GW1--03748_Well Construction - GW1_20230602

WELL CONSTRUCTION RECORD For tmcnml Use ONLY:
Tlifs form en ba used Car single ei mniltip)c wells
11.NVL41.Contrtctor Information:
:14:Il ATER ZONES
Zach Thompson FROM TO DFSCRIPTION
WeltConlydctorNamc ft. ft.
4478A ft. fL
NC Nell CdWzctorCcnifucatioaNturb& t5.OUTER CASING(for-iml*ea'sed neUs)OR LAYER(if a ficahie)
FROM TO DTAAtF,TFR Tn1Ct{NE&S &ATENTAL
SAEDACCO Inc 0 (L 117 fL 1 6" in SCH-40 PVC
Corrgrut)-Naaw 16ANNER CASING OR TUBING igeothermat closed-lour r '
FROM TO DULNIETER I ITUCKNES3 I HATERLIL
2,Wclt Con:itr•uction Per ruit#: 0 R, 135 ft. 2" SCH-40 PVC
Gsr ullappil"able en!N pawits(Le.Counn•,Sew,lrnriarrr,fray-6m esc.J
R. Q. lrs,
3,Wclt.Usc(chock well ascl: 17:SCREEN
Water Welk - FROM TO DrANFITER StIoTsin.. T111CKNr�.$ \IATRRIAI.
OAgteultural L714um;ipatePubAic i35 ft. 140 R. 2" in 010 SCH-40 PVC
Meothetmal(Hein Cool n Supply) Mesideutial Water Su f4 2 Ire
�' g uPP Y pply(single)
ElIndustrial/Conmtercial CIRestdcutial Water Supply(shared) I&GROUT
FROM TO MATERL&L EMPLACEMENT MEMOD&AMOUNT
❑M ation 0 ft. 128 (L Portland Injection
Nan-Water Supply Weil:
ENI0nitodpg bil covcry r4
Lnfectlon ft. (L
O ttifcrilccharge O.GroundmitcrRcntcdialion 19 SAND1GRAVELPACK(ifamfl Ate)'
YHO\I TO MAURLI1. R�IPLAf 2ENTMEVIOn
C]AijuifcrStoragc and LtetiaF'er}' C75�linin'Nanlcf 133 R. 140 ft. Filter Sand #2
❑AquifcrTcst ❑Stomm-atcr DMtnaac
R. ftr
MExpchmcnial Technology ❑Subsidence Control
6.DRILLING'LOG(attactr additional sheets if itecesmrrl
OGeothennul(Closed LoaO OTracer FRO\t TO DFSCRtrrlOYhubr,hArdnc�+.w11'rnckh n�re.<!ai
❑Crzthenmil(HeatinyrCooliu•Mom) OOther(eX IaittunderA-)IRetuads) a (L 95 (L Brown silty clay
95 fL 114 (4 Weathered Rock/S pp;colite,'
4.Date Well(s)Goiupletcd: 5/18/2023 Welt ED#MW-52B
114 f4 140 f4 Rock
$a,Well Locatfon: f4 ft.
Former Charlotte Army Missile Plant ft. fL
Faciff1y hNwrNmao Facility IDk(ifapplicablc)
300 Camp Rd., Charlotte, NC, 28206 ft.. fL
P10sical Address City.end Zip -.2L REMARKS
Mecklenburg Bentonite Seal from 128-1331
Cnuuh• Parcel Wnlificalion No,(PhN)
5b,L.atitude'aud 1-ongftude in ftr'ceclminuteslsecrinds or dccirtr;tl dclgr'et:s: 22.Certitication:
(if a ell l'i41d,W rc 101oug is srdliciCrrt)
35.2465 N -80.8351 W 5/23/2023
ftrUtUM GrCCitifiCd WCE COR=tar Dale
6.Is(am)the well(s): EPerTmanent or E7Temllorary aignbig this jona.f hereby cerfify rbru fhr ivell s %vr wrrel cwmrrnrered in accordance
iviih M NOW 02C.01(k?or 1SA NCAC 02C.0200 Rill Constrardo t Srarnfards and rlssrtr
7.Lsthisart irfuanr-*tingwell: ElVoi or ENn copyo}dilrrrcordhaslncapmrirledratl vrctlmrru:r•
if rhls is a rrlklir,fill Var k"(411 weir carumredoa hrfur?1=1011 anrl'ceplaln ruin+brume of(fir
repair mrderdi21 rrmarkv 3rr iaa or rm the 6rark.uf this forur. 23.Site diagram or additional well details:
You may use die back of this page to provide additional,sell site details or welt
8.Number of wells Ounstntt:[ted• 1 coustmction deiails. You nlay also.at(ach additional pages if necessary.
For ittulriple lgkvi4m or arm-miter supply wells ONLY ndih the same corrstrix4m,you earn
submit one form. SCTDd1[TTAL rNSTCTCTIONS
9.Total well depth below land surface. 140 A) 2•la. For All Wells: Submit (his far av m%vithfn 30 ds of completion of well
For ircnlrlplr irf1ls Ilse all de pips ifdiJlitrent 3@:00Y seat 2@ 1(.l7)' eon5tmetign to tibe fpllouin5;
10.Static seater levet below lop of casing: ((I,) Division of Water Resourcce 4 lnformateom Processing Unit,
1/wafer level 6 above cusing.use"+" 1617 Milt Service Center,RAleitih,XC 27699-I617
It.Borehole diameter.6" (in.) tab.For Inhilga Wets ONLY: In addition to.sending the form to the address in
24a above,also submit a copy of this forte within 30 days of completion of vvell
12,Well cotustntetiou method:HSA/Air Rotary construction to the fonowing:
(i.c.anger..rotnrp,cable dimct paskctc.) Division of Water Resources,Underground Injectlan Control Program,
FOR WATER SUPPLY WELLS ONLY. 1636 RLrii Service Center,Raleigh,NC 27699-1636
13a,Yield(g1tnT) hYcthad of test: 24c,For Watcr Supply&I!gectlon Wells:
Also submit one copy of this form withiii 30 days of completion of
I3h.DkinfLedun h-pe: Amount: te'cti constnrction to the county health department of the colm(y Ivhcro
constructed.
Fonu GW-t Noah Carolina Dcpaanbru of Eavironnicat and Narural Resources—Divi ion of Water Re auan Revised August 3a 13