GW1-2021-01247_Well Construction - GW1_20210209

WELL CONSTRUCTION RECORD FurlmenwtUw ONLY
The form ui he morel few simak or wwhVk wens
1.Well Contractor information:
K WATU MOM '
Zach Thompson vwm TO I ok5e•nwno%
Well Cmnnaim Name p• I p•
h. h.
9478A
NC wen CourmTor Ceeikmon Nmwbcr far
FROM TO 1114M[7Q MA
SABDACCO Inc 0 h, 35 it. 2• u, SCH 40 PVC
('unpin Name
FROM TO I mASQTta Tntt7LNxnt I M,kw
2.Well Construction Permit a: NK0301093 p, R u.
LY YI(r gdvYhle aril pr.mwn li e.Crm,m..Saar.Yf0)(•1.r.lgeroot ra.1
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3.Well Use(check well woe):
Waste$Opply well: tWM TD 1 mAalrTrn I M TVM'KXMs I MATUW.
OAgnculBlral C7Mtmicipabpublic 35' ft. 45' R. 2• u. 0.010 SCH 40 PVC
OGaothemul(Heel sgiCoolitg Stipple) ORMWINI ill Water Suppp tsiAille)
ClbldusrialrConunercwl ClRaideraial Water Supply(sharedr IL
►ROM TO I RxRtwe2hlrmT MrrmoD Amm-a
Entrignitan 0 n. 30' n. Portland lTramie
Nan•Wsfer Supply Well: a.
MMondming ORamtrr
Injectingm. IL
❑Aquifer Recharge DGmundsafer Ri modiahon If.
ID Aquifer Storage and Roonct1- OSRhney Darner ranM To MR
no
33' 11. 45, h. Send #2
❑Aquifer Test OStomwwater Drainage tL h•
OEWma ental Tmhtnksgv OSubsideno:Coolant
OGeothernal(Chimed Loop) OTmcer mm TO Onctu►nDm wrw, rvssn err.
OGeodummol tHemingCoolimill Remmi 001her lexplain undar#21 Remarks) 0 n. I is, top soil
1' p, 45' h, brown clay
4.Dme Wen(s)Compkted: 1/20/2021 Well LDI11N-BO-B22(I)
h. 11.
So.Wen Location: ti n.
Electrolux Home Products Former Copes-Vulcan Fac lity Ft. n.
Farm Onum Name Fawkh Me(if applicable)
1099-801 Spruce St , Charlotte, NC, 28203 p• p•
Plwswcd Addics,.Cm and Zip 2k
Mecklenburg Bentonite Seal from 301-331.
["ouwn Pamdklcmdemion No (t9Nl
Sb.Lathode and L.esidtode is deyeer/mhmtealoeesnOc or deehW degrees: 22.Certification:
(d.ea ICM.sore 1a lomr nsmfkepl
35.219519 N -80.870194 W 1/22/2021
5lgu me of Ccedled R•ell Commcor Once
6.4(ore)the wrlRal: ®Ptrmmeem or OTemperan a uxaiar rM,p.aa I Arrcbr..rril,rAm d•r,.era..,...,(,.,.,,m.rnned m n,oMaw,r
.,m)eA NCACn:C.Ol(h)Y fUNCACO:C non Win('warmm.Suadvd,and Am1v
7.Is tNs a repair lo an existing well: OYee or KNo r•r...,/rAi•m aM Am,arm w•.,„W ern rtr.err(vumrr
Hrsn YY rvprrrr.Tiff eau corms rrfi remYrm rim 1 uad vsPWm d,r mrarr n(rAr
,rp:,r ewAr,rf d.10.
0 mmirE..,•,,.m.,r rm w a(au,!„era,. 23.Sift diagrams or MdiWnd well deWo:
- You now use fhe back of this page to limde additional well see details or well
S.Number of wells cenotructed: 1 conUnwtm deuik. You tory also auuh additional pages if nwemn.
fa,, .n/9r m)r+ram m am-vuwr Y d'urll,ONLY.veld rAr rwaswsee(Yfr.war rw SUBMITTAL INCTLCTIANC
m FEd X " 202.1
9,Tad well depth below land tndata 45 (rL1 gas. Per An Ww94: Submat dos farm Rehm 10 dos of complclsos of well
Formnh,Pfv urns aYan ArjMA,iJArfirvar,ruxYPly" re3p0'sW 2F/(are comfniction to lbC folkmirg'
10.Stink wow level below lop of casing NA 01.1 Minion of Weer Reresrm,leformenes processing Unit.
ry.Yu,hue!..,varror,nYar v,r"� 1617 Man$serjet Center,Rde'ltih.NC 2 76 9 9-16 1 7
11.Swedish:diameter:8' On.) 24b.For Injectim Welk ONLY: In adi ifion to sending Its:Joan to the ad imma in
24aabme. also ambinul a cope of this form within AO dies of wmpkfion of well
12.Wen eenprwetlos rapped: Bored mix mcum In the foluwisg.
(I e.utter.moo.cable.disco pack tic)
Dlabias of water Reawrm.Uaderyuuoil bleellos Central troy...
FOR WATER SUPPLY WELLS ONLY: 16M Man Smkt Center.RakW NC 27699.1636
13a.Yield 41Wml Merited of fat• 26c.For Water Supply C injection Wells:
Also submit one OM of this form within in drh'sof wronyidion of
I� 13h.DWaketlau hips: -. .. - Amount: well contents:wo to this cause, health department o[the county whose
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Form GW.1 Noah Cmohm Depammcis ofEm tmmwem aid Nmwral Reoocet"Uwsmom of N'maR®Vcm R�ntd AtBww rsl�