GW1-2021-06375_Well Construction - GW1_20210915

WELL CONSTRUCTION RECORD :
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Par l�enu�lt
This Forin oti ae amd rot single Of m4ti#k wcUs
1.Wdl Ontracto0hitormatlon:
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*01 cliiiradn?
2593A
i5.0U7 i R fii'�ir t(+�r'mgiFl 1cR OR°GTf!J`F74:8" (lt>thtc
1+iC Well Cbnlm6or Ccrtifitibn Naunbes `T
FROM TO rtMWTER TtrrCt NVS5 MATENTAL
SAEDACCO Inc rL ft.
Ca�siytisrr hJ�intC i6.1`tillilEFt:LC3lZSI°C�fG'01F ti'tl��tr; I�atin`'af�6u€c� ':; _` '
FROM I DL4AtmR_, I Tttie"Ess -MATLTJAL
2,ViJi 11 6inxtructinn Perai►at 70002060 0 0- 21 R. 2" '� SCH-40 PVC
fug wtaamnrrmewritpmm(frfrar.`:f namrv;StirSr,.trrtrinmer,Ir tagrlet.-:1'
23 rt. 25 ri, 2" SCH-40 PVC
3.Wduvw(chtOi wdl glkt. 1773titllt ? 1 �:,;
Water Supplywt4lt - -- FROM. ro AtArwnkl 'ir 1140TIRIM Tt-Ic-XPn,5 i�Ar8RTAz.
DA91Wthrsl DlitatiiapaVMIic. 21 (:: 23 (t.- 2" ia. '.Olb SCH-40 PVC
Mvothcmiat(t7eatintgtOOlind Supply) DR,esitlrntiai Water Supply(single) (i (c
t8:—ROtFi= . _ a s -. ,,,e� ,�.�� .,_.
❑1odust(aKotnnicicial QR�esidentialWaterSupply,(sJmTed) FRukr Tto MnTERLAi EhtPtACKNLYrAtErnQD-"MOUNT
❑&%` rtitrn 0 fL 17' (L PORTLAND POURED
Non�Water Supply Well: tt (t
f7Moatitt►rin [=JRa�cr�� '
Injection Welts l rt
DAcluk(cr RCeharg �i rSALilNiS4�t r ltetticdiNtio9i SA1Vb 'x r.. licttttc�', ,-
19 fit ft~ 2r MATP'RLAL LAC it T Fri n _
pAMtr(I`er Stml c And 1ovol i',mini 8ar-dr 5 (t. sAND #2
QAgtttfcrTc�t Citprtim tier brlige
ft. (t,
❑1 a P.mI mcnhl Taehnolo y ❑ ci salt ecc cafil of
RrikRll,d h("i3�UGIiilathJi84tvfi�isrtah dSi(a►eei ri= - .
❑Get+(ltertimt(Cimed Loop} t717aeer '.170m. ,TO DF.SCRIFFID dt.
❑Cketimmial earit jooll ;Rattan) ®Other diq undermilItetiiathsl 0 fL 14 (L RED SILT/FILLDIRT
14 (t,. 25 (L SAPERLITE
4.]late WOU(s)Completed* 8-12-2021 Wdl ID#Asw-76
ft. (L
Sx,Wt41 lAtcathins
ri rr, C ,
United Parcel Service tL
Fact kWMv PcrNat FssOitw Esgrplicnh7.-)
1600 Cottonwood St., CHARLOTTE, NC, 28206 rt. Yr.
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P10,ikil rtihress.CiI.amd Zip 2 ttEllt ti► , . $ ,. :fit �'
11
MECKLENBURG 07714104 BENTONITE FROM 17' TO 191 .
CAtFMY' porno td�rtfel§ ifi(tn Nd,f, t
5b,1.'tttu(l anil"ngit[tdc in do s/m ntrtcsd' n6 gr ftirnaI ttegrm. 2L Certification:
(ir.s,ttttttd,[�+�Lit9r�ri is trsf ictiil -
S'4' J'acc4c
t9wio� 8/15/2021
sigram' e4cll Contrtictasi wk,
6.b(arr tit-w'ell(3)' RIPermauent 4r o'I'emp rary By 6r +brag this,j4mr,J hereby cer ihar the itvJl 5)Kwy werzl emsmveled irr-tmLrwrJsmer
,viirt'IM NCAC/IBC,0/00 or 15A NCAC-03G r02W Wei$Camorriedon Srdrrd Tdx arlu AWz a
7.Isthisarei►airtoan existing w'elk OVO or KN1► t�r�fthan`rav�nJia�cado�r,�cmi ra�ti, ►nismvxrr.
tf rhfs` �a rcpcidr.j7id rr tmt+hmi ImIfcmWn(mA hr/orrvr fibit awl Aplo at rbr,mote ul rk
rc�reir ttrcder 6R7/mna[F!u serTrara z4i na the brx 'nf tf�irEnrol. 23.Site diagram or.additional!rail details.,
Yowl niay Use the back of obis paw to provide additional sl'il Site details or well
8.Number of wells coccMracted: 1 c nsttuctioti tleinils. Yt tt rr�a also attach dditiemal p�tSes fit e3sery:.
For miPriFJit/rzica�IJaan c4r rurxr-�krarar s�r�lr a'eids d'itLY�idrh rho sure rxraistxurt/oir,y4*li-earn
�dbrxarmvc jgrrtn: SE111NITIAL:INST11--IONS
9.Total w•eil depth below land Surface: 251 (P() 24a. For All Wells: unit tl rs.faeit±,ithid 30 dds's of comptetion of ivelt
FrrrrrctfiaJ�de;i'aPts'fisrarltr/aprJts ffd nrw+r7(erenut+te a7�e3i7/i`;�act2�/dt�! ccmStnictientn#hc,follo fitz�,
10.Static water level blow tarp of casing: 151 f�-) I11�'ixiiin of V4'ater Re�ptt rc�i.infir►rniatir a Ptnct�tang Unit!
/f rush r Jest/ 4 ue crttlrag aatr +"' 1617 MA Sawice r,Rsleight NC 27659-1f►17
11.Bareholediameter:8.25" (in l 24b.Er lii rctl no Welly ONLY: In addition to soiding ft fomi to tlm address in
24a Ab We, also submit-a copy of this forru of itbin 30 days'of completion of wdl
12.Wc11 4MDgMCoon nletbod AUGERS construction to dk folloAAng:
(i.e.auger.nxujy.cable.dived poste.cic)
1)irision of Water"Resources rot,Undet tnd.tiJeciian Omni krogram,
FOR WATER SU'PPLY'VVE.LS ONLY' 1636 Mail Service 6ntm Railelglt.h1C'276994436'
13a t'ldd t ►m1 iVledrnd tit tctit 2 r-For Water;Sn I &En ectism VVctb'-
Also'stabiitit 69i coVv of this grni i0thiel_3t) days of completion of
13b.disinfedion hVe Amount: '"'ell CrmstnaCtitin to the ctnmty hc�lth acjmAmtart of the.Cal t�hcri
constnisttxl. i
Fenn GW-1 Nomb Caralm Depmtnwnr of E tirann►cm and NartffW Resomms-Dixision orNftcrReoutms R.cvLccd../.UguSt m i