GW1-2021-02361_Well Construction - GW1_20210527

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SAEDACCO Inc 0 (t, 13 IL 1° SCH-40 PVC
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FROM 70 DtAhtKY6tt T iCY.l4 Ift MAI R AL
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Water Supply lYcil: FROM 70 DIAMRTM 3r trio n MAYr,NIAi
ClMilnicipalli�tbllc 13 R, 23 R, 1° .010 SCH-40 PVC
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DGe4t►teftadt14lAti off Retum 130ther(exOfnllJKtCt# I tn)01" 0 (1. 23 f, FILL SAND/SILT MOIST TO PET
4.Date Weil(s)Completed: 5-6-21 We111D#TMW-4 � (t.
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Auto Parts Salvage Yard
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1118 W. Craighead Rd., Charlotte, NC, 28206 Infv1.f� Don Pro,.ns5Irk-'0 C nit
rat Address-GIt;V.9rHt Zt11 .+�tti 'A - 77,777
Mecklenburg SENTONITE SEAL 9 TO 11'
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T` w Brie Ewi_n 5/12/2021
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6.is(are) lte:ridi(S): t cm►sdent at IDTemporary *ning,h t foeet,1 hereby erfo rhat thin'KWI(J)Kms towml 4,mwnwed ra~#rdfbmee
with 15A NGACOX-01W or,13A NCAC'O?C:4s'#fJ W21J Co ntrwtviae Susr4areta mid#I ra
7.U this it rlepsir to*10 tvi i#i"A well t7Ves or ftiNo sx tAfihir rararrl larsi>Pm Prrnlrktt m> nrJlrnWtrr.
If r*Ja k a r+rpafi;fill oaf baoifw 4Ty r.arxrrrarslmr drrfareaarton ewal aRplobf rbr stran+re of the
r�prir r r 1 reruurlr a7ci a ar ru+A-bmi oJrJlir firm 23.Site diagram or additional well letallR:
Yon dt1.'13 use tllie back of ft page to prrnid o,ad oral va site deWis 0r irdl
8.o f st m ltroeiis constrocted: 1 consafl edoo deta%ts. You may$tso llIitaeh sadd tional pages if necessary.
!or mwi lrinfncrlcni.ar wcsn-»weer agi »ells ONLY atrh the aaane conch we y0&raw
ssibtiietaue fare".. - - $�]#.T►i_ [7T1l�INC,�TEICT'fON�,: ':
9.Tolsiwdtdeptli bttorn 1Rndslirroem 23 ((t,} sen ftr All V his. Suhutit thisjFottn iriihtn 34 dn}s.cd e0u0tet3eJn'af well
1'rrrAWi$e was iffft+rfikrp0mffdtfrr ;example-302Wwa0 @] ) eonanittiontoftfq►towing:
10.Static water lovi below top of ming {►t.) DiVtslon ref Water Resources.bf(Innattbn Prrrcesting Unit,
J/Kwrrr Wei is Amv mishap.am 114 161,7 Man Service dux.Rs►t�1r,�1C:23G49-t8i?
1 t. br Phttle slitfrnLtCr 2-2 5° tin l 24h.:BE Igti�itoai &O ONM In addition to ttg the fin to the zddmss to
24o aboxv. also sttbrWt a snpY Of INS form Vitlun 16 days of coaVlation of dl:
IL N8,,Cii C01lstrpZ1161"foglhod.DRIVEN omna3 cdon to ft fOilol too
tis:teal :rtNar},tabic clued bosh c) Dh`islon of%later Rifle m ms.Underground tnJCCt►crx GontrolTtngl^am.
FOR WATER SUPPLY°WEL S ONLY: 1636 btai!3tiVice Ccnier.Raleigh.NC 276"4636
13a.'Vivid(gpm) lifett rA oftcst: 2te for Water 5apoll do klmlollWelis:
Also submit one cbpyi of this ionic'41thin 30 daysofeemplethmof
13►t-Di�inf on tvyl Amountwell construction to the cormty health do omen of the Count}-,rbm
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