GW1-2021-02431_Well Construction - GW1_20210615

WELL CON&TRU ON RECORD �' Falrtsatgrluge{11?ty;
'Mis fem can be used fall ai rgk OF taa Ook was
1.Well Cpnttmxor intormotlon: ° ^
Brian Swing DFSCR1"1pY
W41 Cottmtw Name
4240-B ��aCr�e�CJl\G R, tL
NCWaCommor.Can fffcatlon'tim*a "owl aR, ii rwiu[ti+anxd�It t'Idt< _ tics ;' ..
FROM. TO [IE4brr;TF.R 311IGKi\'F,55" MA7EAIAL
SAEDACCO Inc 0 ft. 18 to 1. in. SCH-40 PVC
Cen+peryryt�lame tif.11V3 ,. l+f(1?OR-T9T131{3'G� ,_ >Dtlnxeda, , : :_: ': -:. .
FROM DrMI TER 'rnit 104C$S MATrMA1.
2,`/i'�tC�nssh�f+lnPee�nit#: 7000zsa5 R. R.
Liu ofl oyiplirvt63r ur#In+eitx[e r,Crmnh�.S&ar,Vnriue.ICrion etr.)'
R. R. in.
3.Wdl Use(elecktvell ose):
Wader Soppy Well: kRAN I TO _ DIMMKTRR I SwTsym I "ITCRNM I MATFRtA1,
D>V5iumpammic 18 ft. 33 R. 1° im. 010 SCH 40 PVC
CGeothenazal(HeatimKooling Supply) DResidern ai Water SUWIY(sit>glm) ft. (L 30
Olodustrin]/Conmemial L' mdcrMal Water Supply{Marred) t1°t#i1ODf ;
oM Tt1 31fATBittAL tFt,A iL1T:VtSrirOD s�nMOtner
Olnivotion
Nora Water Supply Well:
mmonitod 17ii€coc
Inject onwen:
DA;p0cr ltechmc 00mu di ater ltemed atiorl
eRMAXIMAL
DAuitcStat�andccove� DSoll"Banicr 16 f, 33 ft. FILTER' al rr n
SAND # Z
DAquffar?'cst t}Su1mm ltmrhrRltclgc
O elimental TmIM61ogy DStfbs deem Comml 2P.I)R:Ifr1M 6'laDt1 tttiicl*#dM ' ht WU;;;;;a W1 1r
Mmthemtal(C.lasedloop) Ct?Is rRiJM a ats a cot�r.#sro ,nau�,rx eu
CI'Geotheitnal eafl of Return) 00da(OgAgin under 0.21:Rematls) 0 M 15 tL FILL SILTY SAND
15 ft, 20 A. WET CLAY SANDY
4.DsteWell(s.)Qmpleted: 5-27-21 Wd.ljD#TNK-1 20 fL 33 (L WET SILTY SAND
54,Well Location R, It.
Touch Down Auto Services th 4.
FnctlkVw r Nam FhcH4 M#(if applkablc)
1022 Woodward Ave., Charlotte, NC, 28206 fit R;
P4 l AiMmss.City.and Zip 2"17MOR S 7'. ,
Mecklenburg
BHNTONITH SEAL 14 TO 16'
tote Pates 1�rrlitiratlora!`ItL;1?t4e)
5h.L#ftde and Ungffadc is dcgnreglmJnutgalscconds or decimal dcgrmF 22,Certifcgriv►n:
(it well OWL-**boom_ig sidtl ko) �r
11` W ,��_B1 i n„Ewi"6,-ner 6,7,2021
SigrA offuufcQ Wcii faniractot Dose
6.10are)the weli(0- CIPennanent or mTemporary yx drirlc 174gmrey wrtlfp rhtirthe.$arll{v)awtrlwrtir cernttnieterl in-oie rdamtre
with 1JA MAC 02C.01M or 1SA ft'CAC 03C 4200!ti 11 Coitfftmsw an Stmfsr&andchate
7.ht tbiR a repair to.an rMsting well: Mts or MNo s of ref �f+ramml Arc a.rn y�rrvtlrti rn Mir xrtt r x�i r.
tf tlkfx ix tr te�rir.fct7 rat krnrr�ra uuiiroaurusrfaro f�'armMrkur mrtt fEeptadn tkenmrarre raf rlre
nMitr aWerf2l rma?a;s r mn or as du hurt of fhfa form: 23.Site dh►gram:or addltionai well detftf .,
You amy use dw baek of this pap to pttltidie.additional well site details or mail
&iNomberofwellsconstructed: 1 consttuctiandetail-. You May alsoatiaehadditional ops iftxeman.
Form[tf�►r firferakar or°nti�-o+orer su,�)�»rfls r7�i1.Y�+�ttArJ�acme tana(rnr�rt,; can �
en6onbt txclonv, SOMtTTAf' t^T=
9.Total welt depth belolr land surfam 33 {() 24s. Phr Ali Willi: Submit (his;fool(ntithim 30 des of Conviction of mril
Far+ tti lr>ocHs drxr retl deptAr tjdiffeteat[erau#tc �2tM'oral 2 11fk7) cS nMuction to the faiitnring;
10.Static water level I elovr top of ramp (ft.) Division of Wfiter Rem l reel.Informbtiou;Protesting[ink,
If vnaW level k above avtAjt. `t< 1611 Mail S&Occ f;rntgr,RalcW NC 27609417
11:'13g1rhtrte diameter 2.25" (in.) 24b.Err tntcetiea Wctts'ONLY. !fin addition to sendingthe foml to fta ddnw in
24aabove.also Math a<copy of this fonn`within 30 days of completion of mrAl
12.a`ell tanshlaction mobod:DRIVEN eousuuction to the following:
(i.e.mpt rolaty,cabft dtw VmIt tic:)
Dh'ision of Water Remoires,UndeMmund Injeetlod Control Prograrm,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Stmice Center,Raleigh.NC 276994 636
tie.For Water 5alrpil fie tnjcetiou'Wefls:
13a 1"lefd tppm) 9►tetho+!of:tesk
Also submit one cop} of#tus torn lrithin 30 days of cor>lpietion of
fib.D-1.4 ftfee on type: Amount: Aveil constnrcfion to the county bench depar'tmmm of the county-obese
COrrsJtmcled.
Fanu G1Y:t Notth Ca mlim Dqndmid of FjMm=xfd and tyro tai Resov=s-Dh-kicu of%law Romrom Revised At VA 2013