GW1-2021-06354_Well Construction - GW1_20210915

WELL CONSTRUCTION RECORD Fur inWrnnl Use ONLY: �
nfs faun con be uaod Car single or a ti ltiglc wells
1.Well Contraetorinfornration:
lk AVATE1-20N LS
Rich Lemire FROM -M DFSCRIP11ON
t'r!t C®tctm Name
2593A
XC-WellContinciorCcnifeotionNwnber 15..OUTER C`MIN0 orPnolikskil rrls'ORLiM- (if eable
FRO31 TO DTAM ETBR THWUN&fi5 ATATERTAL
SAEDACCO Inc ft rL
CdaV Y'.'Nanit 16:INNER 114,s!Tti OR`VIll t "`.iheMat r:bor�e da
ut 06
YROAY TO DIAMETER. THICKNF.58 MAW-RYAL
2,Welt 4Cpn.tivttion Pcrinit W., 70002060 0 R, 21 ft. 2" ItL SCH-40 PVC
List oft rgy}ntirrlkr.ur41}rei,tarr Pi r.:Cnurtr%Strrar;Variance.lrbsdart em-:J
23 ft. 25 fL 2" iri SCH-40 PVC
3jFad1 llsc(F"i well use): 1F>SCRI fN. U
- - ---
Wker S-61-ildy MIMI: FRooil I TO I D1A11i iTr,'R I 0-A)TR5Y�r 1TIIICKAFtiSC I stATRRiar..
ClAgrcultu al inm6idipallmlic 21 rt 23 A- 2" U10 SCH-40 PVC
DGeothelntal(T3eatiu oolin SkTppty Mesidenfial Water Su
®TndustrialfContnlelcial o esidential Water SupplyJa GROUT,
(m�) FROM TO MATSRTJIY E1rYPLACI frYRY F 111SRIOD&Ah10IIN1
016ioRtiOn 0 R. 17' fL PORTLAND POURED
Nor,'M1'Ater Supply Well:
❑MeRi#ttrintr QtrD*c R,. rt
injecl(att Welt: fi. rt:.
0Agtri(crPccharSr C1(`ir4ntlittPtcrRculcctixtion t S+►Nt11CttA_. rf--Azx I Ircrbt
FROST r'-_ 11YA7fi'RGAl. 3VfPY Af i XYt 11T lwr311013
1JAgrri(cr.Sto mgc and Itecat ^ I�Salinily Banicr 19 ft. 25 ft, SAND' #2
l7 Agnilcr Tcst OSteamm'ater 1)-iafi iage
rL. rt.
bExpciilncntelTochnotogy t7fidasidewcC-bistml 2ti•n- ft. ft.
ibnal sHcdsif iicctssari'l
OG:othennal(Closed Loop) ❑traeet R011%1 To DTsSeNrr't1O�t»Bn6atrOncn stit'lrrckiF tf 4in tdt
0Gbothernnal(Flea b DICooTLt Mum) 0 ft 14 fi. RED SILT/FILLDIRT
14 rL 25 fL SAPERLITE
4.Date Well(s)Conipleted� 8-12-2021 .W'elllj11#ASW-80
fi. tL
i
Sx:11r[II Lneativ►n: ft
United Parcel Service ft f4
Fosility/0-ivnerNarm Facli by 1D#(€appikmble)
1600 Cottonwood St., CHARLOTTE, NC, 28206 mAV
ft, fi, Luo
Ph55rcal. ddcess Cat<i nrld Zip IL REMARKS:, Cl
pq
MECKLENBURG 07714104 BENTONITE FROM 17' TO 119' . sAO'�CC'-�;'
�a
Cctrtlri,+ (PIN) v v
5b,11,intitatdc'and L.rinkitude in dcgrscshninut61sccon4ls or'decimul tlM- = 22.ftietfificatireri:
(It,nii;t"K It1,tore Lttflcr dt trcttYe#cltll
R qt _ v.G� 8/15/2021
sigmtdm ofCeitu 4-d4ell61n=tar Dais
6.Is(arel 1 fe,well(ky Oftrmanedt or oTemporary sr nlii Alt fipm,l here&y ce duat dar melt S)ims(ttrrrej mmanreted nr frwmidmee
rw h t 5•t VCAC.02C.01M nr;t J AFeAC 03C.02M snindardt a n dam a
7.Is thL%a repairio an esi5tingvclk 01'es' or KNo p<>lrrttfrliit rrcr+trl time lima pmrirltvi erratie r1rrJ,u^nrr.
lf;h1s'1x a repair.fill ow tcwusa ioell eamam"foa brformmfi6m amule_xpfab1 the naroure of rile
reMir amler 01 rnnarks sieicxir9re 6rexi tht!hrwk of Otis form. 23.Site diagram fir Hdilitmnal N',ffdetatts:
YMI may the the Lack of this page to pfavide additional well site details or t^ell
8.Number of •ells constrltt-ted: 1 consituction delads. You may also attach additional poles if necessary.
For mtdrde In jeer".1 w•ruai-trraver SWI*irrtts ONLY itdrlt the same-coir*acxlen,Sv*ii eam
anttxstiataurform: SURNITICIALINSTIUCTIONS
9,Total lydl depot below,tared alYiocc: 25' 24a.Far All ►Melia: Satbrnit Qt:s farm tiitbin aft days of cbruptedou of Ivell
Poe rrraPtnnla i.etfs tr';retlircFdrs riot pi rr4lx(eafm+al+ 7�2171t` 26�1 ) con-anictipn to tits folknvinZ
10.Statue`outer level below top of casingn 15' tR,a bh,ision of Water Re4-adrtes,Info natiba Frocessine Unit,
tf snorer to vt l is above cvsf0s, "+" ld l7 A1ail'Ser ice Center.ltaleo,lYC 276994617
11.Borehole diameter:8.25^ (ia) 241.Fee inlerHon Weils ONL1`s In addition to sending the forni to ilge address in
24aaboVe, also stibmit a cope' of this form within 30 days of completion of well
12,Well construction method.AUGERS constrde lon to the follavi irk_
(i.c.auger.rda>}."cnbte diw poste eie.l
Division of Water Tiesourrec,tnderground Inn mho Control ProgrAin,
.FOR WATER SUPPI Y'W E LLS ONLY: 1636 Wit Service lbeialer.Rakioi.NC 27649]636
13a.1 rcld(gpm) Mcoind of test: 24c.For Water$RI►_(y&Iniod' n Wells:'
Also submit one cts , of this fiiini %rithih...30 daysof completion of
13la.Llisinftx nn hlsc.: Amount:, cnnstrttctrd. y pertrnprt f t11c ciiilnty,u4ltexs vv^cll constmction,to 1Nc catmty health do
Fenn+GW-1 North Camlina D:•,7xmmk-ni-of Envitalmwin and vnnlral Resources-Division of R'aiC0esoMx5 Revised August 2011