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Home My WebLink AboutGW1-2022-07103_Well Construction - GW1_20220801 r � � WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can be used for single or multiple wells Rc C F g9\\1 E® 1.Well Contractor Information: L. Billy J. Payne Jr. ��J�, 1 2022 14;'vynTERzoNEs FROM TO DESCRIPTION Well Contractor Name UCA 13 It- 19 fL Non-Potable Water 4532-B ft. fL NC Well Contractor Certification Number I5:OUTER CASING for multi-cased wells OR"LINER a litable FROM TO DIAMETER THICKNESS MATERIAL Excel.Civil & Environmental Associates, PLLC 0 ft 9 ft• 12 in. 1 0.154" 1 Pvc Company Name '16.INNER CASING OR TUBING eofhermal closed400 70002951 FROM TO DIAMETER THICKNESS MATERIAL 2.Well Construction Permit#: fL ft. in. List all applicable well permits(i.e.County,State, Variance,btjection,etc.) ft. fL in. 3.Well Use(check well use): 17.SCREEN. Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑MunicipaUPublic 9 ft. 19 fL 2 in. 0.10 0.154" Sch 40 PV ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in. ❑IndustrialICommercial ❑Residential Water Supply(shared) 18.GROUT FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT ❑Irri ation 0 fL 5 ft- Neat Cement Tremie Pipe flow/80 lb Non-Water Supply Well: OMonitoring ❑Recovery 5 rL 7 ft. Bentonite 3/8' Tremie Pipe Flow/12 lb _. Injection Well: 7 rr; 19 rL #2 Sil.Sand: Consolidation Method/30 lb []Aquifer Recharge ❑Groundwater.Remediation 19.SAND/GRAVEL PACK'if applicable) _ - ❑Agnifer Storage and Recovery ❑Salinity Barrier FROM I TO MATERIAL EMPLACEMENT METHOD 7 ft. 19 ft #2 Sil.Sand 20-28 Consolidation Method ❑Aquifer Test ❑Stormwater Drainage I, ft. ❑Experimental Technology ❑Subsidence Control 20.DRILLING LOG attacfi'additionalshvets if oecesse' ❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness,soil/rock e, in size,etc.) ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 fL 1 fL 2"Topsoil-Brn Silty SAND 4.Date Well(s)Completed: Well ID# 06-30-2022 MW-2 1 ft. 4 fL Brn-Grey Silty SAND 4 fL 6 % Grey Saprolites PWR frags Qtz-Granite 5a.Well Location: 6 ft. 8 ft• . Grey Saprolites Qtz-Granite Sam's Mart No. 74 00-0-0000035588 Inc#48068 8 ft• 12 fL Grey Brn Quartz-Granites(Saprolites Clay) Facility/Owner Name Facility ID#(if applicable) 12 ft. 19 ft- Grey Brn Quartz-Granites/(Saprolite Clay) 28213 9810 University City Blvd, Charlotte, 19 ft, 19 ft, Refusal due to Bed-Rock Physical Address,City,and Zip 21.REMARKS ' ` . MecklenburgCount 5112105 Y 0 to 9-ft 2"Sch 40 PVC Flush Environmental casing County Parcel Identification No.(PIN) 9 to19-ft 2"Sch 40 PVC 0.10"slotted screen w/Molded cap 5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 C ation: (if well field,one tat/long is sufficient) 35.18 29.63 N -80. 43 10.84 W 7-27-2022 gnatute o Ce7"",(s): ell ntractor Date 6.Is(are)the well (OPermanent or ❑Temporary By signing this ,1 hereby certify that the well(s)was(were)constructed in accordance with 1 SA NCAC 02C.0100 or 1 SA NCAC 02C.0200 Well Construction Standards and that a 7.Is this a repair to an existing well: OYes. or ElNo copy of this record has been provided to the well owner. If this is a repair,fill out known well construction information and explain the nature of the repair under#21 remarks section or on the back of this form. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well 8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary. For multiple injection or non-water supply wells ONLY with the same construction,you can submit oneform. SUBMITTAL INSTUCTIONS 9.Total well depth below land surface: 19 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths ifdii ferent(example-3@200'and 2@100') construction to the following: 10.Static water level below top of casing: 13.25 (ft) Division of Water Resources,Information Processing Unit, If water level is above casing,use'.+'• 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 4.25"0/2" 1 (in) 24b.For Infection Wells ONLY:!. In addition to sending the form to the address in 4.25" auger-method 24a above, also submit a copy of,this form within 30 days of completion of well 12.Well construction method: construction to the following: (i.e.auger,rotary,cable,direct push,etc.) Division of Water Resources;Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 276994636 13a.Yield(gpm) Method of test: 24c.For Water Supply&Injection Wells: Also submit one copy of this form within 30 days of completion of 13b.Disinfection type: Amount: well construction to the county health department of the county where constructed. Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013 PROJECT: SM74 8"-0 X 12"-D STEEL WELL ID. N0. 9810 UNIVERSITY CITY BLVD MANHOLE W/ MIN 18" X 18" CHARLOTTE, N.C. CONCRETE PAD MW-2 WELL PERMIT # 70002951 (PAD WILL BE SLOPED TO MATCH NCWC # 4532-B EXISTING GRADE SLOPE) GRADE - 0' "IN 1 �c--�c--plc-- ;• 2" PVC CASING - - - - 0' 9' BGL - - - - - - - - - - - - - - \\\lK - y_ WELL SEAL NEAT CEMENT Y ;l1 5'-7' BGL / CONCRETE - - - - - - - - - - - - - - SAND PACK 7' - 19' BGL %" BENTONITE HOLE PLUG 2" PVC SCREEN ` 9' - 19' BGL UNDISTURBED EARTH #2 SILICA SAND - 20-28 SLOT NIN GRAVEL PACK (IF APPLICABLE) TOTAL DEPTH 19' BGL TYPE II MONITORING WELL CONSTRUCTION DETAIL (TYPICAL - N.T.S.) F:NC/PROJECTS/WELL INSTALL/SM74/MW2CONSTDTL_7.27.22