GW1-2021-06358_Well Construction - GW1_20210915

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WELL CONSTRUCTION RECORD For lmcnml Use ONLY:
This fortitcoin be umd.rat sitigle'cr midtigk wells
1.Well Contraetor.lidormation:
,14.,XI�ATER R� k
Rich Lemire FROM rt) dFSCiiiPTpi)S
well comma to NAB
2593A ft tL-
NC Well Contractor tSenifirntion Nnm6es 15.OCiTER CAMN0 010jinghl4steil I P5 ORLINF.R([ a°iklk
FROM TO M%MFITER T TrlrCKZVF R5 I MAMIAL
SAEDACCO Inc 0 tL 4 iL 4" 'In. SCH-40 PVC
Camq�nar t afar 16.1' :A91,Xt'.OR`TUBWC i mail tkystd,16g_
FROM TO DIAMETER. TMCIMESS I AlAiERLAL
2.�v. + +ntrtlonrc?nt : 70002060 rL n►
lru pll.rgilrntrfe w�rtllrrinri'ts ttr. Crkirnty,5'Urar,-Irtarinmer,7r�aYi'a�en,.)
3.Wdl Usc(Chmic wdl use):
Water Suppler Well: FROM TO atAnir;rla SLATC14 T°HWUNng A MAtERTAi,
DAgrkuftitral i3m6idpallP01.ic 4 (L' 14 (L 4" ia• 026 SCH-40 PVC
CGoodlelrararl(ieatingACoblit g Supply) OResidendal Water Stlppb,(single) rt. rL i
ah)dustriallComnielcialMesiftntial i4'atar Stippty(shared)
FROM TO MA1TRLAL I IMPLACEMLNT MUMOD&AMOUNT
❑hii Rtion I
tL tL
lean-Rrat€r Supply Well: rt.
❑lvlonitArin Okaxosr
lojectlt►ti Well:
®AqucfcrRccharria 0601111160 lerRctrtcdiMion '19,SAN 't Eli fiA- fit `�laci t;
rHi)sf- M T't;JCtnl. fi,Aral.Af:nir 'f FT"On
❑Asltt fcr Storr�c lid R o p$al pity Haider 3 ft. 14 tt, SAND #2
17Aqurfcr1eft Cl tomm tcrbi#in,9ge
fL fr.
❑Experimcntal Tachnplogy OSubsid'emc Contml
�0.ilRllili�tr'1i3G"fiillsehtt8rfifionia7 3hcd35f�cccsaxn>
oC tltcnttal Closed Loop) 47 actr ROM; Tt) DF.SCRIFT103S cebr.n®ndka. *Wrs,ca c it.' id*,N 6e.
OGeodtett)ial eatil 2o11. Retum) mother( ainuder#ilRmacks) 0 fL 14 tt RED SILT/FILLDIRT
rt. tL
4.Date Wel(s)Cbnipieled.- 8-13-2021 ,dITD#VEW-25
fL (L
SIL M'Cil 1A)CAthn):
United Parcel Service tt. it
Faciki ftncrj4mac Facni14IDk(ir3pplicriblc)
1600 Cottonwood St., CHARLOTTE, NC, 28206 tt ti, j�CCCC�S�
Plotkil.Add,m Cihy_andZip 111 REMARKS _ tt`' r -•
MECKLENBURG 07714104 CONCRETE FROM 0-3'
cemloj' ParteiWflire-mibnNa,(lvl)
b.1.{iti nde and l not itnde in dcgrmrWminut6jsccQnds n-r(lt�imal t cow.5: 22.Certifumfl n:
tit; It tit;rm�i;,lrt n5 is sl-Mint)
11 8/15/2021
Signtlstiir afCsrte s rYcll Cuntiactms j Dale
6.1s(uee!dte n etl(s): EPerrament or 01femporary srcmn rhu m,t herrfit•rem ihcv rtu wrt a)was(i,err!cwnytnwted at tuvorf mte
s fc fsr t
wirh'IM NCACQC.0100 or;)3A,NC,4C 02G.QW ttW Gntwat crltot Srrtrxlards arnri rlrtrr a
7:L5 thir a r'cpgir jbr an klis ng welh ElVes' or NNn 'a€rpy 0f FlIk W#rd 40,F firma prmirt,d rn Abe wilt VieArr,
If*15l ha ropMr•fill neukmom vellcmrrFramrtnn brIgnmt)bri mdexpfaim fhe mwre(cfrhr
reW r WrdCr 921 reulnrL-Sft-iM Of rr»111e bract Of this fpruc 23.Site di4ram'or additional n'ell detli[t5:
Yeti may use the back of this page to protide additional well site details or well
S.Number of welts corimtrt)eted: 1 nstluetioit details:Ynti utal°also attach aid3itie11a pages if mcessal .
For rirultlrde lnfeerkm or rom-na ie10 i4Wy nrlfs ONLY irkh`the same carrstrrregmt,YO&can
suNnit one firm. fi11i1'hii'1"1'AC'INCTbe-T70NC
9.Total Trill depth below land surfacc: 14 (tY,)' 24a. For All Wells: Sub»mt this:forth mithin 30 days;of c4bnQ1teliou of iMl
Fornwhip,rrii=etlsPiarrr11r1 rks(frlt((,twntte<�inrrr+te a2c^=2f111'rtr„f2�11)i't eon5tnictio-nto the follo,%ing;
10.Statie WSter level below ttlp of caSing: NONE ABOVE WATER TABLE qL) bivWon of Niter Resanites,Informatian Frotemnt Unit,,
tjiEbrrr kvrt is adN)uc r4ahr$.am."+" I617 A1ail Sen lee Gcnter.Raleigh,'sNC 276094 17
11.11arthole dimirtcter.l0 5/8" (in,} 24b.F'nr[pi on Welk OM Y!: LIn addition to-sending Ure form to like address in
246 above, also stibntit-5 cupv of this fern within 30 days;of completion a iia
12.Well cortstmetion rrecthod,AUGERS construction to the f000Ailie:
(i.e.antgct,,rotary.cable.direct pask ctc.)
Ris'ision of Witter Rettoure sr Under'�nnd.bj6mlon Control Program,
F'OR'WATIER SUPPLY WELLS ONLY- 1636 NIA Se tenter.Releigb,NC`17679-I636
13a,Yid(gpm) Method of test, 24c.For Water Supply&1pjoctkmn Wctls
Also subintt one cop.►'.of this Mini ck�ithin-30 days of completion of
13b.Disinfection t Ve: Ainnunt ;yeti Lh constnrckri to the cmmty 1th de`partmmo of the foanly whom
cnbstnutcd. j
Fonn G1Y-t N lb Carmlhm Dcparia"i of Etmitot tma and Nan"Resiomes—Dig+.Ion of R'aicrResotrar Pcv istd August 201.1