GW1-2021-06356_Well Construction - GW1_20210915

WELL CONSTRUCTION RECORD Facii�ritnlLlscfJN1 Y:
'Mis form catn be and f4tivigic of rmgtipk nails
y.Wcl CvtitraetorIltt'oralxtion:
Rich Lemire FRO'" I 0fSCRjMON
!'ercll.C�aia��zr h�titit+,' Rr ft.
2593A R' t6
NC Well CardaciorC ilitimtionNw bra 15.U[tTLii`#I L iii0 rRiu i del:t Fi OR3 LIi R i$ iic bk ..
FROM 70 DIAMETER 'rlttMl'IL% MATURTAL
SAEDACCO Inc 0 ft3_ 4 tc 4" ! m. SCH-40 PVC
Corniirap•.t�amte i6.;il`17yEB�I' �"ipH"771�LiIflt'#� ih��n'ai�6Gcitd� ;
FRQA1 rre DW**I TER.: TInCKNFSS I MA ERrAL
2,W41 C+inv.tMCtion 1'cr[nit 70002060 tt
fisrrrtrrzy�a`P6rwlplaurrilfreiarafs fi_c.Gnx,�ra,Stira>~;t�rinmer:Tr '[�rd vr�.) °fit> ft:. ' in,
3.Wi 'i,lise teteec3,.wci1ciJ1>srilni Water Supply,Well: - — — - - FROlN: 71? m1Atl 97taIt' 51�]TS17i 'I'117t'YCNat5li MATRWAt,
® ltnrai i lvittHici llll ttbiic 4 ft, 14 fu: 4" in 026 SCH-46 PVC
06e OWFUlsl(lieatingtooling Sul plyi bResidentiol Water Supply(srng1t)
C31industrial(Conu timial DSesidential WatcrSuppby(si aTed) Itt_UR0>?P..
.FROM 4-6 MATEFrt!tt FtIiPLAC'EMLNT A1UMOU A AMOUNT
01ni' Lion fl tt
Non-wato Supply Wolf:
17Moauitorito p�Lactut+c
Ixtjttiioit Wett: rtt �
®4gali l�r ldCclaar�ar 04if iLlit(9C9a icr Acniodi•Alon At1$}71ih1�1,fiTL�i__ "t +f (it
PRO, i+9�iFgit]�i Iipi1 -.
�1At4tti r tau i, and kc�o M&Ilinf 3%bartiee
3 ft. 14 it, SAND� ll2
❑ ItCfCr ICSt 0*mm`i76cr 13r tolgo
OFx{aenmcnhl Tochnotogy QSnbsidsaicc C.,ontml
20:-tIR:i1;�i�G�iJCi{3,fiiiitych.li4ifliillinn`�"i�6h�t�ifaecrexs�ai�= "
❑G50thermmrl`(Cin Loop) 37 rage Fxa�r aro DsscRlF ao+ +,haidntt+ati, 'nk m Nr
❑cibodrerrml atii i 0 Rerun) 00dier(ngain under#11Ikewatt) 0 ft.. 14 ti. RED SILT/FILLDIRT
R. ft
4.Date Well(s)Ctuflapleted 8-11-2021 WjtjjD#VEW-19
ft. tL. �.
Sm..WelllAication3 M
United Parcel Service tit. ry
Fay ifflyalDR,mrNa m FwdityjD#fif licnb7sj ad
tt
1600 Cottonwood St., CHARLOTTE, NC, 28206lt�is ticrssCi PeladI .amdZipn _ , . 77
ryy .' QVV
MECKLENBURG 07714104 CONCRETE FROM 0-3'
Sh>X tpiic tlnCl.t tinLril tide inti tal111irtii iGsd rinds or*0mal 4Cgrpc�: 22.Ce tifkation
(if u�llfi�rd,,cm I,tt ldr is iitt3i lEtil)
]4' yW 8/15/2021
917S-1;e r—ta cem _i clj C�mlrmtni Dana:
6.Is(6trel tht well(s)t EPi".cil Anent or 01fe porary al id that.' f herebV rcr' thin ME�t�l��!errs f4'&�l�rimebmered 6rc-arcY�r dernce H7' � 4 a}A' �•.
wirh'IM NCAG 0 C,OffRf o,'IJA aN€`AC,O +G:02M Wee C'ni4omrk"i Sm adods awui.rim a
7.Is thiat a repair to an titi:itfri}+well., PVC*' or K-No cayica}'rhas mconf&ra.Nem P'WVT n d rear carir*sIimrr,
if rh&ly'd repa►e,J'AW o"r b7#40 1041 crtr rarertorrdar}grnuefkrrr a mf rtiptahi the rarrare of the
;r rir dered'er0-1 fie r-ejo u xmiiam Bran the heiel of fhi*prAt: 23.Site dtagram,or,additional will detaiiti:
Vaal may-
flee d lrack of this Oje to jiroti�,alditi al ct�l site details.or weil
8.Nuolber of weM constructed: 1 e`onstruetiou dci its. You ma'aim attach idditiatial s if imessa,A%
Far maldp4e ittWiian or nail-wntie *writs ONLY atdrh the sanir cmrtstraactaivr,,yow om
avehmaf cx>r foray: suBAit ftAL tf tsTtif"Y1m'
9,FP.,To0tlali$*dwtvdUseplslti beepwOnla inddWt-rrefva(oeemm.
iat 4 2tktl"aW 2@ 10100 CBS) 2onstnreti All WehotiaiSitbi t this forto iAthin 30 days of contptetion,of'%v11
Itl.Static water level below top of casing: NONE ABOVE WATER TABLE (tI.) Division of Water Reso rtes, Unit,
If*dWrfevefkvaboi eoTdiip,am,„+° 1617 mailScnvieeGofer,1&1rrimhtNV2't6'3')-I41
11.BtlrOoie dlifineter.l0 5/8^ (iu,l 24k Ear )lWUA 'tLi ONL,V In addition to sending the form to the addtu ss in
24a above. also sarbni t a copy of this forth within 30 days of cotaipletion of mll
12.Well conAmption r etbod•AUGERS Construction to t&Po:llocwing_
b.e.stt�i:rotor}•:cable.direr persi�cte:)
DhIsion of Water Resou es.b riieri I ound tttjei3�6"436'ih(m Control P`rogtaattii,
1636 Mail Scrvlce Ceatttr.knit 11 Ni
Ft!]]I'VVMA�R SUPPLY WELLS ONLY: �
13W i idd(gpm) Mdb04 of test: 24c.For Water Suelti3&Imetth ybetLm
,also sdbutrt one 'of this fiimri v6thiir,0 da•sof Completion.of
13ii.[liz4iufce#�in twp Amount:
mmll camstructidn to£tte county hcs th dcoanwof of Cite fminh,when:
r�n,5tttacRfxlr €
FennGW-t tdet°iscd Atgtnt2l►11