GW1--01772_Well Construction - GW1_20240320

WELL CONSTRUCTION RECORD For rmcmal Ilse ONLY
This tonneau be used for single or rnaltipk uctic
1.Well Contractor information:
t4 WATER ZONE,
Brian Ewing FROM TO tml(Rtr'itepe
%Ccn I oT rurau Name ft. ft.
ft, ft.
4240-B
NC WeilComm:ear Cr:MS=1Ion NHR>bcr `,11.OUTER CASING(kr asulti-emaduallan OR LINER(if asuaeabk) .
FROM TO DIAMETER THICKNESS NI TTRi AI ,
SAEDACCO h. ft. to
'MSG ,
Cevr>parrl ts,mt a Olt l ) . ` ;,I
FROM TO DIAMETER THICKNESS _MATTRLUt.
2.Well Construction Permit#` 70003186 0 N. 23 ft. 1 in. SCH-40 PVC
list allaprificabfr well promo r,r.County.Store:Variance.1rrKR'014 rte,t r H. (I. in.
3.Wdl l'`sc(check vial use):
Water Supply Weft: , FROM TO DIAMETER sta1slit TOKIOh.• , MATE'RIAL.
0Agrieuitiital tiMunicipaVPublie 13 R. 23 ft. 1 is 010 SCFi-40�eY PRE-PACK
OGeotbennal(feaingttooliog Smolt) °Residential Water Supply(single) h' h ifr
1 Ott.GROtrf
Olndusdiaifrotnnietciat ORlsidetltialWaterS h I penned) nom , TO AtATERL1i. EMPLACEMENT METHOD rlAklOt:�T
Obligation It. ft.
Non-Water Supply Well:
eiMonitonng °Rtcovrry
Injection Well: ft. ft.
i' SAN tW appliosdrk) _.,
6Aquifer Recharge OGrotuidfi�ater Renletliatian � __- _ -___v
tans; TO %I4TIDISC t I DPI.srIMINIMImoon
0Aq(nfer Storage and Recovery 1JSalinih'Barrie[
{ 11 ft. 23 ft. FILTEk SAND I # 2
O Aquifer Test CIStormwatcr Doi nage k R. ft. i
OFxperincntat Technology OS(Ibsideticc Control 20.DRiLldNG LOG Causal additional 4ie t,if fret carp I
OGeihennal(Closed LOOP) °Tracer FHOM TO ' DESCRIPTION itvi.r,harden•..:not nnt.i.pa.wean..re,t$.I
OGeothennal(Heating/Cooling Mum} OCkliet(explatn undo s_I k llrul,;I 0 FILL SILT AND SAND
5 R. 15 ft. SILT CLAY MOIST
4.Date WeJJ(sl Completed: 2'19-24 Weil ID%TMW-1 15 ft. 23 ft. SILT CLAY MOIST TO WET
Ss.Well Location: MM -
200 East 7th Street Owner LLC �_. i._r 1,,,.,'''''':>r
Faci]1 yy OwticrNanic Facility 110(if appticabk) _e. -....--.:
It. ft. MAN 2 Q 2024
324 N. College St. Charlotte, NC 28202 Mecklenburg, ft, ft.
Charlotte, NC, 28202 P1ts,ua9 addra,.. Zipfen.and ta- 5,, •-
21.litltMAR1E'�`�`'>. vs r"' .:71's+r.-',.''3,", , .�1.£3 r..
Mecklenburg 08002401 BENTONITE SEAL 8 TO 11' '74=
CoaM2 ratter hierdrficairon No (PIN)
50.Latitude and Loagiftiele In degamiminutestfeconds or decimal dames: 22.certification:
ONO Meld,one tartans is sufficient)
N W . Brian Ewing 2,26,2024
Signature of(:11 i I c.d w cal Coatmetor u.>tc
6.[stare)the weli(s): 3Permatient or xTemporary try straining this farm. 1 herein.ertely rhea the swats, • ,re)caratfuered in oc.orda nee
with 1-4 NCAC 1)2C.tt l t)tO or 15A\'CAC II.C,O 1O ti'eli Cocwr ttr on St as a ie and that o
7.Is ibis a repair to an Insisting v el: OVER or No Carps ofthit terrfnf 4a>been provided i it,the crfi m.twI:
Vt is is a terPadr„„fill oat known wetl evasion-don information rood E.440in the water c9'thr
repair wider S2l meaarkr tertian or oa the bark of this.for 23.Site diagram or additional well details:
You may use the bock of this page to provide ad(ktional well site details of well
11.14umberof wells constructed: 1 constnietion details.You may also attach additional pages if necessary.
For»Ilattipte iajeatuo>or nail-serer ssgcph welts ONLY with Jr WM eaasiratlio►,neon[cape
awbv>ttlanePIM. SUBMITTAL,INS?UC1`IOtIS:
9.Total Sidi depth below[fra !surfaces 23 (ft.) 24a. For AO Wells Submit tins form within 30 days of completion of well
For swhirte'wells list alderear((dif%renites. k-3ia29O`wal201110) eonstnlctionto the foibnileg;
10.Static Water lewd below top of ca±titir (ft) Division of Water Resources,information Processing link,
If Maher level n altcne comott infra"4" 1617 Mal Service Center.[(sleigh.YC 27699-i617
ti.Borehole diameter:2.25" (in.) 24.For Liliation Wens ONLY: in addition to sending the form to the address in
24e above, also submit a aim,of this form tc ithin 30 days of completion of well
12.Well construction method: DRIVEN ConStiUetiOn to the following.
be.mar Mary,cubic,aired push,tic>
Division of Water Resources,Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mal Service Center.Raleigh,NC 27699-1636
13a Yield(gpm) Method tritest
at: 24c.For Water Supnli'dtc fellation Wells:
Mso submit one cop) of this form within 30 days of completion of
13b.Disinfection ttrpe:;. . ,. m Amount: _..- yell construction to the county health department of the count} where
constructed.
Pone OW-I North Canons Detainment otEm`s>oluntmandmanualResources-DiraionofWaterRetain:et RCN seedAItgugIAll