I in. SCH-40 PVC
(:o11via3 .fianrC. 16.'INNER CASING OR T•LIBING t•iutbermal cfu3rd•loiil'•
FROM I TO DLSbturER THICKINUS MATERIAL
?.Wclt Con,trpgtign pCjmjit#, 70003116 R. ft, ht
11rt dill r,,Lptlimbfe wall p x irriu(fir.Corns%:Sm. %irkince.fte:dcA rrr.) ft, A. �®
3.WC11 use(t.c;k weal usq. 17:SCItE EN
WitterSuplrly Well- -- FROM TO I 01.01F.TT:R I Sr-OTST73; I TIEICKWN'S 1 MATRRTAI,
04tioulturdl rJ Nit lllicipalllrublic 2 ft. 12 It. 1" im .010 SCH-40 PVC
®Geodicmtal(ticatin %Cooling Supply) OResiderttial Witer Supply(single)
f6 ft: it.,
r18-GROUT'
©Indusitialt•Contllu.rcial ©llesidential Prater Su
PPh'(SlkTredy FROM 70. 91,%TERLiL EA[PLACrIlLNT;MEitiODtAltOIT,NT
❑hTi htion ft. f4
Nc uAVater Supply Nell:
rt. ft.
�1L4anitnring l7RL�m:n•
Lujeclion Well: rt. rG
Q Aquifer Rccflurge l7ijronrift-alcrRcimcdiation L9:SrUVD;GIL%VEL'I'ACK(i(urtliLAbtL)
FROM to alAr�Euari, "EMPIACMIENTM1'.TII U
❑Aitnifcr.Stgragc and Rccovciy' ❑Salinity Hairier' 1 ft, 1 12 (t. FILTER SAND # 2
Ll Agrt'Efcr Tcst ❑Storm"Itcr Iyminajc
❑E�lctirucntal'1Lrinnalogy ASTEhsid:ticcCartrol A.,DRILLING,LOG famkhaddlifinia.1064slifnr6,isars•l
1:30eothetinal(C lused Loup} OTracer FROM TO 1104CREPTION rt»br,ba!dncn,soil')+nk tr x. 'n sir'dr l
DGeothennat(Hexi11LYCaolitiv Relum) OOtter(explaitt under#2l Remarks) 0 IL 5 ft. FILL SILT AND SAND
5 it, 12 rL MOIST TO WET SILT/ CLAY
4.Date Well(sj Coiuplefcd: 2-15-23 well imTMW-6
ft. fL
5a� rL rL -
Space Craft n.. ft. ,1
Factliiy,POvmrNun!c FacililylD,4(ifappli:ablc)
525 Parkwood Ave.., Charlotte, NC, 28206 ft. fl. Jfh_i. :_;,,,,..;,I•',,- .';,,: 1�,,,:
Pby3ical Addross.City.and Zip 21.REMARKS `-
Mecklenburg 08304212 Bentonite from 0-1'
Comuly Iarccllrk:nutia;piauNp,(P1N)
h.L.;uitudc,.lnif l,ongittalr.in dcgt ccs/mirrutes!!cerinds oe decimal dt gr'css 22.CCITitlCatilln'"
(if a ell Y�;Irl.Sid lat,7isug ix stdl3Ckru) � �,�,e
1\ W �/_ - _-_ _ 2/1_7/2023_
Si�ru� efificd Wcll CantnctatY Date
6.is(are)the wells): ElPernianeut or zTemporaryi by.vigning this femm.l lrembT rerrifv rhar the well(s)Ims(6i re)c'amuyered Lr:ixwonlmire
utirft 15,1 NCtC OSC.01M or l,[A NC,1C 02C,maq 11'e?l CotrsrixirNtul standards mlcl rlhrr a
7.Is this a reivair to an existing hell: Mm nr N NII ri pr.gf rJris rrrorrf 1,rr flC a(irrrir&'d r+:rh,r loll nir,r,r.
lf,rr(s:Jt a re)W4 fill urr 4'run i lied errrrmmie n hrfgr mml n mil ci.%plaia rile mrure of Air
repairravlrrP'21 mnarfisse,:•lian ar rm ilia barL-q(dnis farm. 23:Site dingranror additional well deraiN
You may use tf a back of this pqa a to provide additional%sell site details,or%iell
S.Number of wells Constructed; 1 Construction delails, You Ina%'itLo il[Iacb add]I1U14TI pagLs if 11e1 L'SSar%'.
For oe oon-wirer syj4y a•effs ONLY rrirfi do s,nnr cnrrstrurrixr,yen eev,
sah lit m.form. SUBMITTAL INSTLiC-TiONS
9.Total well depth Delon land surf tce: 12 (ft.} 2U For All Wells Sir6ndt this faun within 3u daps of Comptedotr of 1vell
Fornwhlple iredflisr all depths ifdifferem lercrr!pfe-3 200'<Tral.:@ 10) constniction to the foiloning:
10.Static water level below loppf CasluW. (fe,} Divisitin of Water Resources,Infrrrniatiun Processing Unit,,
1f irdmi level is stove edsfn',mm"}" 1617 hlatl.Ser1•ice Center,Raleigh,NC 27699-1617
tl,i3m chn[c dismctcr.2.25" (in.) tab.Frir IIi[ty;ljort Tygl[c ONLY: in addition to sending the fomi to the address in
24aabo(•e. also submit a.copy of this form within .10 days of-completion of Hell
12.Nell e0u5tr"etion method: DRIVEN CU115LrnCL{Ult Lo II%e IOIIUR`III_L':'
(i.c.auger.rt»ury,cable.direct push c(c.)
MvWoll of Ritter Resources,URdergmund Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ALAI Service Center.Raleigh,NC 27699-1636
I3a,Vicid(g[fm} Method of test: 24c For Natcr Supply&[Weel[on Wclty:.
Also subniit one copy of this;farin %%'ithitt 36 daysofconlpletion.of
13b.Disinfection type: Amount.- %sell.construction to the county,licai department or the coimty when:
corl5nictcd,
Form G%Y-t NonhCarollm D parlm ent of Esvironnxm and Natural Resources-Divis lon of%rvicr R-:--aLr=- ftcvised August 2011