HomeMy WebLinkAboutGW1-2021-06351_Well Construction - GW1_20210915 I
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WELL,CiDNSTRuenON RECORD For Gtcenmi Use t3h V:
71th.torm salt be ascd f�.Siigk or ttttal[ipls�sOs
1.�aCti C-' Dtt:tCiSll'�IttQlitl�2t4tt: E
Rich Lentire eR1jH, Tt1 Dt?SfkIP1InY
!Atilt Cater ici�rr Nt+d ft, ft,
2593A
S..OUTEdt,iu4fjiNY3 orer4ifil h�tl£ (tttL (±lF;lt (aen6
ITC Wr7t Commcior Cc[i( etinu A7vtotirr FROM TO Pt66M TEE TiltCE.NF-RS MATUTA!<
SAEDACCO Inc 0 (L' 4 fL 4" I ia, SCE-40 PVC
r
Caaa�rxn�t+C�ntr 'i6:,1lV �. ib3#' IT�iGT i9tl'al;�W�etla
FROM TO DIJOIFTER., TBTCKNESS I MATERLkL
2.Wrcu n i ctto trinit tr 70002060 IL fia
LW#i1.a 4#Jca6k terrfj-hw ix ii r..G'pu oy.Somr .t Valor etp Trtya 6m ex J
3,well#sc(ebty well used �v
Witter Supply tell: ^FRrilt TO_ otantBl Fe 6t4►1rt t i Tt+tCTCfiF:+9 AtrixftRtatit:_
0 lia ml 04uni6p:VPubtic 4 f# 14 (L. 4 to 026 SCH-46 PVC
®Geatit nWi featitig/CloOl ng SUPp1yj McSi&ntial Wat r SUPPly(Singe) 7t fi i
13 musuiallcolimiticim cResidential Water-supply(Slutbc!) - K,,GR0UT, .''. w a. •.r _
FROM TD MATERIAL �.�EhtPU\CEMENThTEfi147? AMOUNT
❑ltii (tr>tt n ft
Ntin^Wlatcr.at pply doll:
❑lV1At9"ItCi,Tilt _ :QRti'tC.,• �. rN-
1 etilDdt'Weli: f
❑Aquikl"R ctiargn tirxitti dt fterJt6wtl ali4aA 3 P]U Tit arts w fih
i}4f
Ofticr. tatr ti itec" + pS
. F MA At
i 3jtr Th1A �tr VYS►flT, ,D
14 fi. SAND #2
DAqu fcr`iest- OStcainti�ttci[}re'ri1:i� fl. tt..
OExWrimcnhtl Toelmtalo6v ❑ idisi l€atct Cu>dm1
�tfullRtl�l1'it3'3i3CFi'��liaeh�8ifii11�iit"istiefis�(�ecc'aiFnra "�
❑Geatkmtrtl(Closed Loop) btriacet xRO31, TO PE5cRxrnOx tcobei boohc"*Wnku typt.,ovid e*,
❑GOtltlfe9lttal r'1lieatit ' rill 32etttflt} 00ther f sill tri f r- i Reti5�f 5} 0 tf 14 IL RED SILT/FILLDIRT
d.,Da We (s)1C6nepltted: 8-10-2021 'W jD#VEW-21
rt fi;
S&Well Locathuit. ft ft
United Parcel Service ft ttt.
Ftict1h'YowncrNow PkIn P#h�*pliCtittfcj0. tti
1600 Cottonwood St., CHARLOTTE, NC, 28206
P]tt°saceladdss'Ciq.andZp 775tijtt+
MECKLENBURG 07714104 CONCRETE FROM 0-3'
h#tit' Pdtr4i wlliliwifipn o,(PIN)
W1 Seconds or decimal dcgr es: 22 Ccrti#etatican:
Otwv*lt t .'triit 1;i 9a s ielFnc t`i�}
W _ _ t�+a.. 8/15/2021
x:�-,..a.d.,
Slg®in7r:b!(eQt S cil C091ttt}titaa' .Dade
.ig( )the—wells).— EPeronancirt or 01femporary Ifdy'sig hig ahat,fMnn 1 hcrL+y cceA,fy that tfar wdli`s?waa{i4mJ mwinrtted irr;aa-twd ee
�44154 PVCAe 02G.01m a:i JA AfCkc 01, anov Ni#f'oa4rvreicrtteir SRdaddr&and Aw;a
7.h(itisa repairto an tJdsl*w:li:` ovo, or ENo c.v&o-iihir reavanf tier firm jir�ntdcd2�'t5r atrff�?ir4rrr:
tf rfefs`txarc rcroafr dP,xcrkrn+f i6 rveJl ccrcrbrctmrl+m hV( ,rrtatiid Random pfaht the owrare of rAt
re,wir affd ee 0217ern6Hts:ve§rfeata 6r,fm-A.8raek afAix fvrvr._ '23.Site&*a tk or.addiliouni will dfillls:
-you M*ttse die back of tltls p4 t4.peoildi addi66nai[4A site amails of ts�jt
8.Num b, &of wells omdrnt.•ted: 1 cotistiuetiotf4ti ai[S. Y6tmayals6affachAdd6hil pi if tmessait°;
Eur mlmffi le kj-Vn an�wrcnii=lent+;e s**7r¢f4 OWLY I'lith rho wme ceirslraMour,y oi,cm [7I#IkifTTAE INSAICTiON9 .
sm first star f arRa
9.Total wdl,depib belowland sttaia+ 14 (fi,) 24a. For Alt Welk Submit this font v6thin 34:ads of cvmpictiott of 4 vit
For mithiplewrflsARofhiquft�fdWi r•ri€(exoritok-7@2VQ'"drui20rg?) constiliwionto tipfollacviagr,
10.Sti die vt`ater Inel below top of tasiulp. NONE ABOVE WATER TABLE (j j Division at Water Re�aurtes,I Unit,
if tva"r kwi fs A66W wsfrift&fe'+' 617111A'3ert•ice Ce ttcr,kale.kid 2%S")4417
11.gorrbole diameter.10 5/8" (itt) 2Jlt,Ek tie tt 9�etls OIYf ;, tit addition to s diti °the farm#0 tl sddtess:in
14a above. also s*abmi.t a"copy of this form within .10 dm,9 of completion of istll
12,Welt constru-coon method:AUGERS cutt$ittti ti0tt to tits fdllutkseg_
(i.e.Stt _ram,caibfc.dind,push cte:t
Phislon of Water Rrsoumcs,Underground tn)eciloll Gsntmlt rogr�atii,
1636 Mail Set- ice Center kale by
1TC?R►�`ATER.;Stt3i'gLl'R'fLGSQI�I�yf F�It, C27d99-Iti36'
lu Yictit Wm) Method of test,. Zit For W.ttcr�nliptc A:Enjcrtion Wells'
Also sihi it omit colni of this foni s4Kthiii,3ti da}'s of completion of
13b.E1islnfcc tirtn., e- Amount Well commiction to the comay Health dcjodmc ,of the coup y wh
cofigmctod. caa Fttrtn�,`tY-t Nuntt Carolina th ntttt of E-miiotuneni aid Minim]Resouims-Division of%Alatcr(i � Revkcd_August 20I'l,