GW1-2021-05694_Well Construction - GW1_20210727

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WELL CONSTRUCTION RECORD Fedor suMUSCONLY:
I In norm can be aged for S ftk of emaU*was
1.Well ClontmtorIfffortnation:
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t4.1trA3Edt 7.ONE5
Brian Ewing PROM TO OTSCRIP170
A141contmaorName R• IL
4240-B << �.
NC:WclitoinractorCertilkrl[on Nwrta VK-Ot1l S mYie YAM()Rlam— pcab
FROM 'M V1.10 1-M 78410 F,S4 MAMAJAl.
SAEDACCO Inc 0 rL 16 ft. 2.25" tn, NA STEEL
i�olnOtaq* at 1 f' !' R tTF .-1:,..'- ._.._.t'Ibced 1" « -,
OM 70 f)IAh1FTRk 77i1[Y.f�F55 MAl1RiAl '
2.Wd{ConstloctionPermit* WM0301134; 70002898 R. ft. br.
Gtt an apptirable writ pamih(i r.Couare.Swe,Variance,IfteCuf R rim)
3.Well Use(eho wch ast): �
Water Supply Wdl. PRO." to ,6101t:rF.R I STrorst$l: I T"ICIOMW - MAnMIA-1.
.004 STEEL 16 R. 20 R
OAgimtai gMtlnfcipOltPubiiC 1.25"'la. NA
>aGeothemtai(HeatingtCooling Supply) OResidendal Water Supply(single) fi' ft. to
otndustriamm"tcrcial QRes�ider>tial Water Supply(slmtad) FROM. ro MATERuis arorPtA ^rafelson fi AMOUNT
131fri tion ft. n
Non-Water Sapply Well: R.
®Monitonn Oltecom
Injection well: rt, t4
1t. icnTi
(]AuuifierRecharge t7GrmindanterRcmed�at?on i . D :: :.._ .
OAquifer Stomge and Reco leiy OSalinhy Barrier PR 1ArP1rlA1, tctia r -rttrn
R. it.
Oftrif'er Test t3Stommfmtcr Draining-
oExperlmcrtal TochnokW QSnbsidcncc Control n.
2tI:DR11�-w.• .� iiiori,�3trtlfs�taii _'
oGeothernet(Closed Loop) OTtacet .FROaf TO otSCRrPIIo+: oebr A.,u a u'tdc
oGtothennal(Reatignaby Return) C30ther , mUntider#21Rentals 0 (t. 20 ft. FILL SAND/SILT MOIST TO WET
ft. IL
4.DateWell(s)Compieted: 7-7-21 A. ft.
50.Well LAICA ftn:
Bill Jarrell's Automotive fl (L
FacOiryewmrName Facility lDNorw ubk)
4830 Old Pineville Road, Charlotte, NC, 28217 F t
Plosisal.AddresLCiQ:aadZip 31 t '7,7777 v,, C.
Mecklenburg SP-22 WATER SAMPLE VIA DPT TOO Cv i 1y�
Caam�• 1'atect tderHtkattau Nb.(Pt1�)
5h.t.ntifitdc soil iwingitude in tl mimrtcstsrconds�r dceimai cf 22.Crrtifteadow
iif mtllt tteM,one iatl14r�6&grditeigad)
N Bria1n Evuirg 7/14/2021
S[smmis of C0drxd WCH Con=tor .DWt
6.is(air)the r<ell(s): nPerntaneitt or SiTetnparnry By A44np der fame,t lhrrel r cY rfrfy.thou for+1rll(s)mir for d csr>,is7 tad u nn,rt e
ndrh INA AFCAC 42C.D100 or 154 XCAC inC.MW Well C*nsMw m&mdards and two a
7.Lr this a repair fa an exiWn well: 0Yes or f>0N1► coppajrhlr rmjrrfhna brcn p mlttrd rn tKr art!IneRe,.
1/thlt ix a reprslr./Rl�rlxroi,�t xmlt rorbsrtuttimi frtfo>sseriw�sent replain;d ie ralrare r.Jrlu
r etuir arafirrb?1 reauarrBs;sricti,fa en aw ttu bait of rMs/Firas 23.Site diagram or additional well details:
You may use the bacl:of this page to provide additional well site details or well
8.Number of a ells t onstry ted: 1 constnictiott detail. You ffW also attach additional pages if necessary.
For mm1W#e lojeer)m or xnvt-i*w gplt wclb 0N1,Y q lrh the inme mmov vapor.war von
selloutgaefans. s>)jmmA#;1NS'rucriONS
9.Total welt depth below#and surface~ 20 Ai 24a.,For Atl Wells: Submit this form within 10 dent of wurpletion of well
For m4dple wells lisr rt!!deptdtr ConStmetion to the foltonina;
10.Static water 1mvi below top ofeasing: M.) Division of Writer Rdourtes.tfturmstionProeesshtgrnit
tf wetter level it a6otY CddnX are"4' 160 Mats Service meter.Raleigh,XC 27699-1617
11.Borehole diameter:2.25" (in,) 24b.For tnitxtion VYp71s ONLY:- In addition to sending the form to lire address in
24a above,also subunit a copy of this form ti►ulna 30 days of completion of well
12.1t't it rorrstrnct{on tttetbod; DRIVEN construction to the foilowiW
(Lt.aapr moon,cable.direct pwkA*-)
Division of WatetReaoutuxs,Ufidergrvrtnd IrtJt:ction Conh»1P009►a1n,
1636 Mail Service Center.Rate
FOR WATER SIJPI'LYi�rEi.TS-ONLY- lp,NC 276"4636
13a.'Vidd(gpm) Method of test 24e.For Water Salrp E&rotation�'dts:
Also submit one copy of this fonn mfitiin 3q daysofconVetionof
13b.Disinfection hVe Amount: well construction to the county health!de mdit cot of the counly whera
constructed,.
Perm G%V.t North Carolina Ucpamoeffl of Ewimmnentand Mrwat Resow=s-:Dhision of Water R Revised Ai gust 2013
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