GW1-2021-06352_Well Construction - GW1_20210915

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WELL CONSTRUCTION RECORD For ntertud Use ONLY:
T1to Corm can be usad ror.c_ipgk ar multiftr wds
1
1.Weil Contractorla orination:
IJ...AVATE-R20NLS
Rich Lemire FROM t(r bptif-kIP111)\
lITCIII Comr tllyrt�cSFM` Q. (• I i
2593A
NC Well Comn6or Cen"Irimtton Ni mrecs 5..0I1T>1t G 1+tG oreriilli sixvl�tcAs OR L,NIRR Tit sE 't3cat+
FRO.1 TO ntAMFTER• THICKNESS 14fATEtItA1.
SAEDACCO Inc 0 (L, 4 h. 4" f 1' in. SCE-40 PVC
Ctrn�:ttige�hCan� 1S�1NN8R" �OtDR��IBtN'O" ` ihio�at"rRilxda `': ,
TR0;•1 TO Dt0fET6R. I 'MW KNESS MAMMAL
Z.Wr7't Crtnstrgtction Pcrttii; 70002060 ft. ir, 6i
list alirgrp�7iriabl¢well jrrritaitx ti F:Gnanry,Swe, "briomrr.rrob:Ven err..)
ft. fL in
3.Well Use(Cfia0:m'e11 as x?.SCRE N, .M_ !a, ,
- -- FROM TO 0tAatETtta
Water 3ulaplll•Well: $TOT S17y, I TnrCrey"-"s I 3dATRR.tAt,
MAgliCtihitral Omanicipal/mlic. 4 ft, 14 (L 4" la• .626 SCH-40 PVC
DGeothenmtt(Heiting/1Cooiing Supply) OResidential Water Supply(si-ngle) ft. ft, in,
©IndustrialfConmercial Qlkesidential Water Supply(slmmd) �-1a.,GROV _.�'x
FROn1 •TO 71ATEMI, E►tPI.10E>4MWAWY1lon&A1lfotmlT
01di ation fL t)
lion-Water Supply Well:
❑lvlpnilrlrn f�)tccctsr.• �' ��
Injecliotl Well: ft+ IL
CJAtjai6fcflxcahargd CiOniutidtrnicrRenrediation t4SANbi(:1tA�E1;= � - �i "�rti��tttsf.__ :,,, ::._,�_. _ . ,
FRO" (ttA7 kf4L t?riP3 A(-", ra-m4l"14611
pAgi<fcr$tor,rgc At i li ccoX ❑$alinity l9arricr 3 It. 14 ft SAND, #2
13Aquifer fcst ❑$fornm:ltci Ltiairtage ft.. ft.
❑E.Vcrimerttal T-muotogy ❑$tdmidencc Control
'24:'nRI1,3.1i4('i'isOC"�ailseb adifafidia'I slicef�?if incccssBr�'.i
13G.otheftiml(Closed Loop) Mmcet FR0,51" TO DESCR3MOt;corr.bard"mxdnv,&tr ol*4,,4*
❑Gootllenual(Fteatif 0li 'Retum) 00ther(; aittUnder#21 Retuaft) 0 ft. 14 ft RED SILT/FILLDIRT
rL ft
4.Date Well(9)f6pipieted: 8-10-2021 Well ID RVEW-22
L ti
Srt 1IrL41 LtiCattitrn:
ft. ft.
United Parcel Service fL (L
Facility,0vv erNa= Facrgiiy'WOijirapplimble) Q. t1, tit-
1600 Cottonwood St., CHARLOTTE, NC, 28206 ft fLrr,r,acg;C+..
nn d.sV
F111sicol:Aitd ss.Cali•.irnd Zip 2i•ItED1ARl�S;; i t�4v,
MECKLENBURG 07714104 CONCRETE FROM 0-3'
Cc)mrI!! PAitNt id^_ro Cr ifieiiNd;(PIN)
Sh,Li h1u4e and Lw_ingitudc in deg"mominutcalscconds or dccin-m'Icgreies; 22.Cer0wation:
(Ir,nelll�:Ids'�Iaf�1Q�dR' td'rlcr�3ri)
n w _ +�rw 8/15/2021
5igm k afCcit' Ntll Cam trnstor'' Date
6.Is(aril the well(s); � m Pe anem or ❑Temporary
.. JIt}•.srgning thisjbvrr 71Feroy*crrfr;6•That the rrwlijs?arty(inprcJ cmrrutterl by tecrartlim[r
410Y 15A NCAC402C.01 Ml dr.ISA NC,4CdI3C,02M Well Comorricrharr Srondan4s and fianr a
7.I6-thisarelvairitrantXiT ngWclli ❑Yeti or ZNir copyii}oilsrtr[+rt{htribirnFanriilr�ii Ricirrlt vrrr.
if#fINIs a repair•fill ontkroi4w tird cxplahi the mmire of rlie
reps r Under 0- remtkrL—rdrara or an Ar brink of ibis•fprac 23..Site diagram or additional wki dem lR:
You.niay else tfie back of this No t6 prfAde additional uA site details or 11VII
8.1\urribo of welts constnteted: 1 construction details. You may also attach additiotfat piaes if Imessary-
For m horde lrrJc+1W or am-itmer rilpplt,wrlh ONLY ii*h rile w MF cmrs#arrrlan,yqm eam
Au6ni`t me.form. S 1BALI1 PA :=6-.T1ONC
9.Total well depth below land surfs wn. 14 (n,) 24a lltr AEE Wcllsr Suhrrtit this fonff �idthio aft daYS of CcsM' ticin Or 1xelt
For re iliirle iAcPls'rili'rrNidi*prizs ii°riole'ren)(em ejpre-J@?tV*Licari l@ It t conSdmCtit�n ifa th�fgil�na;
10.Statle water level below top of CSsiki$ NONE ABOVE WATER TABLE(i1.) Dfv6ipn of Water Re_4nur es,Information Brocescing Unit,
!f rrnprr k vri le due rvistrag "+" 161T AiRi[den lee(erittr.Rillclgh�NC 2769')-IG 17
11.13orebote diamchr.10 5/8" (in.) 24h.for LiomgN Wells ONLY., In addition to sending the foml to like address in
24a above. also subtlut a copy of this fonts within 30 days of Completion of 1vell
12,.Weal eunst'etion t shod;-AUGERS consinfction to file folJOivilre_
(i.c.aagsr rdnly,cable.direct P'3sti etc.) j
Division of Water Resources,Underground Irijettion Control Program,
FOR WATER SUPPLY WELLS ONLY' f636 AliA,Service Center.Raleiph.11C 27649-1436
13X Yidtl(glim1 ikletlrotl'oftsst 24c-Fnr Water Snnyly_dtr lnimtI.I.�Vrm':
.Also sublimt one ice'of this f6ti within,30 dg,s of'completion of
13ii.Llit9nft t+tn,tyTit, Aenobnt: ati'ell consinacat"to the ammltr t alth dep'artM cat the tmanty WIXL c
constnicted.
Form G%V-t North Carolina DcpaRnwnt:ofEmimmi mandNantealRewumes-DivisfonofRraterResowm RcriscdAtrgust200