GW1--04590_Well Construction - GW1_20240731

' WELL CONSTRUCTION RECORD For Wynn'LriaONLY:
The form can he ms.d for singk or midUpk.as
1.Well Contractor Information:
14.WA1=R ZONLS
Tyler Brown riot I TO DVst NIPtnti
A. ft.
Well Unlit:mot Name
4625A A ft
NC Well ComntctorCemifitxtion Number IS.OUTER CASING ffor mekI-caxrl wrNoi OR LINER IY apphralJ
rnON ' to I nfyytr rre rimlorss 1, NI inn tAL
SAEDACCO 0 ri. 25 ri. 1 ie. SCH-40 ' PVC
1_
Compaq Name 1 16.INNER CASING OR TIRING elnd4uop)
1 fROM , TO DU'IIFTER Tltic I.'i.5 NI uEialAr.
2.Well Conrtroction Permit It: ft. R. r•
List all applicable well p.rant,(i.r.County.Starr,I'ariamrr.//✓atm rt..I
3.Well Use(check well Owl: l710811N
Water Supply Well: ,.*OM TO DiAMETER satyr sITE _ tend h.l.s ll vrntaf.
fJARrxultural ❑MunicipaLAtbhc 25 ft. 35 A. 1 is .010 SCH-40 PVC PRE-PACK
OGeothertrol(Heating,Cooling Supply) OResidentlal Water Supply(single) A, ft is i
OIndusiria1iComntcreial OResidenual Water Supply(shred) LI si " TO MATERIAL EMPLACEMENT METROD t AMOUNT ,
❑Impation , 0 A. 15 ft. Portland Tremie
Non-Water Supply Well: R. ft.
®Monitonnii ❑Rccovcn _ _ ,
Injection Well: A. ft.
•
0 Aquifer Recharge ❑GmundwatcrReutediation If.SANDIGRAVIL PACK-(Ifapplicable) -
❑Aquifcr Storage and Recovery ❑Saliniq Ranier 23
To Sf y I-Ftll%I_ F:MP1.si tMENT MFYNOn
23 ft. 35 ft. Gravel pack 12
El Aquifer Test ❑StommatcrDrainage rt. A. —
❑Expenmcntal Technology ❑Stthsidesce('ornrol
S.DRIILUNG LOG tailed adltltleual dieats M ne essan t
OGeothennal(Closed Loop, ❑Tracer "MOM TO DESCRIPTION owl.r.r.w ,w,ivos•k opr.rem win.dt.I
❑Gcothemtal IHeaung+Cooling Retuml ❑(Alter(explain under IM21 Remarks) ft. A•
ft. ft.
4.Date W'ell(s1 Completed: 7-4-24 Well iDAi -68 A. A. t
Sa.Well Location: f " ,�, X 1.�
A. ft.General Electric Company A. ft, JUL 3 1 20/4
Fnei1il)''Ou nrr Name Factlay iD4 Of applicable) R. R.
Spartanburg �a pHwy., East Flat Rock, NC, 28726 irk s_r•r.� ,4�v
3010 S g
PIe5lcal Address.Cit,.and lip L RCMARio _
Henderson Bentonite seal 15-23'
I,idi d, Iahcl l..nldteainn No I PIN I
Sb.Latitude and longitude in rkt;rres,'minutes.'scrnndy nr•decimal degrees: 22.Certification:
id troll lint Mk:Ial long I.stdlicwnl l
N W
, 5.---2- 7/8/2024
Si .of Certified Well Contractor Date
6.Is late)the steno): XlPermanent or Temporary
M Milgtting thin tans.I hereby certify that the wr14a1 Mar tertrl nimbi hied tin a rordeer
with 154 NCAC 0:C,0100 or I SA NCAC 02C.0200 Well Conatrmrriam Skralard,and that a
7.Is this a repair to an existing,well: Jeer or IGNo .47pr of ilia retool has hrrn prarldrd to the men owner.
/Jrbis II n repair.(I!.et itrauww l.rll,041001r4 hart aifarro arwal and rA"p,lain air,wrsre of the
repair aader Ili retrtarar snYeorr or on the bark of this foray. 23.Site diagram or additional well details:
You new use the back of this page to pont&:tdditirnutl well site details or well
S.Number of wells cauelrlrcI d: 1 Colistmctlon details. You'nay also attach additional pages if nceessan.
For nrahrfplr a flied an or more-water aqip/s evil:ONLY wilt the same cmaaracttm.sod,i ou
rwbrwitaaie form. SLIIIMITTAL[NSTI)CTiONS
9.Total well depth below land suriacc 35 (A.) 21a. For All Wdle Submit this form within i0 days of completion of well
Foe mahtplr wells hsraNJepnrtifdrgrrentM.raag*.?@ 00'awd:O1(101 constnlcttonto the following
II.Static water keel below lop of casing: (ft) Division of Water Resources,information Processing L nit.
If wratrr iir.rl r,„h...,„„.., ,1•.• . 1617 Mail Service('cater,Raleigh,N('176994617
II.I lor'ehule diameter:8.25" (is,► 24b.For[Menton Well ONLY: hi addition to sending the form to the address in
24aaboie. also submit a copy of this form within '30 days of completion of well
12.Well coesiroction method:BSA construction to the following.
ti.c"auger.ratan.cabk.Wed push etc I
Rh Won of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh,NC 27699-1636
1341 ti'il9d IPPm) Method of will 21e.For Water Sup,*&Injection Wells:
Also submit one copy of this form within 10 days of conipletiovi of
131r.DisiefeCtioe h Amount: well consuction to the county health deportment of the county-where
constructed
Farm GW-t rvonh Caroluta Ucpmrnlcia of Em sionmelu aid Nines)Resotwcs-Dn won of Wafer Resotrces Rcl lscd Artgilst 2011