GW1--04592_Well Construction - GW1_20240731

' 'WELL CONSTRUCTION RECORD iN�� For!mental Ilse ONLY
This form can hi:ri..d lot simtk or moll'plc,.r:lc
9 1,Well Contractor Information: \
64.warm E 1IIS
Tyler Brown 11IIOM TQ j DTA(MITI ItMN
Welt('onmrncie,Nance ft. fly
ft. ft.
4625A
NC Nell C onlrlclor C enificalwn Nnnbcr 15.OUTER CASING(for m lsi-tasnl%east OR LINER IY Ikatk)
F'IOM I to ntoirrr'N THII'K\F's N{tt NIA[
SAEDACCO 0 ft22.5 ft. 1 Ir. SCH-40 PVC
('mripaii)Nark I. 16,INNER CASING OR TL'RING Igrtheriesf dosed-hop)
FROM TO- nU NFT r'N_ THI('K..E\t MATT FOAL
am—
r
2.Well Construction Permit II: ft. ft. M.
List all epplirable writ permits(i.e.Coen, .G,,v.•.I'doom . I!YeeD.ttI eh-.) ------
ft, ft. in.
3.Well Cie(cheek well rise): 17.WHIN
Water Supply .MOW TO D*AMRrita MOT SITS TIff(Te tit 1 MATERIAL
OAgrkulptlal OMunkipTl;Albhc 22.5ft. 32.5 R. 1 is .010 SCH-40 PVC PRE-PACK
OGeotliermal IHealing,'Cooling Supply) ORestdennal Water Supply(single) ft ft is.
❑hldustrial/Comnfercial OResidential Water Supply(sl ired> 1e'CROtfI
FROM 1 TO MATERIAL 1 EMPLACEMENT a tenon A.(MOUNT
❑Imgation 0 ft. 18 It. Portland 1Tremie
Non-Water Supply Well: i ft. ft
.
EMontmnnt; ❑Recotrn . - _•
!ejection Well: ft. ft.
❑Aquifer Recharge ❑Groutdnatcr Rcinediation I .SAND/GRAVRL PACK gf appficsMr)
riots to MAnRLAI. BMW.afEM VAT Mrrnon
❑Aquifer Storage and Recovery ❑Salinity Hamer 20 ft. 32.5 ft. Gravel pack #2
❑Aquifer Test ❑Stommater Drainage
-
I ft. ft,
❑Espenmental To;hnolog. ❑Subsitkncc Control
a DRILLJNG LOG Isllath aditilionsl ah%'Hi if mct..an I
OGeotnemutlIClused Loup t ❑Tracer 11011 TO DESC KIP MIN rt,.br.hedsr..,imit,,rk Opt.enS. tit.I
❑Geotheunal t Ideating+C'ooli,ng Retunrt ❑Otter(explain under.21 Renlat$sl ft, r
ft. R.
4.Date Well(st Completed: 7-3-24 Well(D.MR-72 ti ft.
`"�
Si.Well Location: ft. ft. • �-. . i/t`" '
General Electric Company ft, ft, AIL Uittit
Facility.0ancr Nanic Facility tON(if applicabkl ft. ft -
3010 Spartanburg Hwy., East Flat Rock, NC, 28726 ft. n.~ ••I:p+t �r
I- rhi�,� -.f"t1.3�i
Pln sisal Address Cite.and Zip ii.ICMARfi;9 D fPC SC4
Henderson Bentonite seal 18'-20'
+,,m« I'.rccihientdicdiouNo IPIN i -
5h.I.atitudc and!untruth.in tlegrr.•.minutrslsecnnds or decimal degrees: 22.CvlNhatina:
Ill well field.one fat tit i g is sidficiCN 4
N W ".* a te_ 7/3/2024
Signals'.of Certified Well cb Connar Daft
6.Cs litre)the w rills): mPennsnent or ❑Temtwarat M,signing this form.f hereby cerrya the,11w*riffs!,hate Own.)cwarrnurrd in mronianre
with 114 NCAC(12C,0100 or 154 NCAC 02C.0200 Well Cosrsfrnenar Sruadards ruin All a
7.is this a repair to an esistieg well: °Yes or lNo ..r'•',filial record ha,hero provided M the 1.01 owner.
If alis n a repair.fill oat known well.,',Ours.iv..odor raarn'n and r.plunt the,u,rare of the
reluir ardor A'f remark,Nr.lion on on the hart n(this fora.. 23.Site diagram or additional well details:
You Ina% use the back of this page to Ino.itk additional well site details or well
8.'(umber of wells constructed: 1 construction details. You may also attach addult'iUl pages if necessary.
for meltiplr ut$rrrN,n or fowl-..viler writ.writs ONLY wash nun WWI eamttrurn.m, v.w,mo
•,uhsir..ne Gorr.,. SUBMITTAL INSTUCTIONS
9.Total well depth below land.airtace; 32.5 (11,1 24a. For All Wells: Submit this him wiihtn 30 days M'completion of well
Far.nnhepk wells tot all depth,oleo)ervaf -wwipk-ti 2Mj'and'It Mal ennstnrctton to the folkiwing
lit Static water level below Imp of casing: (ry,) Dirisfun of Water Resources,information Processing t nit.
flume,h•.rt r above,euin: ,•. - 1617 Mail Service('cater,Raleigh,N('27699-1617
IL Borehole Maunder:3.75" tin.) 24b.for Injection Wells ONLY: In addition to sending the form to the address in
24aabote. also submit a copy of this form within 30 days of completion of well
12.Well co.sfrecdon method: OPT construction to the following-
si c.mgr.ratan.cable.direct push eve.)
-
Division of Water Resources.Undergnm.d[ejection Control Program,
FOR WATER SUPPLY WELLS ONLY: 163E Mail Service Center.Raleigh.NC 27n99-1636
13a tirade 11[Iuhhl Birthed 24e.For NA,later Supply I.Inj.rtion Wells:
Also submit one copy of tins lotto withers w days of completion of
IJb.Disinfection ty pe: Amount: well construction to the county- health dcp;rnmenl of the county where
— constructed
Fenn GW-I Noel Carolina t.kpunnria or Em imn anetu and Natural Resources-Division of Water Resources Re.red August Nil