GW1--07244_Well Construction - GW1_20231108

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• WELL.CONSTRUCTIONRECORD'. Furtetstmltisc.ONLY;.
This foim can be t.wil.fit ittlgte at multiple wel4'
fl.?4Vclt_Cnntratctop Information \N\P
&t.wxrER ZONES_
John Eisenman PRAM 10 DESCRIPTION '
WvflCat9rtelar1:im0: R. ft.
4439 . it. (t:
NCBet)CmaiaciorC.niticitioaNuntier •
"t5.OUTER-CASING'(!orasiti=eadedwcttsVORLiNERtitdp Ocabkl- ..
FROM ' To DIAMETER• THICKNESS • MATERiAL
SAEDACCO (t.: ft.• I '. tn.
C'ImpuryNauic. - 46r INNER.CASING'OR-TUBING't'i iherr I ck d-loiipt_' .. •
• FROM To • DIAMETER. TRICKNESS, MATERIAL
' 2.Wdl Construction PeiTuit#: 0 R. 40 ft. 4 ilk, SCH-40 PVC -
Littufl app• 'Woke,sire4 prnrq)s,(_c.Ccuirtu:Shrc::Varimxr.I1 e rt
3;Welt.Ute(check well aso): •
• t7:S[It!EN
• WaterSuppty Wept - mcoM• TO p?AmETER st•OTSIM . TRIMNESS. •AI 11*Ir t.
L7Agticultutal_ iAltinicipallPublic; 40 - Ili, 60 -"it. 4 I!I' .020 SCH-40 PVC ,
DGeitheinat(Heating/Cooling-Stippty) 1Resideptiat•WirnterS.upply(single) - ti: ' ..'"' '-.in,
Clittdustti:d(Conmterciai I:Residential Water;SuppI (sitatedi '. •`tS GROUT
FROhr --' TO. • -MATERIAL • •EMPLACEMMT hiEfIIOD S AMOUNT -
Olntpaltion 0 -ft.- 34 ft: Portland Pour
NNriWafer Suitt]ty WO:
p>1pnttonng •
•ItRecoverY ft.. (t .
- Injection Welt: - . rt. . ft:
. IZIAttnferltecharge AG[oulid%r tetRcnrrdiittian"• as1SANO1CHAVELPACt (if uirtllicabltr _ - _ ._
FROM •in • 1 mA'rpRIAL ttMP1.AC'EAtF:VTHEt'IIon
pikipiffcr"Scor igc and Itcco%ct• .[]Salinity Ramcr 37 tr.: 60 ft. sand. #2
ElAipiltrefcst D5totitinatcrDrtitiago tG. iG
Clekpciiaient:11 Toehnotpr,a EISribsidcncc:toigrt}t .
20.DR[LLING'LOG lattaeliiddltioffalibeik,If nrccssan'},
tIGeoiIutrnat(Closed Loop) DTracer FROM- iO DESCRIPTIONar.baUnett.suaurae4trrx;rrsnAre.ti )
13Gaothennaii'Ileating Cooling Return) DOdter(explain underi€2l under/al-Remarks) 0 : f't ft. 5 • , c (o
lay' '.• .
5 ft., 60 iL saprol'ite/rock .
4.Date Vill(s)Completed: 9-28-23 We11H)#RW-7 F
'ft. ft. I F a '? r•'-'-'
5a.Well L icatiunl • .ft. ft. 1 [ ".r.r.•‘•,J' ....i' V 2�.
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Lilly RX ., -14" . . ft' • NOV•u 8 71173
. f�acility,'On•ncrNarac. FactIit Ii)k{ifappIrabib}• ,:, tl.
1420 Concord Parkway.South, Concord, NC, 28027 '
ft •� �� �; -=u"c�: t1t Y
. P h 3,cu1 A4dinss City:Zulu Zip L. -21.RE IAARK.Si' '
' - Cabarrus ' • • 'bentonite seal from 34-37'
ComW - Parcel lck:ntitt aiIon No;(PIN) i •
Stu;6.ttitadc aild•i oilgitude la dcgrceatrninutcslhcconds nr~dccitnal dcgi ecs: 2:Cettirmatitrn: i
(1 eiir,,tit,anc l;urioiZ t iY arlDeicnt)• 1
N �V J --'� _9/29/2023
6,is(:ut)the:A1•etl(s}t XPerrnoticnt or DTemporar}' Kk s:F,;u,glll hlii foi,a�r �Y 6 iful.k n f 1 •=axrru?nrcred itr,mtiorrf cr
with`15,t N'C$C tl3'C.!1,; =:- rf4....0 02017}{ail Coifs wi ticur Skun4trtis miff iliara
7.Is.tfu.,a mzimic to an exi tia tvettili ®Vttt or KNo 'cci&Oftfur irronll+irs fncn priwitrat ro- w imll mrrirr•
(f thr's:len ails!..fill roar krroiaw a ell owatiuc1!oo irrfor tnatka and ctplafn the norare of the -
reriirirrcnrlrrp2f:ir,narks.srriwu pion the both of this form. '23:Site,iliagriuiior additional well.1}iiauits: .
You tuay'.:use the buc1 of this page to':proilideatithliolial;well,site:details°or Well
S.Nant ter.of Wells cotlsfl'ucted: 1 . •coustniction&faits. Ytiu niaY also attach additional ages if necessary.'
Fer ntatlriplc h(jactl n i'-von-wirer sup&wilt ONLY with rhe.ernoq conitruettoit,.pea coo "
s:.+irarift o,ur form. - SUDM11 AL iNST1JCt1ONS• .
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9.Totul well depth tialo*-land stirfacei '6P • ' . ([lt.}-'21a1..Far Alt Wars: Submit this form n ithitt 30 days-of contptetit u of welt
For inohipfciiellslist all dept4i/drf•roil(example- 6.2OO trod.2mlO1)) :cousinletionto the foitonigg: i
IQ.Static Water itw'ei hdow top of easing: ((I,) Durum of Water Re'Onrca,InfornnntipaPnncesshig'fait,
7JMAY tc'Pel it dove eaafeti Lk.••t" t617 Midi Sera•ice Center,Raleigh,NC•27699-1617
El.ilorellotc diameter." • (in;) •24It:-For kilecliolt WeliciONLY:•iti addition to•sending Ate form.to the address In '
240--abrise..also subunit a-copy'Of Oils fonts within 30 da}s"of completion of Welt
12::Wellconstructiou.method::Air • consinicliantotttefollosingr ; ,
- . - (Lc..misci,talar}•;oablc'.direct puslt etc:} . • .
.Al�'isioit of Water.Ri'sonmei:,Under 'ou®d[ujeriiott Control.Program,
FOR WATER SUPPLY WELLS ONLYl 11636 Malt Service:Center,Raleigh,NC 276994636
t3a.Y%dd Q�ryemj 71Fctliad.oftost: 21c.;Fo."rWater Supply.&Injection Wells:.
Also sulinut one copy of this farim within'36:daysofcottipletiott'of
13b.Disinfeetinn,typet Amount: ..well-consiniction to the-county health.department of the.canary where
. constl>,icteii. •
Form GRr-1 Noah(Waltrn DApatim m.of Ea>,•3rottntnu aad Natural Resources-Mitten!of Water Rt otctes Revised August 20 13.
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