1304_Cabarrus_CharlotteMotorSpeedwayV_MSWLF_WellInstallandAbandonment_FID1541301_20210224

Environmental Consultants & Contractors
February 24, 2021
File No. 02201314.91
Ms. Jaclynne Drummond
North Carolina Department of Environmental Quality
Division of Waste Management
1646 Mail Service Center
Raleigh, NC 27699-1601
Subject: Monitoring Well Installation and Abandonment Report
Charlotte Motor Speedway Landfill V
Solid Waste Facility Permit No. 1304-MSWLF-1992
Concord, Cabarrus County, North Carolina
Dear Ms. Drummond:
SCS Engineers, PC (SCS), on behalf of BFI Waste Systems of North America, LLC a wholly owned
subsidiary of Republic Services, Inc. hereby submits this Monitoring Well Installation and
Abandonment Report for the Charlotte Motor Speedway Landfill V. Facility solid waste permit is
1304-MSWLF-1992. The wells installation and abandonments performed in support of Phase 3
landfill development.
Should you have questions or require additional information, please do not hesitate to contact Jared
by email at [e-mail], by phone in the office at 704-916-1528 or on his cell
phone at 704-726-5814. If you should need further assistance, Albert can be reached at
ai�,[e-mail], 704-916-1534 or 704-787-3074.
Sincerely,
Jared T. Hamela, PG
Senior Project Geologist
SCS ENGINEERS, PC
jth/ble/adg
I (i �11 M——
Albert D. Glenn, PE
Project Director
SCS ENGINEERS, PC
2520 Whitehall Park Drive, Suite 450, Charlotte, NC 28273 1 704-504-3107 0

Monitoring Well Installation and
Abandonment Report
Charlotte Motor Speedway Landfill V
Permit No. 1304-MSWLF-1992
BFI Waste Systems of North America, Inc.
wholly owned subsidiary of Republic Services, Inc.
5105 Morehead Road
Concord, NC 28027
02201314.91 1 February 24, 2021
2520 Whitehall Park Drive, Suite 450
Charlotte, NC 28273
704-504-3107

Table of Contents
Section Page
1.0 CERTIFICATION...................................................................................................................................1
2.0 INTRODUCTION...................................................................................................................................2
3.0 MONITORING WELL CONSTRUCTION................................................................................................2
4.0 MONITORING WELL ABANDONMENT................................................................................................2
Figures
Figure 1 Site Location Map
Figure 2 Groundwater Monitoring Well Locations
Appendices
Appendix A
Monitoring Well Construction and Boring Logs
Appendix B
Field Notes
Appendix C
Historical Map
Appendix D
Photographic Log
Appendix E
Driller Certifications
M:\PROJECT FILES\02201314.91\Deliverables\Well Installation and Abandonment\13-04 Monitoring Well Installation
Report 20210224.docx
Monitoring Well Installation and Abandonment www.scsenciineers.com
Page

1.0 CERTIFICATION
This Monitoring Well Installation and Abandonment Report has been prepared by a qualified
geologist who is licensed to practice in the State of North Carolina. The report was prepared based
on firsthand knowledge of site conditions and familiarity with North Carolina solid waste rules and
industry standard protocol. This report was prepared in general accordance with North Carolina
Department of Environmental Quality 15A NCAC 2C Rules for well construction and abandonment
standards and North Carolina Solid Waste Rule 15A NCAC 13B .0601
Senior Project Geologist
Date: February 24, 2021
NOT VALID UNLESS THIS DOCUMENT BEARS THE SEAL OF THE ABOVE -NAMED LICENSED PROFESSIONAL
Monitoring Well Installation and Abandonment www.sCsertaineers.corn
Page 1

2.0 INTRODUCTION
This report details the installation of groundwater monitoring wells MW-37 and MW-38, and the
abandonment of an unutilized groundwater monitoring well labeled as MW-14 at the Charlotte Motor
Speedway Landfill V. This report serves as the required certification for the well installations and
abandonment. The landfill operates under solid waste permit No. 1304-MSWLF-1992 and is located
at 5105 Morehead Road in Concord, North Carolina. The landfill location is depicted on Figure 1 and
the monitoring well locations shown on Figure 2.
Well drilling/construction and abandonment performed by Innovative Environmental Technologies
(IET), a North Carolina Certified Well Contractor, under the supervision of a North Carolina Licensed
Geologist. The well construction records (GW-1s) and well abandonment record (GW-30) generated
by IET are provided in Appendix E.
3.0 MONITORING WELL CONSTRUCTION
Under the supervision of SCS Engineers, PC, installation of monitoring well MW-37 occurred on
October 21, 2020 with surface completion occurring on January 20, 2021. This time separation was
due to the inability to access the well location caused by an extended period of wet weather.
Installation of monitoring well MW-38 began January 18, 2021 and completed on January 20, 2021.
The well boreholes were advanced using a Geoprobe 7822 DT with a 6.25-inch hollow stem auger
and 6-inch air hammer and tooling for MW-38. The wells were constructed with 2-inch diameter
schedule 40 PVC slotted well screen and solid pipe, sand filter pack (GP-1), and bentonite and grout
seals. The wells were finished at the surface with a 2-foot x 2-foot concrete pad, above ground steel
cover with a lock, and protective bollards. Monitoring well boring and construction logs provided in
Appendix A with our field notes in Appendix B.
Monitoring wells MW-37 and MW-38 were developed by SCS Engineers, PC personnel using a
submersible pump discharging well purge water to the ground until visibly clear of sediment.
Approximately 10 gallons of water was purged from MW-37 and approximately 30 gallons of water
was purged from MW-38.
4.0 MONITORING WELL ABANDONMENT
During the course of the well installation activities, a monitoring well was discovered that was not
previously identified and not included in the landfill's Water Quality Monitoring Plan. The well tag
was photographed and information from the tag was included in the well abandonment record
included in Appendix E. A photo of the well tag is provided in Appendix D. Upon review of a historical
potentiometric map sourced from the NCDEQ online database (Potentiometric Map, S&ME,
September 1988) the identification for the well was determined to be MW-14. For reference, the
historical map is included in Appendix C. It should be noted that there is an existing MW-14 located
near the eastern boundary of Cells 2A and 2C that is included in the Water Quality Monitoring Plan
for routine compliance monitoring. The abandonment of the discovered MW-14 completed on
January 19, 2021 by grouting it in place with a neat cement mixture ratio of 47 pounds of portland
cement to 2.5 gallons of water. Location of the abandoned monitoring well MW-14 depicted on
Figure 2.
Monitoring Well Installation and Abandonment www.scsengineers.com
Page 2

Figure 1
Site Location Map
Monitoring Well Installation and Abandonment www.scsengineers.com
F-1

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APPROXIMATE SCALE IN FEET
BASE MAP SOURCE:
USGS TOPOGRAPHIC MAP, 7.5 MINUTE SERIES,
HARRISBURG, NORTH CAROLINA, 2016
•' Vv yO —
e 2
SITE LOCATION
CHARLOTTE MOTOR SPEEDWAY LANDFILL
5105 MOREHEAD ROAD
CONCORD, NC 28027
qr-q FN(,INFFRS
FIGURE 1 - SITE LOCATION MAP

Figure 2
Groundwater Monitoring Well Locations
Monitoring Well Installation and Abandonment www.scsengineers.com
F-2

LEGEN D
700 — 10 FOOT ELEVATION CONTOUR
- - - — PROPERTY LINE
-- — — — — —- — LIMITS OF WASTE
— PHASE 1 EXTENTS
— PHASE 2 EXTENTS
— PHASE 3 EXTENTS
— FUTURE PHASE 4 EXTENTS (EST.)
— LIMITS OF CLOSURE CAP
BMW—# — EX. GROUNDWATER (GW) MONITORING WELL
MW—# — PROPOSED GW MONITORING WELL
A-,MW—UNK — ABANDONED MONITORING WELL
w SW—# — APPR. SURFACE WATER SAMPLE LOCATION
TOPOGRAPHY NOTE:
1. LANDFILL SURFACE GRADES TAKEN FROM JANUARY 9,
2020, AERIAL SURVEY BY COOPER AERIAL SURVEYS.
w
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EXISTING
PHASE 1 EXTENTS ,
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SEE NOTE 1
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NOTES:
1. SW-1 LOCATED UPSTREAM ON ROCKY RIVER BENEATH
US 29 OVERPASS
2. MW—UNK IS PERMANENTLY ABANDONED.
EXISTING PHASE 2 EXTENTS
- - W-1
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J SCALE:
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DRAWING NO.
REPUBLIC
SERVICES 02 of 3

Appendix A
Monitoring Well Construction and Boring Logs
Monitoring Well Installation and Abandonment www.scsenaineers.com
Appendix A

N
N
W
Date Started
: 10/21/2020
Date Completed
:01/20/2021
LOG OF BORING MW-37
Hole Diameter
: 8 in
Drilling Method
: H.S.A.
(Page 1 of 1)
Depth to water (TOC)
: 14.95
Charlotte Motor Speedway Landfill
SCS Personnel
: B.Eigenberger
Well Material
: PVC
5105 Morehead Road
Northing Coord.
: TBD
Well Diameter
: 2 inch
Facility Permit 13-04
Easting Coord.
: TBD
Well Slot
: 0.01"
Concord, NC 28027
Driller / Company
: Johnathan / IET
Sand Pack
: GP #1
Project # 02201314.91
Logged By
: B.Eigenberger
Total Well Depth
: 20ft
m
Q
u-
c
Surf.
Elev.
U
CL
U
07
o
�
0
I•a
4
N.
0
10
12
14
16
18
20
22
U
DESCRIPTION
SANDY SILT, brown, very fine grained, dry
MIL
SILTY SAND, grey, brown, moist
SM
bgs = below ground surface
SAA = same as above
PWR = partially weathered rock
NA = not applicable
TBD = to be determined
Auger refusal at 20'. Boring terminated at 20' bgs
Well: MW-37
Elev.:
TBD
Cover
Surface
Casing
x;
y
.=
:e-
Riser
y
:e
'=
''
Grout
F�
Seal
Sand Pack
Screen

Charlotte Motor Speedway Landfill
5105 Morehead Road
Facility Permit 13-04
Concord, NC 28027
Project # 02201314.91
m
Q
u_
U
c
Surf.
_
Elev.
U
Q
U)
of
0
2
4
6
8
10
12
14
16
18
20
22
24
Date Started
: 1/18/2021
Date Completed
: 1/20/2021
Hole Diameter
: 8 in
Drilling Method
: H.S.A./ Air Rotary
Depth to water JOC)
: 15.9 ft
SCS Personnel
: B.Eigenberger
Northing Coord.
: TBD
Easting Coord.
: TBD
Driller / Company
: Johnathan / IET
Logged By
: B.Eigenberger
DESCRIPTION
LOG OF BORING MW-38
(Page 1 of 1)
Well Material
: PVC
Well Diameter
: 2 inch
Well Slot
: 0.01"
Sand Pack
: GP #1
Total Well Depth
: 22 ft
SC
CLAYEY SAND with silt, red -brown, slightly moist
Auguer refusal at 5'
Air Rotary
bgs = below ground surface
SAA = same as above
N PWR = partially weathered rock
NA = not applicable
o TBD = to be determined
Boring terminated at 22' bgs
Water level at 12.8' bgs on 1/20/2021
Well: MW-38
EIeTBD Cover
F—hasing
urface
Riser
3rout
Seal
Sand Pack
Screen

Appendix B
Field Notes
Monitoring Well Installation and Abandonment www.scsengineers.com
Appendix B

Date Started
- C7
Date Completed
:18`L1
LOG OF BORING
Hole Diameter
ga'rj
SCS Personnel
�c, f
Drilling Method
: �.jdj
Charlotte Motor Speedway Landfill
Northing Coord.
Depth to Water (TOC) :I'y,QS
5105 Morehead Road
Easting Coord.
Depth to Water (bgs) :
Concord, NC 28027
Drilling Company
Drilled By
: If£Z
?+�"
Well Development purge vol: In— 11a'15
PiB��
Facility Permit 13-04
Observed clarity :
Proiect # 022201314.91
Logged By
;wCt �
Purged Dry? qpfj
0
" 5; 1 +
SPA got -,a
LcrA
i
gm,,,.r, S;14J S.'Ad
wd
13-vPej, S"d) 5:�OC/
1
20 91,
O
m
N
bgs = below ground surface
o SAA = same as above
N PWR = partially weathered rock
NA = not applicable
TBD = to be determined
DESCRIPTION
SOAL
no - ,
M S1
Well Construction
Information
WELL CONSTRUCTION
Date Compl.
tOPP
Hole Diameter
Drill. Method
: 141D
Company Rep.
: ZL- -I
WELL CASING
:ya ?o5
Material
: pv<-
Diameter
: 7, If
WELL SCREEN
:B ,ZC�
Material
PV1,
Diameter
: t
Slot
p fig
SAND PACK
y �d
ANNULUR SEAL

Date Started 16
Date Completed ?0 ScnccVJ
Hole Diameter
LOG OF BORING
Drilling Method : 0540°kI5q�1
Depth to water JOC) 151 q
SCS Personnel : (3 p�b�C�
0 V
�(
-3 U (Page 1 of 1)
l�/� �� t J U� /�; �'
� GtY
Well Material : PVC
Northing Coord.
Easting Coord.
Driller / Company T £1 ""h''�
Logged By Ps �p�
Well Diameter :
Well Slot : 0.0 1
Sand Pack : V P " )
Total Well Depth CP
JDYLL
.=
Description
Well construction
o
information
°,XL�, 5' I41 Sn,a# Cim�s
Date Comp: 26 $cgw7
Cj- -2D'i
Hole Diameter:
Drill Method: NSA, A;"
7�/ S �t n4P -` �� j` I� S,'�
Company Rep: T
�-
e_, 5 , 1 J 11 s 1�
1 °
Well 4,3
p
to, Fct t obvi aj 4;
��
al
Material
Diameter: a"
G -q go 0" �'''°� � �' ✓ `��'�
Well Screen:
AcRff 4Caj04 5'
Material PUC
r Ncm
Q�
Diameter a "
Slot o •01
``''
__ ,,„JJJJ
Sand Pack:
�0►�p
r �
Annual Seal: S �;
jt oat
Depth To Water TOC: �S
/
Depth to Water BGS ��•�
;2.0 QG5
Well Depth: 25•' 70C
Well Dev purge volume: %O
Observed Clarity: VC'j Ck4V
Purged Dry? OUO
bgs = below ground surface
SAA = same as above
PWR = partially weathered rock
NA = not applicable
TBD = to be determined

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r

Appendix C
Historical Map
Monitoring Well Installation and Abandonment www.scsengineers.com
Appendix C

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Appendix D
Photographic Log
Monitoring Well Installation and Abandonment www.scsengineers.com
Appendix D

SCS ENGINEERS

i"L
�4
is tt '4
Photo 2. MW-14
•
Photographic Log Project Number:
CMS Landfill V 02201314.91
5105 Morehead Road Page 2
Concord, Cabarrus County, NC

Appendix E
Driller Certifications
Monitoring Well Installation and Abandonment www.scsengineers.com
Appendix E

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3455-A
1. WELL CONTRACTOR:
Randy Phillips
Well Contractor (Individual) Name
Innovative Environmental Technologies
Well. Contractor Company N arne
STREET ADDRESS 30 Grant Park Place
Piedmont SC 29673
City or Town State
(86� - 288-1986
Area code - Phone number
Zip Code
2. WELL INFOWNIATION: MW-14
SITE WELL ID # jifapplicable)
STATE WELL PERMIT # (if applicable) _
COUNTY WELL PERMIT # (if applicable)
DWQ or OTTER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑V Monitoring ❑ Resideutial
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery d Injection © irrigation
❑ Other (list use)
3. WELL LOCATION:
COUNTY Cabarrus QUADRANGLENAME
NEAREST TOWN: Concord
(Stmet/Rosd Nam, Number, Community, Subdivision, Lot Na., Parcel, Zip Code)
TOPOGRAPITIC / LAND SETTING:
❑ Slope ❑ Valley ® Flat ❑ Ridge ❑ Other
(Check appropriate setting)
May be in delrecs,
LATITUDE DE Mayminutes, seconds. or is a
LONGITUDE decimal Format
Latitudellongitude source: ❑GPS ❑ Topographic map
(Location ofrvell most be shown on a USGStopo map and
uttached to this form ifnot using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(]fa residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME or- FAC1Lrl�YCharlotte Motor Speedway Landfill
STREET ADDRESS 5001 Moorehead Rd,
Concord NC 28027
City or Town State Zip Code
4b. CONTACT PERSONIWELL OWNER:
NAME Charlotte Motor Speedway Landfill
STREET ADDRESS 5001 Moorehead Road
S. WELL DETAILS;
it. Total Depth: 27.20 ft. Diameter:2 in.
b. Water Level (Below Measuring Point): 15.5 ft.
Measuring point is ft, above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): 17.2 n. 2 in.
b. Casing Removed: 8. in.
7. DISINFECTION:
(.Amount of 65%75% calcium bypochlorite used)
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement 47 lb. Cement lb.
Water gal. Water gal.
Benton ite
Bentonite lb.
Type: ❑ Slurry []Pellets
Water gal.
Other
Type malenal
Amount
9. EXPLAIN METROD OF EMPLACEMENT OF MATERIAL:
Pour through tremie pipe
10. WELL DIAGRAM: Draw a detailed sketch ofthe well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materialsused.
11. DATE WELL ABANDONED Ill 9120
I DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH I5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD FIAS BEEN PROVIDED TO THE WELL OWNER.
�- 71 1-19-2021
5I NATURE F CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who mom llyabandons his/her residential w6l
in accordance with 15A NCAC 2C .01 11)
Randy Phillips
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -10
Atfn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. (919) 7-13-7015 ext 568. Rev. 5/06

WELL CONSTRUCTION RECORD GW-1
I_ Well Contractor Information:
Print Form
Randy Phillips
Well Contractor Name
2209-A
NC Wel I Contractor Certification Number
Innovative Environmental Technologies
Company Name
2. Well Construction Permit #:
L.isl all applicable wwdl cortstrt ctiwt Permits fi-e_ UIC, Cunnty, State, Yananee, elr.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
In dustlial/C ommercia:
Non -Water Supply
fer Recharge
Storage and Recovery
Test
rental Technology
mat (Closed hoop)
DMunicipal/Public
[]iesidential Water Supply (single)
Residential Water Supply (shared)
[]Crroundwater Rernediation
[]Salinity Barrier
[]Stormwater Drainage
[]Subsidence Control
[]Tracer
under-421
4. Date Well(s) Completed: 1-20-21 Well ID# MW-37
Sa. Well Location -
Charlotte Motor Speedway Landfill
Facility/Owner Name Facility ID# (if appiieablc)
5001 Moorehead Rd, Concord, NC 28027
Physical Address, City, and Zip
Cabanas
County
Parcel Identification No. (PUN)
5b. Latitude and longitude in degrees/minutesiseconds or decimal degrees. -
(if a•cli field, one lat/long is sufficient)
I4. WATER ZONES
FROM
To
DESCRIPTION
ft.
IL
fr.
ft.
1S. OIiTER CASING (fir
mold -eked nelis pR LFNER 1f o le
FROM TO
pIAMF.TER
THICKNESS MATERIAL
Ft. ft
io.
16.INNER CASING OR TUBING hernia! closeda
FROM
TO
1n4METER
THICKNESS
MATERIAL
0 ft.
s It.
2 in
ft,
ft.
in.
17. SCREEN
FROM
TO
OIAWIETER
SLOTWE
THICKNF-A
MATMUAL
5 R•
20 ft
2 in.
D10
SCH 40
PVC
ft.
IS. GROUF
FROM
i TO
MA7'RRIAL
EMPLACEMEnT rtETH011) a AMOUIrr
Q B'
2 R,
cement
pour 5 gallons
2 &
4 [t.
Ise dug
pout _6 cu tl
tl.
M
19. SAND1GRAVEL PACK
1f lieabie
FROM
TO
MATER1Ar. VMPLACEMENT METHOD
4 B•
1 20
#1 sand pour
k
IL
20. DRILLING LOG attach
additional sheets if necessar
WROTH
TO
DESCRIPTIONfoatar, Ilfltdue�, soiYrsA s" Ne.
tL
fL
ft.
ft.
ft.
ft,
It.
21. REMARKS
22. Certification:
6, ls(gre) the well(s)opermanent or []Temporary Signature ofCgefified Well Con cu>r Date
&y signing; this form, I hereby certify that the ive11(t) was (tivvre) constructed in accordance
7. Is this a repair to an existing well: []Yes or ENO with 154 NCAC 02Cn100 nr 15A NCAC 02C.0200 Well Construction SlandanIs and that a
lfthis is a repair, fdr out knowi well comsrntarinm htformr rtwa and explain the manure oflhe c'eP)' of this m mrl has 1i en provldal to tine 1ue11 owner,
repair utrder 421 rewarls .section or on the back of this fond. 23. Site diagram or additional well details:
8. For GeoprobefDPT or Closed -Loop Geothermal Wells having the same You may use the back of this page to provide additional weld site details or well
construction, only I GW-1 is needed. Indicate TOTAL NLTIMBER of Wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL 1NSTRUC_I'IONS
9. Total well depth below land surface: 20 (ft.) 24n. For All Wells: Submit this form within 3D days of completion of well
For multiple wills list all depths tf d ljere)tt (example• 3@200' and 2@100') construction to the following:
10. Static water level below top of casing: _ _ _ (ft.) division of Water Resources, Information Processing Unit,
fj'water level is above easing, tree "' " 1617 Mail Service Center, Raleigh, NC 27699-1617
11. borehole diameter: 8 OR-) 24b. For In'ecti n Wells: In addition to sending the form to the address in 24a
Auger above, also submit one copy of this form within 30 days of completion of well
12- Well construction method: construction to rile following:
(i.e. auger, rorety, cable, direct push, etc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY-- 16361.411ail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: M. 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
13b. Disinfection type: Amount: completion of well construction to the county health deparnnent of the county
where constructed.
Form OW-1 Worth Carolina Department ofEnvironmentai quality - Division of Water Resources Revised 2-22-2016

Print Form
WELL CONSTRUCTION RECORD GW-1 For Internal Use Only:
1. Well Contractor Information:
Randy Phillips
Welt Contractor Name
2209-A
NC Well Contractor CerlificatimNumber
Innovative Environmental Technologies
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i e_ UIC, County, State, Valiance, etc.)
3. Welt Use (check well use):
Water
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Non -Water Supply Well:
Recharge
Sturage and Recovery
Test
Experimental Technology
Geothermal(Closed Loop)
Geothermal (Heating/Cooling
[)Municipal/Public
Residential Water Supply (single)
C]lrtesidenrial Water Supply (shared)
Groundwater Remediation
QSaiinity Barrier
DStormwater Drainage
DSubsidetice Control
E)Tmcer
tinder #21
4. Date We"(s) Completed: 1-19-2021 well IN MW-38
5a, Well Location:
Charlotte Motor Speedway Landfill
Facility/Owner Name Facility 113it (if applicable)
5001 Moorehead Rd, Concord, NC 28027
Physical Address, City, and Zip
Cabarrus
County
Parcel Identification No. (PIN)
5h_ Latitude ;end longitude in degreeslminutcs/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
6. Is(are) the well(s)oX Permanent or Temporary
7. Is this a repair to an existing well: [3Xes or E) No
If this is a repair: fill out known well construction information and explam the natureofthe
repair under #2) remarks section or or the backofthis farm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
9. Total well depth below land surface: 22 (ft.)
For multiple wells list all depths if different (example- 3@200' and @100)
10. Static water level below top of casing:
If water (even is above casing, use +-
11. Borehole diameter: 8 (in.)
12. Well construction method; Auger
(i.e. auger, rotary, cable, direct peash, etc.)
14. WATER ZONES
FROM
To
DESCRIPTION
IL
fL
rt.
ft.
15. OUTER CASING: for multi -cased wells OR LINER ff applicable)
FROM
I To
I DiAMI&I R
THICKNESS MATERIAL
16.INNER CASING OR T1fBING eotherat closed-lao
m
FROM
TO �IAMETF..R
T13[CI{NE35
MATERIAL
U ft,
7 f t 2 in.
R•
fl. io.
17_ SCREEN
FROM
To
n1AMETER
SLAT Sim
TtnCKNESS
MATERIAL
7 f'
22 R'
2 hL
.010
SCH 40
PVC
ft.
rt.
in.
I& GROUT
FROM
TO
MATERIAL.
EMPLACF.MEh"1' MEMOD & AMOUNT
0 g
3 ft•
cement
pour 5 gallons
3 tL
6 R'
Hole plug
pour .n cu tt
rt.
tt.
19. SAND/GRAVEL PACK it applicable)
FROM
TO
NLXTERIAL I
bVIPLACEMENT METHOD
5 B
22 &
#1 sand
pour
ft.
ft,
20. DRILLING LOG attach additional sheets if seceisa
TO
DESCRIPTION color,h-rdank-WrwkIr aim, eta)
rt.
71-
IL
ft.ft,
ft.
ft,
rt.
21_ REMARKS
22. Certification:
C L
1-20-202 1
Signawte of�ified well Contractor
By signing this form, I hereby certify that the well(,) were (ere) aonstruaied in arcordonee
wait l5A A'CAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
c( ofthis nxond huv been provided to the toe11 owner.
23. Site diagram or additional well details:
You may use the hack of this page to provide additional well site details or well
construction details- You may aiso attach additional pages if necessary.
24a. for All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Resources, Information Processing Unit,
1617 Mall Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: in addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24-- 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
13b. disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department ofEnviroatnental Quality - Division of Water Resources Revised 2-22-2D16