GW1--07771_Well Construction - GW1_20231201

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells - '
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1.Well Contractor Information:
- KENNY SARGENT -14.MATERZOOES i .
FROM TO DESCRIPTION
. Well Contractor Name . - ft. •• • ft. .
A -4226 . ft.. it: ..
NC Well Contractor Certification Number 15.OUTER-CASING(for multicased wells)OR LINER(if ap licable) ' •
. • •FROM. TO' DIAMETER THICKNESS MATERIAL •
• • GEOLOGIC'EXPLORATION' -: tt. rt
Company Name'' 16.INNER CASING OR TUBING(geothermal closed-loop) ' • ' : " '
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70001364/VVM03,01318 . FROM . • TO 'DIAMETER THICKNESS .. MATERIAL
2.Well Construction Permit#: it. ft. in.
'List all applicable well construction permits(i.e.County,State,Variance,etc)
ft.- ft. in.
3.Well Use-(check well use): • , . • 17.SCREEN ,-
• Water Supply Well: FROM TO '- DIAMETER SLOT SIZE 'THICKNESS. MATERIAL .. .
. ft.- ' ft In. .
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' ❑Agricultural 'DMunicipal/Public .• . ' .. ' - -
❑Geothermal(Heating/Cooling Su I - ❑Residential Water Supply sin"le ' IL- , • it. in. -
(H Ff g Pp Y) pP Y(sing" )
❑Industrial/Commercial • ••OResidential Water Supply(shared)- 18.GROUT' • -
FROM TO - . MATERIAL EMPLACEMENT METHOD'dr AMOUNT
' ❑Irrigation - ..- tt. Yt
Non-Water Supply Well:
ft. . , ft.
©Monitoring . ' -ORecovery •
Injection Well: • • ft. ft.. " ' ' - : .. . _'
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❑Aquifer Recharge - 0 Groundwater Remediation 19.SAND/GRAVEL PACK(if'applicable) •
FROM TO . MATERIAL EMPLACEMENT METHOD '
• ❑Aquifer Storage and Recovery '' .❑SalinityHarriet-' •
fit. tt
• ❑Aquifer Test OStormwater Drainage . : • • . - • : ,
iL
OExperimental Technology ' •❑Subsidence Control
. • •20:DRILLING LOG(attach additional sheets if necessary) .. - . ...
❑Geothermal(Closed Loop)' . •.' ❑Tracer FROM TO DESCRIPTION(color,hardness,soll(rock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) • 'OOther.(explain under.(hi.Remarks): • '0.0' . ft' 1.0 • ft. ' ' • ASPHALT/GRAVEL
10/1.6/23 • VAP-1 : 1.0 ft.: 11.o ft. ' '. BROWN CLAY .
.4.Date Well(s)Completed: Well ID#
' 11:0. ft. • 52.0 • ft- ' . . ' .BROWN SILTY CLAY . : , .
5a.Well Location:' F I-
. 52.0• n• 60.0 ft' GRAY SI4[Y ""
. UNIVAR PwR.:_
• fit.' .. ft. ,._,r, <.,e,
Facility/Owner Name ' • ' ' . Facility.ILA(if applicable) ' • ' ' •f -
ft.- L . . D.-C- 1) .l• 2023 : . -
5010.HOVIS ROAD CHARLOTTE.28208 . it. ft.
' Physical Address,City,.and Zip . •':
21.REMARKS ,n! ,
' . MECKLEN BURG. SONIC
WATER SAMPLING THROUGH INFLATABLE PACKERS INSIDE TOOLING
County' Parcel Identification'No.(PIN)- • , ' !
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• 5b:Latitdde and Longitude in degrees/Minutes/seconds or decimal degrees: 22.Certification:
. (if well field,one lat/long is sufficient)
35' 16' 07.67" N 80° 53' 53.27" - 10/20/23
Signature of Certified Well Contractor' 'Date •
6.Is(are)the well(s): ❑Permanent or Temporary '- • • By signing this form,I hereby certify that the well(s)was(were)constructed in accordance .
' with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
• 7.Is this a repair to an existing well: DYes 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 • •
S.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 one form. SUBMITTAL INSTUCTIONS '
9.Total well depth below land surface: 25.0�40.0�60.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@100) . construction to the following:
• 10.Static water level below top of Casing: : 15'0 . • • - (ft.) Division of Water Quality,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 _
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11.Borehole diameter: 6•0 - (in.) ' ' 24b.For Injection Wells: In addition to sending the form to the address in 24a '
SONIC 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 Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center;Raleigh,NC 27699-1636
13a.Yield(gpm)" Method of test: 24c.For Water Supply&Injection'Wells: In addition to sending the form to ••
the address(es) above, also submit one copy of this form within 30 days of •
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13b.Disinfection type: Amount: completion of well construction to the county health'department of the county
• - _ ,_ where constructed.
Form GW-1 - North Carolina Department of Environment and Natural Resources-Division of Wateri QualityRevised Jan.2013
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ROY COOPER •• .,r,:+ • .l.
Governor
EL ZA ETH S'BISER.
Secretary
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•RICHARD:E ROGERS„1R;,
Director:. . ? ;,
NORTH'CAROLINAc_
:EnvliiininentaI Quul!!y<.•
"October'9,2023
Mr: Mark Kleiman(via'email) : -
Univar Solutions.USA,:Inc. . • "
: 503.SW Hampton Court: : .. " •'
Port St:Lucie, FL 34986
: . : RE: Monitoring Well Construction Permit'
`Permit#WM0301318: :. : :
Former Univar Hovis Rd Site, Charlotte
' "" �Mecklenburg County • .•
bear.Mr.:Kleiman; : : : :.. : • . . : .: : ..
: In accordance with your completed application received on:October 9;2023;•we'are forwarding herewith " :
: - :Monitoring Well Construction Permit Numbered WM0301318 and issued for:the construction of three(3):": : :
. ::monitoring well located near the subject site in Charlotte; Mecklenburg County,. .. " .
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This:Permitwill be effective for one year.from:the date of issuance and shall be subject to the conditions and "
limitations as specified therein.
:
Should you have any:questions, please.contact Edward Watson at(704) 235-2199,or by email at :
edwa rd.watson @ ncden r.gov.
Sincer ely;•
DocuSIgned byc
• A444e441 N )444
. F161FB69A2D64A3:.. - -
Andrew H. Pit ner; P.G. Regional Supervisor .
Mooresville Regional Office
'
Water Quality Regional Operations Section
Division of Water Resources
CC: WQROS,Central Office (via Laserfiche) •
Bill Anckner,Arcadis
Geologic Exploration, Inc:
North Caiolina Department of Enviionmental'Quality I Division of Water Resources
Mooresville Reaonal Office I"601 East:Center Avenue,Suite 301 I Mooresville,NC 28115
r+« �/�� 704.663.1699
DepmmmparmSommW wart I
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NORTH CAROLINA
DEPARTMENT..OF ENVIRONMENTAL QUALITY ••
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DIVISION OF WATER RESOURCES •
PERMIT FOR THE CONSTRUCTION.OF A MONITORING WELL . :
In accordance with the:provisions of Article 7, Chapter 87; North Carolina General Statutes,'and other applicable Laws, Rules and
Regulations: : .
1 PERMISSION IS HEREBY GRANTED TO
Univar.Solutions USA, Inc: (Arcadis G&M of North.Carolina as Agent)
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM consisting of three;(3)monitoring wells owned;by Univar
Solutions USA, Inc: at the subject site located:along Hovis.Rd and GulfDe.; .Charlotte,'Mecklenburg County. This -
Permit is issued in accordance with the application received on October 9, 2023, in conformity with specifications and .
supporting data, all of which are filed with the Department of Environmental Quality and are considered integral parts
of this Permit.. .
This Permit is for well construction only:and does not waive any provision or requirement of any other applicable law or regulation:
Construction of any well under this Permit shall be in strict compliance with the North Carolina Well.Construction Regulations and
Standards(15A NCAC 02C .0100), and other:State and Local.Laws and regulations pertaining to well construction: -
If any requirements or limitations specified in this;Permit are unacceptable, .you have a right to_an adjudicatory hearing upon
written request within 30 days of receipt of this:Permit The request must be in the form of a written petition conforming to Chapter
150B of the North Carolina General•Statutes.and filed with the Office of Administrative'Hearings 6714 Mail Service Center,
Raleigh, North Carolina 27699-6714: Unless such a demand is made,this Permit is final and binding.
This Permit will:be effective for one year from the date of its issuance and shall be subject to other specified conditions;
limitations; or exceptions as follows: ;
1: Issuance of this Permit does not obligate reimbursement from State trust funds, if these wells are being:installed as part of
an investigation for contamination from an:underground storage tank or dry cleanerincident: :
: : :2. Issuance of this Permit does not supersede any other agreement, permit,or requirement issued by another agency:
3: The well(s):shall be located and constructed as shown on the attachments submitted as part of the Permit application.. :
: 4:• Each well shall have a Well Contractor Identification Plate in accordance with 15A NCAC 02C .0198(o): •
: : 5.: : Well construction records (GW-1) for each well shall be submitted-to the Division of Water Resources'' Information,
Processing Unit within 30 days of the well completion: : :
.:6 When the well is discontinued or abandoned, it shall be abandoned in accordance;with 15A NCAC 02C :0113 and a well
abandonment record (GW-30)shall be submitted to the Division of Water_ Resources' Information Processing Unit within:
30 days of the well abandonment:
7: If the well penetrate s any water-bearing zone that contains:contaminated waters,the upper three:feet'of the well shall be
grouted within one day after the casing is set:or:the well abandoned. :
8. Temporary wells must be permanently abandoned or co nverted to a permanent well within seven days (168 hours)of
completion of drilling the borehole.
9. Adequate permits shall be obtained from Mecklenburg County Groundwater and Wastewater Services:
Permit issued the 9th day of October 2023
• FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION ."
DobuSigned by: I, ;
A4444w H P4444 :
. . . . _F161F869A2D84A3::. i•. .
. Andrew H:Pitner, P.G:, Regional Supervisor
' .Division of Water Resources
By Authority of the Environmental Management Comriiission.
Permit No:#WM0301318
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N Caroim Department of Environmental"Quality I Division k Water Resources
Mooresvilleorth Regionala Office 1.610 East:Center Avenue,Suite301 I Mooresville North Carolina 28115
NORTH JEQ
balWIMMII 704'.6631699