GW1--01770_Well Construction - GW1_20240320

WELL CONSTRUCTION RECORD For Internal Use ONLY:
eTllis ktrmlan be used for single or multiple sie"k
1.Well Contractor Information:
14.WATER ZONES
Brian Ewing VROMM TO I DF�l R(P1KI\
1l'cll C'ortrr*nr ti.nne 1 ft. ft,
ft. A.
4240-B i
n -I' i „•<.-nigh sar•*amberi c.rot It ftCASLNG flow meMi-cased wells�NN t LINER_tif able)
FN<tt1 t TO DIVWFTER TH1(I F%S l M>•TTR14.1
SAEDACCO tr. ! N. 1 W. ___.1
I t,.I�.t:kCASINq 91t 11AING•( e l4raral duse443 rlr!
',)butt In DI4 Uern TltickNTSi M.UTRI4I
2.Will(rein,.truerim.Permit M: 70002916
0 tl. 20 ft. 2 isI- SCE-40 PVC
,p/hnistr trti p.ntri:,,...Cosmic S. I,,ritler-r• r eCDCilrt... II. H. itw
..Weil 1 sc wheel;well owl: • 17.s(Rt.t.
\dlt•r\Upph ►ell: FRII 1 to i RUMUTr.R suit\t7i ! t mi.to rstt - liATFR141.
1�o:rr n1[ul,tl blAfurrcipcTlT'tdrlrr 20 II. i 30 N 2 M' .010 SCH-40 PVC
LIGeothcmtal(Heating.Cooline Supply i ''Residential Water Simply isitts.:ic) h" t H i M
OlndustrialiConticRra) I1Rcsidcltti:ll Water Supply Ish r(id) 1 I$.GROQTI 1
r
i ERON TO MATERL11. PMPLACIME‘T METHOD 4 AMOINT ,
❑tmgntion 1 0 ft. 16 H. PORTLAND TREMIE
Non•Watcr Supply Well: t fr. ft.
®!.:nnimnn ClR:crt n t r — -- --.i
Injection Well:
❑Aquifer Recharge OCitntindu iI r Rcrnediatioo .-1-43—.4911/014AillILPM9Clif yelieshle)
❑Aquifer Stomp and Reco�'cn DSRlinin Barrier + PRt!>M MxT6RLu. r r:vPI.0 rsn s T.IrTHou
18 ft. 30 N. FILTER SAND d 2
DAgirifcr Test DSWnm►a1M Dcii(Ki,.,I'C ft
DEVenmcntal Technology OSidisidcoce C'a+aml
2a.DRILLING LOG(attach additiansl sheets if aeressan t
OGeutliemul(Closed Loup, D'fracer PRoSI To i ppm-laPTIU.'um.,hard,,.•.'..r.u.n.r►r!i.t.A..n•rr,Nt-I
t
OCa`othermal tHeattnpp,'Coollrug Return► DOther tertpklin under/t21 Retnatls) 0 u. 5 n PILL SILT AND SAND
5 ft. 15 It. 1 SILTY SAND
1.Date WrelkaiCompleted: 2-22-24 N„it 11)pmw-19 15 fl. 1 20 R MET SILTY SAND
5a.Well Location: 20 n. 30 p, SILTY SAND 1RDISTr_TO..ItINT,
PST Site 1 rt. - . Y.ft. E 1' i�,,o - - '1 `y: 1 a
Fat this(htrirN,ntk F.acrtnt Mt',ifxrTtlranks -._._.W.�.: m- _..... -
�. MAR 9. Q 7fi74
8421 Old Statesville Rd., Charlotte, NC, 28269 a ft M.
Phs steal Address.Cits.and Zip 3I.REtNARtwti trftuTre.si'. .. . ,..yira;r12-U1*
Mecklenburg • BENTONITE SEAL 16 TO 18' Dtt Cj13JCi
t'<"u.n P.n.rc:1.1•nilr,Caion Ni.IPP,
Yb.Latitude and Inngirude in Iki I's.'nrinu resr'sanmits nr decimal degrees: '2.(ertitirati in:
td atI fvhl ,as-kr ion;P.Nanict.:al:
N w Brian Ewing 3/1/2024
6.IS tare)the nails): ZPermanent Rw l7Temporsty Bs signing ekes font[./kere-hr eerie%that[Jar weliPx)Met!were)tw2,ln«atll in accordance
wail I to VC AC t)C AIM,or 1 ra lC:tC 0.'C 1ml..)1441 Cosi/no ti.u,Sena,/ur.l..rnd Aker n
7.Is this a repair to an existing well: DYra or ENo •,rn of rhts re:on/has beer pim•ttlyd ro ihrr:wit owner.
If,nt.tr;.:Ir/hl;r.tiliss:lrlolti Itft1tttnrlsn.IWO,rrt etina,rrnells!rtlrl'a,P r!N'IatrNre'.ifthe
repair war-trY?1 rrtnarkv.te.•ti•et.tr on the buck of Mix jam. 23.Site diagram or additional well details:
you mray use the back of this pow to pros ode addrtiotlal'sell site details or(Tell
S.Number of netts carnstnieted: 1 conatrudion details. You out also atiacft additional pages if n xessan.
i,',maist1At+Hart-rt•rt;n nem-..o4,.WTI I a•elh r1:1'LII wrth the mot ronilrwctww tr:,p tear
tleMpt<wit frtnn. SUBMITTAL 1NSl'llC't'IONS
9.Total well depth below laud surface: 30 a',.l 21a. For All Wells: Submit this funn n ithtn 10 days of completion of ss ell
For ma/10k wrlf.!is/fell.4.-pripi ifdeArrrnt Fetoenjsir- +li?'ta/'rear[20 100l construction in the foaming,
tit.Static water lesel hellos top of raring: (lt.l Uisision of Water Resources,Information Processing I.nit.
t t•r,,;,.,:•_ ,.. 1617 Mail Service('enter.Raiei>;h.N(-2 7699-16 1 7
t I.13i.rrhok diameter:8.25. (in) 24h.Fur(gjectiof Wens ONLY: fa addition to sending the form to the address in
24a abos e. also submit a copy of this font, unlit. ?t)day s of completion of well
12.Neil oin..t1'uctktu method: BORED construction to the(alining.
i•',. l i-::r.rca:ict.:ark.direct posh,Sic I
Mishits of Water Resources.Underground Injection Cannel Program,
'I'ClR W 1 TFR SUPPLY WELLS ONLY: 1636 Mail Sees-Ice Center.Raleigh.NC 27699-16J6
21e.For Water Suigplt A Injection Wells:
I 3a.1 itid(2pm) Method of test:
Also submit one copy of Otis turn, a it11111 to day s of Completion of
13h•Disinfection n pc: Amount: well constnietton to the counts health deportment of the county'where
consiRL:ted
harm G11'-1 \Nth(.AultIlaI;LIwullcllio1 hit.trultiltiltt:s d`ativaiR.ic.urCes- L)tsISMRof11':iicnResotrce R.ts.d:s<ugust?trl