GW1-2021-06366_Well Construction - GW1_20210915

WELL CONSTRUCTION RECORD ,For ti9cflml Use ONLY: j
This rarin can bc,u,;d rxsirglc&adtivk weds
1.Well Contractor Intbrotation:
Rich Lemire FROM tlt9�ktt*ttr3�i" i
A14111 CootratAIDT Naming
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2593A
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NC Well Contiuetrsr lniCtion t isurii
t&I0VUR,CA$h1G a uFtlea ei'ideH�ORMSYR; TiraE�ic
rxxowl TOt�AtF.TEtt 7rtItGK. r MA7ERtAL
SAEDACCO Inc
Ccsngstitir tiamr 36..I`N,yEit G+DIi 77FBlt�� fb�iim�l�Jri€cd-i4ii
FROM 7t1 DMWUR 7111CK ESB M.IiE?tleW
2.Weli enitivition 1'ertt'r9t s: 70002060 0 4, 21 ft. 2" Ift- SCH-40 PVC
I.i€t,ali,e n'iirt to rselP Irr.�nn a+s(rrr.>Crku�rry.Sfir�r'.;-t�iariareeX.TI*6cn orb) .
23 ft 25 k 2" SCH-40 PVC
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3,Wet],Usc(Clit�:el:wii:11 t7 SCtttEN at
Witter SupplyWd1: --- - -- __ Fr:t),a Tt) :otANIPa'rn
stA7'Str� 'tt'Ir[lChlS$ 3flAxRn7aa,
D "' ltimal n1v m ieapa.VPUblic 21 Ift. 23 fir 2" lim '.616 SCH-40 PVC
tithernial(lfeatin olin Si lul DResidentiisl'�Ater Su ft fr )b
CIGe tpp �i�'(sirr�lel
0khtstriavconimcrdal Residential Watcr'Sii
pFiS{sty) FROS 11 MATERULL -Eft tAC rtlrtTatstHOD&ANImrrer
D1rti tlpn 0 ft. 17 k PORTLAND POURED
Non-Water Supplyy Wall:
Otvlonitorin l�ltr�0�� ' ft, ri,
Injection Welt - n (L
L�rlgdtrfGrGGliarrt �CicorindrtGrRetrtcdianon19,,SAN6Pt�ii1, Eli• .' l $tdtc� :, t.,
0 dfi<r,Storr G£nal R,GO'� 7s'dtdni Htirrdet '��RI?lkf ,16 Ydf L k7Y3�d'�,.A'f'4`,�'S'dl'„VZ' id(�i9d
' 19 (t; 25 ft. SANDI #2
l7AgdtiferTest IStcdOrmatGrbAe ngc
OExperimcntal T-cclutology OSu11ja lfrtcc f antral
3fF,�Itt211i1"� UCr`faiiseir~aaiiiii`atfa't�ti� f s�dr�3
t7GeotltemW(Closed i oepi EiTnicer YHONT TO MCRIrtlOI V*br.hArddr. *IWr"&opt.,0451i*--II k*.)
gGoodiermat ffodsW 00dier.0 aitt under'#21Itematlts) 0 ft, 14 fl. RED SILT/FILLDIRT
14 (L 25 (L SAPERLITE
4.Date Well(s)Complet€d 8-10-2021 Wdl jp#ASW-71
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.r+a. rcll LtlCato+rn fL ft,_ t i
United Parcel Service ft ft
FwtiWo0wrrcrNmac fscilii>7D#t E l">cnfila) fi fi. 20
1600 Cottonwood St., CHARLOTTE, NC, 28206 ft, f4"
..Dins veZi�
P7nIkil'A'dd.ss City.wd Zip lit"EhlAtrtl b •.
MECKLENBURG 07714104 BENTONITE FROM 17' TO !19'. �i3 pis ®w�5� '
Gosttdb, i?arma jr 7iM-jIIp.I140,(PIN)
5b.Wtirtle and Langiitiade in.tic sfm ma# s er nds ttc i al dcgr . 22 i eiYi#rcat on:
(if urol W4,t�sec1,10 ngtt'fiidf3 tYi}
a W
8/15/2021
sigmtti%pfC2ati' Well GoTt tos„ I}aie
6.Is(sire)the:wefl(s). oPeernianeut or t.7Temporary Btr#grim,dY'iu fopff I trereby rrrt r'rhar Phr md4Ix)rmr fiitr)rwwmmred is wwrihmr:-e
,-dy i'I5x1 NCAG 02C.(I M or MA NCAC(P-C,02 0 Well e.6 morriedmi SraWelyds and d aI a
7.is this a rcyrair i(t an existing welk 0Y0 or KiNo ropy Of014 rrrO'nl hos d ron p gwfolc,f ila Ar,wil rnvncr,
If(frtx h o repair,fill r,"r A"44M y4l cmjonft*i M,brorrurritivi Md"Plabi r ie ofarerr of rfir
M#.ilV dIril irreer&ssfcJama.11W I&hmri Ofthh-fgrut 23.Site d+ap'ani,or addi'liobal well deuW _
You nay itse dl bar ;bf,this Page,
proR7de addipt►tial well site details or well
$.Number of wells constructed: 1 collsttuctfon detain. Ydu quay als�atlach atidiiti6hal=ems if ti cessaly
For airaslal�!'c isrfec'iivn esr-gaii-raxtTfP iZtr ra'rtls flriVl<Y ii�1tA rFir?.sasr(C c+arrs(r+rrlt�ur,yc�v+can+
aarlavrit,rur fnrrra. suil"htrCt AL If4`PsILICTIONS
9.Total well depih below land surface: 25' (ft,) 24& Fbe Ali WellSubunit this farm txithift-10 days.uf completion of vmll
For,arid iple i�pfzrfl P alld�ahs it +rna fesoolbte-3@?t7 *aiul 2@,IWF comanictioh to the f0ttoning;
10.Static water level below tip of casing: 15' tFi.l bh°Esitrn of Water
R P Unit?
If*twtrr kvr 1617 hxn Senixr,kalei�1,i NiC 21699-1617
11.Borehole d amctci-8.25" (in) 24h.jar,In tim ONi,Y: In addition to sending the form t0 the address in
24dabove. also submit a copy of this form witbin 10 dms of completion of treil
12.Well VoIlStrttction uMbnd,AUGERS Loostmetion to'd a 116110*iiig:
ti.c.un c roisq,ruble,dind posk ctc:)
Divisioit of Water Rcsoure6i.Ilnderkround inieciion Cont►olPrograin,
WA
TER ATER SUPPLY WELLS ONLY:' 1636 Wil Service 6,11der.Raleh;h lgt 27699-1636
13,a,titld(gpm) MctltrA of test: 74c.For Water Strnnly ak INectum Wc*E
Also sabiiiit one copy of this firm ulthin,30 da}sotcompletionof
13h.bisinfeciiini type- Amount`:, �tc9ltit department of the caunh where
con l consinrctran to the cormty E
Farosi"W-1 Ntoab Cwolim l quaitteat of EnvironErta assl NoraxW Resoums-1`tivi ivuofAlalcxR utts RemisedAigWA201