GW1-2022-07198_Well Construction - GW1_20220804

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WELL CONNSTR JCTiON RECORD For Imenull Use ONLY:.
This,form cantr'used.for.stnplc.oi,tnultiplb melts',
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]c1YciCCnli(rtct�r Iiifornlaiioil:,
Scott Hunt, Jr FROM TO I DENCRIPTIO:t
�icllCtir�irlp�tl\alnid, ft. u. I j
4561-A
IC Nklcll Contractor Certification Nuirbci iS OIiTF.R CASING(W multi•ca%ed victlsl OR LTAER U/a IicaDk)
FROM TO DrAMETFR• Tille Nrss MATERiAi
SAEDACCO Inc 0 ;/t: 16 fl: In io. SCH-40 PVC
Galltjrul�ir9na2 '16:INNER CASING'OR`TUBi 46hxrmal cb`ccddal"
FROM TO I DIAMIETER I THICKNESS JLA7ERIA4'
2.��'Cll(9n.St111Cti11t1PCiwntit#: 70003030
l ilttrll atyilit.h wcH.P6WUa O'r:'Gntmfa'Sfb:r;41160'icc,148c6C l el,,).
rt. Ile )n:
3:R'c11115+ (chcckh'cll use): •1T.'SCRit.I;N
Wat�rSupplyVl'cll:: FROM TO•_. DIAMETER• ISLOTs17r. THICKNINS I-lIATFRIAL
fJrlgricultiilal t�Iu4itnicip:il/Ihllilii i 16 26 fL': 1" ;in O10 SCH-40 - PVC
.Mot hcm151'(t1dwinglCoolinr Snpp.t) ©Rcsideniial\Voter 5ilppl� (Single): 1
QlndustriallContnicn ia) C7Residsntial\Vatrsr 5nppl (slriredi' W GROUT
FROM TO0.` MATERIAL. I E.IIPL\CEMENT1lEnIODd.VNOITNT,.
i]irrinalian ft. rt.
Non•Watcr Supply NVcll;
fi: fl.• .
®tiloniorin� blicco)'cp•'
Injection Well:-
0 Aqi0f1d0Recharge QGrotilidsl Ttcr RciRedtatioti 19:SAND)Git 1Vt L YACK 1d a r i1kaA4) -
. .. 'FROM •- ,m:. -. •MAfFRm I FMP1.1Cr mvxT Mr.rnoo
Cltlijnifcr Sfora a aiid Itcti m'ci} ❑Salmitj'Aimcr 14 rt:. 26 A. Sand Noe
0Agilifcr Test f] l rl nagc
OE.ip rintcotal7ctihnolok• t7Su6s!dcnecCont.r l
'20 DRiLLI\G'LOG-/utt,►elrndililioniil�hitiYs°)r'iiPccscnrr.= .��' •,' '°'•
17Gwilteni3!(Clused Loop) CiTruoer FROM• TO Iasi-meno�uubx hardnrct sr VYn,ckit in'wr.ttl.l
OQ IiIiemlal(96atniglCooline Return) ❑6tlicr(explain ulid'er 3)3J Reulaihs) at. (I. 'see Geologist r s log
rt: ft: •
4.Aate-WcIi, Conil►Ictcil 6/15/22 Wc1lIDN13-1
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5a: lon: h.' R.• �'
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Four Points by Sheraton fi. f1:- AUG p z
Facilil)i0i!:n rNun+c Facility 1D (it appliirb!0, fl: fl.
315 E. Woodlawn Rd., Charlotte, NC, 28217 Ar�r�acM
MMMOG
Ph\si:ul'Addnsc Gity,p6tl Zip 21�;Rt:MARKS;.:` - - - ;� ' -
Mecklenburg Temporary well to grab water sample
IM1>:d I&.111ifia,3116n No;-_(PiN)
�h,I:mtudc and I on(,�imtlo in cltgrccc/minutcslicconils iie'dcctinal ilegi ccc:, •22.Certification:-
(lfa�`C1I fiCW;41c IaUlprig iv s(!ilici•1111
N W . . .. 7/9/2022
S'igmteir:'ofCcaift:d Well Contractor Date
G.IS(ai c)the mil(s): •flPennancnt :Ur 511TCIigrtrraiy By sir ri;rg.Mir Ybn l herrl,r errlrjr rlmr Me;+rubs)tvas f Frrn•),c iawucred in r:eorda,rr
161W Ull JVCW 02C.QIMnrISANCACQC';U01?Iltt'llCnlcarrtrrrioils6oldrdsiron Awl 47
7.L�`fhl�t a njialt to da cu tio{;.�Ycllt' flYtS i t .®NO : r�� ojrLi.�mcrnllaprhrcii jtr}�I irhd raitir:mll inF,icr,
IJ+J;tslcnrt'�Ir,fillrn+rkaullariellconsintc8onbl�urrnirrFondrullr-infn)nrbr:iurr;rreojrGr.- �:
i rgwdr urrrlrr dr37 rrnmrki scc7tav ar ai Jir 7iarl ajlhn/ar'i r. 23 Site diagraut or additional n iell.dctails:
1 ou n.a ISO il.b►c}.of th1s pago details or\i'e11
8 l\inaherof\«lh cailsttTatcd: COnSlIUCtiD11 dclall5 jrOU liL1\3150 atlaCll'addI1101G1f paageS If lie cessal .
For.i»e;irlplr FaJccilvn os.iuM1+ucue r r{rphJr)ra lls ON/,i'it frh ihr sa»ie consh+(eslail,.yc;t -
sub+,ii(nnr Jnrrri; �iLtDil fTAL i11TS9��TIONL:
oFo.rTioiut+alrllpl well
r,depth lielov.InnJSiiaic: ' WYltcfollo\\ing fpliioi of 11
26 i Fnm cf)
+rniteuhsl%Jij oft(orzacI@' 9' u2G constnictiantoU A ICI.Static water Irvd 6'cluw top pf casing"17- (ft:)- Uii ision of Wat&Rciourci% information Procming�[Init,
IJrrorrr lel r!fs rrt tri c cuiVns; 1G17 A1ail Scrrtce Genicr,Rulctgti;�1C 27G9'1=1G 17
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!1;Borehole i1lamcter;2.25 n (in) 24h.Eff &'6NL1�- yin addition to sending the forin to Ow b in
24a66V &6 snbnut4-copy of this'fonii'\mithin.Si)'d*'oG.courpletioH of i\ell;
12,Nell constniction method: DPT coil nictiolI ro lite followilig
(i c:�n per.iarar,.cagia difcci piislti c(c°) , e � .
Division of.Witcr ltcsourco,;UnJcr•�oHnd injcetion.Control Program,..
F010VATER.SUPPLY WELLS ONLY:- 4636 AILii Sci ice Center;Rvlei�li �1C27G99=163G'
i3a Ytcl!1( int) i<lctha(I of test• 24c-Foi Water Sunnis'&'iniection Wells
Also subnut one'copy`of.this fond t\Tthnt U da)sofcoutplctionof
" uc11 constnlction to.the county he Ilb dcpar mcnt of iyc:cannt\.\titcre,
13b pismfi•itlon typir-: -- Amqunt:• l,coyLtnlctc:d.
Fann G\1'-I bodh CCllli wa Dgp4r1urboa of Enl•iro n xid artd N:n11ral Resources-Divisiou o-w-tiCy Resotttes Revised August 3013