GW1-2021-01246_Well Construction - GW1_20210209

WELL CONSTRUCTION RECORD C�{�\ Far lmmWUse ONLY
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I.Well Cmmtneter IoRNasadem: \
Zach Thompson "MOM TO
Wd CONUKW Nam R. ft.
4478A E. a
NC WC9 Comna m Casiflulw Number ' •�,� � _
SA®ACCtl Inc 0 IL 55' IL 6• 1a SCH 40 PVC
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2,WsD C4ftpawpya p"Mk p; NK0301093 0 OL 74 II. 2• 4 8CH 40 PVC
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WSW SupplyWA: 74' a 79' a 2• .ia 0.010.. 8CH 40 PVC
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0 0 IL 69' R. Portland TIemie
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m Ottem ti a
a IL
OAgaife Rrcbefge oo mmdlmle Remubl i=
❑Agmi6a SNmaprad Raman• OSalaayBvnw ,.72' It 81' a Sand N2
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OCeArmal ftwqKoWim Rem) 00dw Wylims lade 021 Remade 0 a. I IL top soil
1' IL 55' a tan silty sand
4.Date Weft)CemylklN: 1/20/2021 Weft M#Mff-Bra-B22(n) 55' a 81' IL rock
5a.wen Leradom: a, R
Electrolux Rome Products Former Copes-Vulcan Fac lity 0. al.
Fad)game Near Fw ft mr(if Wplicdkl R
1099-001 Spruce Street, Charlotte, MC, 28203 a, a,
Plgad Adbew.Cip.wdZip
Mecklenburg Sentonite Seal from 69'-72'
Comp Pmod MrAdkmrs No.(m)
5k L *mdr and Linglmde In deRrmhdombatremm4 w dedmal dW*m ZL CerYRntlem:
IIf wed Belt rep hdasa is udSekal
35.219519 N -80.870194 w 1/22/2021
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You may me de beck of do paps is panicle aditiod urR so dmit or well
S.Nmm m of wells raarlreemd: 1 —.�—,y-y--deodk You may ahw much sddtaoad Pope if wcrnay.
Fw.ftw*+(Av*e,w mw-wwrr+m4'h wwh ONLY MA IA.err 1.M{�
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9.Taal well depd ielew Ird surfs.: 81 �: .I. Us.2Ar AS Wetlm Submit dos farm wW" 30*%of oogl:bom of wrll
For aedeilr Rrdr Arm as drp*,4fdOrm,frmwwM,JQ.00•ad 7P 104 commmake to de foll"O 6:
16.Smde wafer lewd helaw up of mbW MA IRI Dkkbn of wow aewrem bdilmalom FmcealaE 11e16
If awe,kwf n 1617 KO$mice Cade,Rddgk NC 276WI617
It.11mvink dhrehr:6• Dal 24k Far Medea wells ONLY: In ad&Ws to aemdi g de foam to the addtml a
24sabm'e. Am atbmk a copy of this tots ukhm 10 days of complaion of"I
1L Well OMMUdam Mud*; Bored/Air Rotary camtmetlw In the foiowba.
41.C.sROM rM*y ably 910d pmk er.l
Dla•6Ym of Wane Rewmrm.Umder¢mmmd hJ[etiam CaatrN FrOEru,
FOR WATER SUPFLY WELLS ONLY: ifim Mum Savior Ctow.Rddgh6 NC 27699•Igi
M Yield(ipm) NOtbod of let 24L For Wane SMeIY d leladom wens:
Abu a6ma our copy of this form wubm 10 days ofcomplaiom of
12h.Dblefetbee M m Amrume. well comauction 10 the cway bmkh depaamml of the marry alum
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