GW1-2021-02366_Well Construction - GW1_20210527

WELL CONSTRUMON RECORD r�lt�nm)tlaxot4lx:
14ias rt/Frt�cun be amd for sftk or multi*rmUs
1.Wdt Contrwaor Infonnaliolr.
Brian Ewing FROM TO I D : FIVION
AWN coltmClor i'lam R, ft. p
(L m
4240-B
NCWd)CdimdorCcaifrcanibnNarithe 35+f) ti<1Q. ah""illfated` a {l1 #r�l[ b1e"t
FROM TO DTAAII T[tR It"CKWUS I MAUNTAi.
SAEDACCO Iac 0 fL 10 ft. 1" in. SCE-40 PVC
Cemncln}Natnc 16.Z' t+TG OR„ IteG f►eYiNitli
FROM T DIANIMR TIIIC'FMTM I MAUMIAL
2.Wdl oIn;itrt e*n t erMit#: 7000z87z ft. n. 1n.
Um 4di oRpt-Nf-41pemelts lie.County.SU00,Variam'e,*#kd9n eri^.)"
R. t1.
3.Well Use(ebecimell use): t7
Water Supply Wdh FROM TO VIA prX RRW T•Y. noc'Kp m ATMIAI:
Oftri ultund 0Nhmidp;fl1mlic 10 ft. 20 ft. 1 im .010 SCH-40 PVC
mtrmotitetTtral(IieatinivtDoiing Supply) OResidetttial hater Supply wngle7 ft. ft.-
DtndustrwOom"mial DResiftntial Water Svppl}(shared) Ia:�ilit7Al
FROM I TO MATHRL1i. 1M1F1ACFMMMMOo&AMOUNT
Otrii Lion ft. d.
Non-Water Supply Weil:
mmouitati2aDittxoti. n, - -h.
Injection Well fL
DAegitft. Rcch,irge G 0mundwaterR mediation 't9 i►�l V k
D Ifcr.St a and Rc qv", t]5,0114v.8arrict FROM I » r F PIA ,iFvr . H »
8 ft. 20 p. FILTSR SAND # 2
0Agn'rfer Tess DStommater Drn nage
DEVCrimrntal T=hnotogr ❑SA Rd=C CCI*Ml-
'aft<:1)RTIr1.1lti `{iiltifie`t+ i iri►ltr sdti� ' >� .
DGeodwonal(Closed Imp) DTram FROM iD DhsctntTta�osbr haNn taohaek' +rsr
DGeof iennal 0tea1hWCwlJM Retnr) E30dw lain under#21 Retuatis) 0 ft. 20 tL FILL SAND/SILT MOIST TO WET
tt. ft.
4.Date WeffC1)Completed: 5-6-21 Wdln)#TMta-3
tl. tt.
So.We"Location: fi ry,
Auto Parts Salvage Yard tL 14
i W1ftyKM'mrNsmc Fmi]ity IN(ifeppitabte)
tt. ft.
1118 W. Craighead Rd., Charlotte, NC, 28206 {t, h, v �
Ploaxe)Aaf =s Cite.and Zip 21:-W,
Mecklenburg BENTONITE SEAL 6 TO 8' y n^vr1i;3 tor) t roC SS lrl. Unh
Coaany patto Id rHifimi on No'(P4bt)
Sh.W tude'snd 1t nOtode in ftnalmlootc0sm6nds or decimal dcgreem. 22.Certification:
(i[aell tkK orK l to CF S+tflltittA)
>, W ,elan f wiU;,,g,a®,,� 5/12/2021
5*x n zm of Catifmd WcO Conrmctar _.Due
6.Is(ar*)ihr wdl(s): L7Pennanent -0r MTt:mporaey 4 gpink etch fora,I herelr4 ttrrv'e that the*kt )softl+�')omffntemd im'& Ordm tr
oath l SA IVCAC i01C.111fV or.l SA ri'CAC 07C;QZM%41 Comm aim SwWdW5 end Amer a
7.Is this a repair to an existfnp well: oYes or mNo ryM of d1 r ream hm bem pnwk d ro hr .nrll aaowr.
If this is a f4rdr.fm rat p wik"wall coamm Thm informarlon 4ml exptain the jrormre of dv
repair tomfor#21 remarksxe um or die back of this fo►m: 23.Sttt dtagnm of ltdditibnal sCdO deftitsl:
You may use the tact of this page;to pTVYide aditiottai well site Needs or well
8.Numbe rof cells aottstrtreted: 1 axer>sttuctiottdetails. You may also sttlaehadditional pages iftWessaty.
For multiple lnfrrtkvror am-waetw jWp ly`wiltt ONLY xtrh the erne conshvrc4m.ibmem
sadotftowfomS, iIII1I11TA[INSTCtffi _
4.Total wdt depth btj0WLLIAfjdLsurracft 20 {fk) 44a. For All Wells: SobTtdt this fort atidt#n 30 dpys of comple6ou of nrll
f sir m iNENr itarfla ilsr ofi d�ysaiar,Nd crept/cxnr+{pte�3 diKr`earl?mil )} cwmStmction to the•folloning:
10.Static water level below top ofemlor. (1},) Di1'ision of WsW Resouttt&Infotmat'ron Pmces ing Unit.
I/wear k et h dhove cdang use"+ 1617 Man Sen ice C616w.Raleigh,NC 276"4617
11.Domhole diameter:2.25^ (ln? Zdh..i r lnftrtion Welts ON1<.Y:,'fin additiori to sending the forni to dIw a tess in
2466dw- elm sulbrNl a copy of ithis fomt rtthin 36 4s of cornpletion of tcell
IL Wrdl constructloo ttlahod:DRIVEN constmedento thefotlowiug:
(it.au�rr.retell:c�bi dins pus1L eae t Dh'islon of;aterRt�ont*cs;Under and Injeclltm Control Piregramr.
FOR WATER SUPPLY WELLSONLY: 1636 Mail Service Ciemer,Ralefth.NC 336"4636
13a.Yitdd(gpm) mcthhod of ttt Zia For Water SvUAX di Idection Wells:
Also submit one copy oftft fotjii mitbin,L10 da}'s of.completion or
13h.:0I%1ntbWonhpe, Amount: -weft construction to the cotmty ha&fth deptirhnent of the counh whem
constructed, j
Fong GlV-t Nofth Cwalim ftmi vo of Fmimman t and AlBWW Rewnrors-.Dh*&n of Wsta Rmrms Revised Atitg d 2013