GW1-2021-02360_Well Construction - GW1_20210527

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WELL CONSTRUCTION RECORD FmfrtsmnitlscONLY:
Th6;f®ran con be oxd for siq&or rant 4k mils
1.Well Contractor Information:
44[4zA3rTfF.
Brian Ewing RR M D tPitt)N
WWI Cbafractor°)ante
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4240-B
NCWc1JCoafWorCat1fiwiDoNnnbcr 13'�R 5iOXI it ar ien�t ed sc OR iki►bk
FROM I TO DTAMP.TEtt . TttfCKYES& ]1tATMA).
SASDACCO Inc 0 fL 17 fL 1. ; iin, SCE-40 PVC
ZFROXMft
GtAStNCOR
Cornnrug�Karat
D[A!t£TER TItiCKARSS MATERIAL
2,Wd1 C nstrticthan PCrretit 11: 70002872 ft. lu4
UW o1inppt MNf wrtl penwh 0 r.cmmm sk".:Varialwo P#bcdon a .)3.WdI'USO(Chockwellau):
tit,'aterSupptyWell: FROM TO _Im
n1A{ffP,7CCR" CATS M T1oCKftPSS XA'r IAL
DAgriatltt M t3whmi `�1Publir 17 It. 27 1. % 010 SCH-4o PVC
OGeothermal(HeatingZooling Supply) ❑Residential Water Supply(single) R. are
OlndusaiflUGontmercial OResidentialWater Supply(siTSTed) d8't1itO1T1'•. >. , . _. ; ....
FROM To MATIUML EUPLACM41IN-f UMOD&AM URT
Olrri tion n. R,
Non-Water Supply Will:
' p,
mmonitori != ft.a
otl Ye► n. fr.
QAgP*rRCChrge OCmundwaterReintdidion
fei$ FR M fA1Pf RfAr. r MPt A
❑ f �7.!<f. D
ATO tone and'RCI wi3• ❑$Rliil ty 13flmcr 15 IL 27 (L FILTER SAND # 2
❑AgRifct'1'R:9 ❑Storn watcrl>n imp
0ExpcfimcnM1 TcchnolM, ❑subsidtafcc Conitoi
20« R A`tD1Lrt3 .itftfKM�iddlt3"
❑Geotllenifal(Closed Loop) ❑Tracer FRoM 170 opscsrt=rTox asMr:ner .enamtx' eeG
13Geoffiennal(Hwfi1wrAoflM Retufft) ❑t7Wte(ft
urAer#21Remarks)j 0 ft. 27 tL FILL SAND/SILT MOIST TO WET
fL R.
4.Date Well(s)Ompleted; 5-6-21 WeltInitTMW-2 ft. fL
50,Wetl 1ACA116n: fL ft.
R �
Auto Parts Salvage Yard ft. ft.
i ititq�VDnncr.Namre Fecniry,WA(if applicabkl
ft. (t. r
1118 W. Craighead Rd., Charlotte, NC, 28206 R. fL . y
Pkl deal.Address City.and Zryi 2 t;ttEA ;'
Mecklenburg BENTONITE SEAL 13 TO 15e l CTI' MUR f St}CPp11
Cugefy hrtclldtfluricAftnNo,014)
Sh.lA bade and Unjorode in ftmes/mimategmefinds or decimal dqaa:s: 2L Certification:
ONO field or wor*is Sm lckro)
W Brian, 5/12/2021
5itnd"It of Cextifnd wsil Cdnitamr 'Daft
6.Is(sit)the-weli(s): OPerinanent or ZTernporary th sigma&Aft jinn,I herrbv rerf6'thEf Ahr nrl4ki WO.1 j***)a Wrlftted 7n oatWAt4rr
wfrh 15A A'CAC(J2C.OlOO ar.15A XCAC OM OM C=tmerfon Sowards wjd rlurr a
7.h this arepair"to anOdWogWell: OVes or WNo ropy qfAhn'AmA4s form prm*k!dmthrvnrff~ r
If ft is a repair.fill mr 1ofr kv wrli cowr oMon Olommflan w d exptoin Ov+xrnrrr of the
repairorrderE21 nwwrix Avrr or m the bare of dib form. 23.Site diagram or additional veil details:
You mat°afse the bacb of lids page to proxide additional,)veil site details or well
8.Nomberof wells constructed: 1 constfuctiofi details. You tray also attach additonat pages iftfommy.
For mum a or eras-nvnre siq!pdrIMIJ ONU n Ith Af ufmr corrstrucrtorr.>�core
SURWIMALINSTUCTIONS'
9.Tate]well depl#t belch land surface: 27 (ft,) 24a For Alt Webs: Subfnit WS-form vilhin 36 dn319;of comptcdon of ovil
F'arnwitiekkvits Ulf otiOrprAv comtn►ctiontoihef0ihmng;
10.Stack water level below top of twiny (ft.) Ditislon of Water Res®nrttsi.lnfnf matiotf Pratesning Unit,
if wo"o,hurl it dhove evfrmg.use"t" 1617 MaR Service Center,RAW WC 276"4617
11.Borehole diameter 2.2 s^ 24I,:Ear io iya n ffjQ ONLY: in addition to sending dw form to the addrsss in
24aobom also safbfnit fl-.copy'of Alas form c hWo 36 days of completion of weJ1
1L Well construction method:DRIVEN cmutmetianto the following:
ti.c.sneer,ralsr)•.�b1S di>ccttinslholc.} '_
Divislon of WsterResouroes biderga°oand 7alJeWon Conhol Progaram.
FOR WATER SUPP Y MIS ONLY: 1636 Mail Service Ciattr.Raleigh.NC 276"4636
i3a )t{ciA(gptn} Method oft 23c.For Water SovMj&1njogk «dts L
Also submit one copy of this forth tvlthin 710 days of completion of.
131r.bislntbcitan.ype Amount: vmll construction to the counh•hcgith deps m ut of the countymb=
cottstractod. f
Farm GW-t Meth Carolina Dq mtmnf of Emirnrmm a and Wtnral Resowucs Dn sbn of Alater Reo r ees Revbed AtVA 2013