GW1--05165_Well Construction - GW1_20240830

WELL CONSTRUCTION RECORD Tor lai lUseoxl,r
This'form can be used for single or muhipk uctF
I.Well Contractor information:
14.WAi*R ZONES
Rich Lemire FROM t(t DT.1('RtPTIO\
Well Contractor Name h• ft.
2593A 1 h. ft.
NC Wcl Contractor Cofifcuioa Number IS.OUTER CASINO Oar aauln-word wxas)OR LINER Cifff t ieSsa►te)
FROM TO PLAMTTTR Tmr-IiNr s MATTRo 41
SAEDACCO ft. f. in.
Company Nam laatiNa1 CA81740 ORTlR1NGiLIgtllennalcMned•toott_ _ ' '
1 FROM TO DMFTER '70k 71S5M ATTRI.IL2.Welt Coa#trpctlon remit 1: WM0301368 0 f. 20' h. 1" v SCH0 PVC
fiat alfalr)beabk aripermits fie:County.Sear.Variance,lrf(CDirl ra i .......
ft. h. sir.
J.Weil Use(check well awe):
Water Supply Well: FROM To i DLA%t/'Tm;R MATT SITI ' IOU ksi-,• M4TFRTM,
❑Ag��ral °>ti unicipal/Public 20' ft. 30' D. 1" ia. 010 1 SCH-40 PVC 1
OGeothemnal tHeating/Cooiing Supply) °Residential Water Supply(single) ft. ia. 1
OlndusuiaVCommercial °Residential Water Sttpph(shared) I8.GROUT
tritOM To show silt. 1 IMPL(CTME\T ME7110D d AMOL VT
Obligation 16' ft. 18' ft. BENTONITE j POURED
Non-Water Slipply Well:
ft. ft.
alMvMonitoring E3Recosety ,.
Injection Well: h. ft.
°Aquifer Recharge °Groundwater Rentediation `11t, -�- _,
ttA1lr!'A7CdBspisluir)
FROM 711 MATRRIal. i SIPI.0 I MINI MI 11111D
°Aquifer Storage and Rrxovcn °Salinity Barrier 18' It. 30' ft. SAND 1 #2
❑Aquifer Test OStonnwater Drainage —
D. ft.
❑Experimental Techmolog• °Subsidence Control
410.DRILLING LOG(attach■dditioaal tit if ar.:roan t
❑Geothermal(Closed Loop) ❑TtSC'f FROM 1(1 DE5('RIPTIO\Bair,Aordnea,x.il INN k Opt,r0n..n.c4'1
❑Geothermal(Heating/Cooling Return) °Outer(explain under 121 Remadcs) 0 ft. 30' ft. RED SILTY CLAY
ft. h.
4.Date Wel(s)Compkeeg: 8-7-2024 Well ma P-2 ft. h. r _
Sit.Well Location: h. h. .y ,Z.^r f --Z V
Jason Ernst h. h. AUG J 0 E624
Foci*,11 1.r V;1me Facile!11} (ifnpitcibk) h. h.
1r.`t:4,. . -1 .---sc 'Je.%
3100 N. Sharon Amity Rd. , CHARLOTTE, NC, 28205 ft. h.
Physi
cal Md,vsa.Cite,and Zip }
REMARKS
MECKLENBURG 10301137 BENTONITE FROM 16' TO :.8' .
(omit. Pared idenufeeauonNo.(PIN)
Sb.Ur**and Longitude in degrees/minutes/seconds or decimal degrees: 22.Ccrtt amnion:
Of well field,one balms is luf flcrc to
l
'-rl
K �r —,e" ,: ...G� 8/9/2024
_ ,_
Sigsatniv of Cent :Well Comae' tor Dluc
6.is(are)the well(s):'°JPermanent or 21Temporary 8r Filming tint from 1 hereby terrify data the snits)soar(owe) mint-led in acY'a1401er
wok I CA NCAC 02C.0100 or I SA NOW 02C.0200 Well Crunnw•rice Standards and Mai a
7.Ls this a repair to an existing nchi: OYta or XNo ropy of Chit reroni/no brat provider!to Me writ miner:
if tins ss a repair.fill par boom well coarsrwo 1(tat infnnmariun trail mpio st the&Mire of the
repair waArr 021 rlraaarks Fortier Or art rlr bark of this form. 23.Site diagram or additional w ell details:
You may use the back of this page to pros ide additional well sue details or well
8.Number of welts constructed: 1 conatmetion details. You may also attach additional pages if necessary.
For swfrip(c irtiet rho or rain- me,~Iv wells°Alt ..Jo,the UM(construction Teem oat
submit one Iona SiIBlitI TA1.1NSTUCTIONS
9.Total well depth below land surface 30' (f1i.) 24a. For MI Weft Submit this form within 30 days of completion of well
For murk writs list Mt*Orr iftitikrrmt Ceram lkr-':3Q200'utat 20100) constriction to the following-
10.Stank water level below top of casinV 21' (ft.) Division of Water Resources,Information Processing Unit.
if barn r hotel ea above,easing,are"+`• 1617 Mail Service Center.Raleigh,NC 27699-1617
11.Borehole diamaeter:8.25" (in.) 24b.For_lniectioa Wells ONLY: In addition to sending the form to the address in
24a above. also submit a copy of this form within 30 daps of completion of well
12.Well construction method: AUGER consunction to the following
(ie aucr.rot:ln.cable.direct posh.etc 1
Division of Water Resources,Underground Injecdea Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mad Service Center.Raleigh.NC 276994636
13a.Yscid(ow___ Method of tart: 24c For Water Sunnis&Injection Welk:
Also submit one cops of this form within sI) days of completion of
13b.Disinfection rt p(: Amount: construction to the county health department of the county where
cotlwructcd.
1',.1n1(,5h-t Non),Caroltna Doan mem of Ern memos and Naolnal Resources-Dwntnn of Water Retards Rcs toed AinJlk 2 t11