GW1-2021-06367_Well Construction - GW1_20210915

i
WELL CONSTRUCTION RECORD for trsFrnnl Use ONLY:
This florin cnn he asdd.f siftic or miidtipk wads
I.Well Contrtctorfntarnration:
Brian Ewing FRIYM IKI DIRSCRu"110N
y4dl Coiatr ctm m rino ft:. ft, t
4240-B
NC Well Corninc4or CenificantioiiNiun6cr 15,OUTER CANING(furpnnNi{asivl wins:OltLIKF11 if' "TiCaEk
FRODr TO VIA 1}t1 TLiR TtlfCIiNE<5 AIATE z
SAEDACCO Inc h it 'In.
cafigurr"ltarirr••- 16,[NNI ER CASING Oft Bi G '_re',iktniil:tMFed4da
FROM TO 1011"Fins TFiiEWNESS AFA'TERML
t Well Crtnstrtretion pej glut 70002060 0 fL 21 ft. 2" SCH-40 PVC
fist ufia g4jenHe wrff prrinrdts(de:Lrnraty,SwIr.,Varineee.11*6en err
23 ft. 25 fL 2" in SCH-40 PVC
3.Well Usc(chcd:wdl u sc?:
Willer Supply Well: - - FROM, I TO DIN%tK7rIFt I SLOTcrrF; I 7"lMrrrt9 1,MArRRTAT,
DA tiltittal OMmiicipaltf`ttfiflic 21 ft, 23 fl. 2" in 001 , SCH-40 I PVC
ClGaothemwl He1615 o0li: St 1 l Residential Wiser Supply fi. it-
0
( � �' a�9 i�h'(single)
MustriaMontnieivlal ©ResideutialWater'5ii YP [7R0Vr' ,: at _.
pJ)1}'(SitilrE�l) FROM TG.. AIATERIIAIL EXPiA ITT atgtnOD&AMOIINi
oIrrn . titian 0 ft. 17 fL PORTLAND POURED
Ikon-Allaiter Supply Well:
❑Mranil@rin ❑l2cc@tr ' ft, fL
Injection Well: fL fL
0AglriferRcGh*t 0 rou dTMICr Remedial on 19.5ANbiGitA1 'TA (l,` A�` i z
_ .- FRd)}� pSA9`t�7fMI. CyN�PS,.A .-;�tpVYh43,"1`tf n
QAgncl'Cr.StQIl ttC prnd itCC+ l7xnlinitt 13-fti r 17 A. 19 ft, FILTER SAND # 2
❑Agnefcr Test OStor awn,tar iliaiii.7gc
ft. it.
❑l=wxprrimenial Toclmt)Co�;p DSrttasiderkcc�bldroL -
2fi.,I1R.t1,1.7\t3'Ld.G�taidaeb�i`drlidicliiAl 'licelslf�ececcsnri '
13Geo llenuid(closed Loop) DTracet .FROM TO IDMCRIMG` (,Wbr.haroaew en It'mer#tx 4 Art,ete.
0436otlientW LeatilIggoligg Rerun) ®Quiet(;. ainuudeet2.l Reload ) 0 fL 15 fL FILL!SILTY SAND
15 ft.. 25 ft. SAPROLITE
4.Date Weit(s)Coniplded: 8-16-21 Wrdl1D#ASw-57
fL fL
52,Well'Locati6n: (L
United Parcel Service
Fsctliiy,-R,ner Nmnc l''ssiliiy jD#6r i"icaitoc)
rti h• 5
1600 Cottonwood St. Charlotte, NC 28206 Mecklenbur, tL fL
Charlotte, NC, 28206 F15t alAddicssCitg.mrdZip ^2LfRC;PtARhS. gt►
Mecklenburg 07714104 BENTONITE SEAL 17 TO 19'
C<lnrit4' S�EiZvEI Id.`r4Crradij.nNp,f,Pin)
Sh.I i►tihitle-an I Lnnl;ittrdG in.tic, ii sJao ntitcslseerindspie sir m rl tlCgic : 22.Certification:
(l(ixr311-Wd,wit la gong is sIEt 44oil)
N V4' Br Q I f I n er, 8/20/2021
Sigromm ofCeitified Well Contractor; O�ie
6.b(are the well(&): EPerulauent or oTemporary Np iigming Air,Qom fhere4 re.M*Thar the milt{vl okra f�,67),:m-Inrered huftt oAmee
sil*154 NCACO2C,01M or IJA NCAC-ft3G.02451 Well GomtrPirdmt Standards cnrdrrxrra
7.Ls this a repair to an%aihaftng wclli Meg )fr NNo talk bf thbr rccrrnf has Nev prmI*d tnahe urfl fwner.
If;*IsIsarepaattr,jf1onrkm(+trwi mil corwrifodonhrjornwAi jrevileyla1)tdirnrtrarreofdie
repair Wder021 rrxanrRr:rM im or rrq stir hrael of this forms. 23,Site diagram or additional wtll demffiq:
You.niay'use ilia back of this pajo to pr6kri&additional%va site details or isell
8.Number of wells constructed- 1 c�onsttuction details. You inay aLsu:ttach additio naf p s if ime eskin°.
For t"fdrde imleErhurw-nor-wafer rgpfy nTpti ONLY h'trtr the senor consfruaim,yaw ran
sa6matmie form S1111AICfTAL'.INSTUCTIONS
9.Total m*dIAe;ptit belo�Fland surfae' 25 {f 244L Far Atl V4rrllr: S+ubin t this:fond i(ithin 34 days,of commptelion of'is�ell
fur,twfipk weflslio atpctaprhr if dkyrrvit texemtj k-3e@20`and 2Q too) construction to lk foiloningr,
10.Static hater Icvcl below top of casing: (ft.) Division of Water Reson rces,Information Pr otessing Unit,
tfarbevrlevelIsn6ovecdsfhg,am + 16 0A1RitSmice61ttcr,ftricivlr.NC27699 id 17
li.Borehole diameter 8.25" (i.a) 24b.FYir fnf o?rt Wells ON-Yl 'in addition to sending the fork to like address in
24a abiwe, also svbtikit-a copy of this I[oft within 3t1 dm,s of t:onipletion of well
12.Well 4mr-O- ction method,AUGERS construction to the£olloAing_
(d_e.miser.molly,amble.dins push crc:)
Division of Writer Resources.IUndergmund cnJeeil¢n Control VrograIii,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Sersiee Center,Raleigh.NC 27699-1636
13a..Vidd(gpm) iklrolod of test: 24c.For Water Supply&InNc' a,Wc115:
'Also suFantilt olido cctpl'of this fgrrn filth rt,30 do}is of completion of
13b.Disiuf(:cd II ll Ivv Anioiiot' AwIl construction to the cotmty he;ilh de,p ilmml, of the couniv palm
cnnstnacted. �
Form G%t-1 Moult Carolina Dcparlocz of EmIrru nrin and NnatrslResources-Division of Waicr R=Lr= Rcv&d AugmA'sif 13