GW1--01247_Well Construction - GW1_20240229

-STATE
� !?r, QP� NONRESIDENTIAL WELL CONSTRUCTION RECORD
i " }�o; North Carolina Department of Environment and Natural Resources-Division of Water Quality
N,a a:aF• ' WELL CONTRACTOR CERTIFICATION# 2717-A
1.WELL CONTRACTOR: d. TOP OF CASING IS N/A FT.Above Land Surface*
Jay Little *Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
Well Contractor(Individual)Name
S&ME, Inc. e. YIELD(gpm): N/A I METHOD OF TEST N/A
Well Contractor Company Name f. DISINFECTION:Type'N/A Amount N/A
STREET ADDRESS 2016 Ayrsley Town Blvd, Suite 2A g. WATER ZONES(depth):
From N/A To N/A: From N/A To N/A
Charlotte NC 28273 From N/A To NMI From N/A To N/A
City or Town State Zip Code
(704 )_ 523-4726 From N/A To N/A From N/A To N/A
Area code- Phone number 6. CASING: Thickness/
2.WELL INFORMATION: Depth I, _Diameter We 4j Material
SITE WELL ID#(if applicable) ITZ-29 From 0 To 57 I Ft. -In. sc PV(;
- — N/A N/A_ N/A---
- —s — —From N/A—To N/A--i-Ft.
_ STATE W ELL PERMIT#(if applicable) K/A
From N/A To N/A !Ft. N/A N/A N/A
DWQ or OTHER PERMIT#(if applicable) SIP 70001078
WELL USE(Check Applicable Box)Monitoring❑ Municipal/Public D 7. GROUT: Depth Material Method
From 0 To 54 Ft. Neat Cement Pour
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection❑ From 54 To 56.4 Ft. Bentonite Pour
Irrigation❑ Other (list use) Air Sparging
From 56.4 To 56.7 Ft. k-packer N/A
DATE DRILLED 1/29/2024
8. SCREEN: Depth Diameter Slot Size Material
TIME COMPLETED morning AM al PM❑ -
From 57 To 62 Ft.2 in. 0.010 in. PVC
3.WELL LOCATION: From N/A To N/A N/A
CITY: Charlotte COUNTY Mecklenburg Ft. in. N/A in. N/A
From N/A To N/A Ft.N/A in. N/A in. N/A
Mount Holly Road(MCK Terminal) 9. SAND/GRAVEL PACK:
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) Depth Size Material
TOPOGRAPHIC/LAND SETTING: From 62 To 71 Ft. #2 filter sand
0 Slope 0 Valley El Flat ❑Ridge 0 Other From N/A To N/A 1Ft. N/A N/A
(check appropriate box)
35.2803 May be in degrees, From N/A To N/A .F(, N/A N/A
LATITUDE
-80.9431 minutes,seconds or 10.DRILLING LOG
LONGITUDE in a decimal format From To i Formation Description
Latitude/longitude source: XGPS ❑Topographic map 0 43.5 Silty Sand
(location of well must be shown on a USGS topo map and 43.5 71 granodiorite
attached to this form if not using GPS) !
4.FACILITY•is the name of the business where the well is located. �-►.+^i 3
FACILITY ID Cif applicable) N/A - R f_i.L itIE 0
NAME OF FACILITY MCK Terminals, LLC(MHRG)
FEB 292024
STREET ADDRESS 8035 Mt. Holly Road
Charlotte NC 28214 ijorlrta:len rqmcwxrig tlydl
City or Town State Zip Code DAFICE;BOL
CONTACT PERSON Scott Janashak
•
MAILING ADDRESS 1100 Situs Court, Suite 100
Raleigh NC 27606 11.REMARKS:
City or Town State Zip Code Sparge well is direct buried. Water level is approximately 5 feet
( 904 )_ 571-2011 bls.
Area code- Phone number
5.WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wmi
15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
a. TOTAL DEPTH: 62 feet RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
_ 2 On 'L' l b. DOES WELL REPLACE EXISTING WELL? YES❑ NO( S L lr -Z`/
G TURE OF CERTIFIED WELLL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use"+"if Above Top of Casing) Jay Little I
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-lb
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. i ' Rev.7/05
i
1