GW1-2021-03345_Well Construction - GW1_20210603

NVELL CONSTRUCTION RECORD
For lianna!Use t7NL.`;':
Blip form cast ba mead rm sift orinoltipi=%vtis
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1.WcM Contractor Information,
Brian Ewing FRr3H Tr? o "ttlM01S,
Wol C'ntArpow ham ft. to. h
fb fl.
4240—B
NC W""ell Coimucrar Ccrlifie:itian Pinaribcr J :OLt�'4fl G`A��Clttidfne Miflh .il`w•d . O!t t�iik �, #tank FRONT TO TO 01A1tit9M T"W" SS MATERIAL
SAEDACCO Inc 0 ft. 5 fL 2" I Its, SC8-40 PVC
Camtanif Mamrti >N0 ii►�r+af� 91r5ht1
FROM To otA.MITEe I THICKNESS MATMAL
2.Well Consttaetion Pcrmit#: 700002858 tt tt.
Liu all arppflrvMr ict-H pits ri.e.County.Ss".Variame.:fifarfial rdr.3
4.Well Use fa;leck well U.40. L. �
ater:Supply We11: FRFROMTO, WUN OTrit stor�rtx Ttrtcl avirts aH4rtRo%t.
ne ..,
DA_erkultural MirttrkipatT ablic 5 n- 20 tt. 2" in. 010 SCE-40 PVC
013cotheri tat iHetltiop(Coofirg StgVtyl OIResidcn iat Water Supply(single) tr. ta: io
0MdustriallConsumcial CIResidentiatWaterStippl►-fshamdI It1:C,RQU1 ;;. "• . ., t
FROM TQ IATERE+ll. ryIMPF.At"83ItM NI OD&iMOL\'Ly
OltTa n 0 FL 3 tt. PORTLAND POURED
Non-Water Stapply Well:
®hrtaraitari c �Racowet%' -
nion Well: tr. fr
0Agp*rRcch:argc 00roundtatcaRentcttiaariilaa Fg.>. D. !.NA
Gi itiferSt XgHM ' iu�l aaa Pr-4pp'ATM' r"PA
Aq Storage aarad Ro owvn• Cafialintly Barrier 4 ft, 20 0. FILTER SAND # 2
0 Aquifer T� O.Stornmater Drainage.
01, timcnial Tocimolo 7y CJSvibsid¢wc Canim! 2A RII:d.11iG i°aft herra��"
I3C,eotha:rraan1;Clased loop► Effracer FROM I TO nR5t RteFiO�fc e.rxnebe .,[riarrura atte t
13GwtltemW d•lcatit 'K;Otali Return) 00thet(t!t `fi Undet#21 Rettaa&) 0 ft. 15 (L FILL SAND/SILT MOIST TO WET
15 (L 20 fL WET CLAY SANDY
4.hate Well(s)Completed: 5-13-21 Wd.I;m#mw-1
(L ft.
52.Wdl Lncartiaa: h n.
CA Body Shop R, Ft. --
Factlplr'Claatacr Name. Facub)-lD
548 West 32nd St., Charlotte, NC, 28206 R rt. n Uf111
Pita skal Asisim s.Cir<.and Zip 2L 1t77.
Mecklenburg BENTONiTE SEAL 3 TO 4'
Comw} ,.. P�cse7 irt�rdaC`�atitam.NO.it't'\l ., _.
5h:l:stitudc and Longitude in dcgrtes(sninutcstseconds or decimal degrees: 22.Certification:
tit„clt tt«f8.�L>r Nitrintr is fiasatiti�aril
• •i
>, W v..Brea t#t_ Et ►�rig 5/24,2021
Sigma=of Cmifind Wdl Con Date
6.13(mv)the%irell1s): 3 Permanent or OTemporam- Sti,av�ninr thu form,I Arreby ceroy r&a fix,rslx+rd urns rtirrrl amsmua-rid ih r.%vvrd=re
4+1111 d.`rA NC AC{)mt:.r 100 0r l tet KC AC t11C.01 i ta`rli{'i>n+;rrKfiriu�i St�iadtiaris aNitl tlarrr sr
7r Cc this;a repair to an existing%sell: 1 is or IS.NO r,rrsr ;%drat riu�+ni{ref hpaai{rr rrittt'd ra ha>nrrli nr`rirr.
lf"W h a fovi;r.fill arrar 47trmiv urdi i(mo ,Min orkarr Thurarid rxpbJ#j rats nirrwre n(rfie-
r crie rrrcrler S2T a^hn�rlFe ae.^tieas arm die br.t1 ot'Niiv,fOrm. 23.She diagram or additional well details:
You may ttse the baclz of this page'to provide-additional%veil:site details or«ell
S.Number of%veils oDustrurted: 1 construction details. Von utav also ouncb additiotal rigs if trecessary.
&er rit,4Npre rrrjo fiv,4 or oiva-%wwr snip.+:,tve?h ONLY well dir arrow tv,rtstraredM.ysaai i-an
snrbmirrw1e Juan. S.[111 IMAL IMIMC UCTFONS
7.Total well depth below%land surface: 20 (ft.) 24a. For AD Wells: Submit ihis fora; wt•itbin .10 days of completion,of iwll
rr r m+.rblWr Ice"Is"ber trff'fi r+lR t if l a 5 re rrrir:tam i?le. Lh'4 f??'and zQ 14y;1 construction to the folloni ng:
10.Stadc water level below top of casing: (ft.! Division of Water Resa umes,hifinmation Ptocessing Unit.
at rizrtts lrsrrl Fsrrfrraie rriai'tar ttx"j" 1617111ail Service Center,.Raleigty IiC Zlfi"-I6t7
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11.Borehole diameter:8" (in.) tab.For InbXdW qXtilw O:%LV:I to ataditiou to sostling the fort to the address in
24a above- also sobiWl R copy of Ithis lbrol within 10 dot's of c'orvoetion of well
12.Well vortstrur-tion method.-BORED c:orignwtiam to the followbig:
fix.auger.riaatf,imble.di=ecl push.em I
llis°ision of V4'ater Rea+ vrres,Uederp'ound InJeclibn Cantrril Pt+oArawr,
FOR WATER SUPPU WELL$ONLY- 1636 Mail Semite Center,Raleigh.',NC 276"-1636
tic.For Wrater;Su ►&Ipjeeta►I�leils:j
13a.>,idd(4[pin) Method of tesC.
Also submit-one copy of this foisn')jwitlaita 30 days of coanpleWit of
13b.Disinfeainu type. Amount: _h r^t tv �ulth dep utaar+rt of tdc erntnl};w 11
A _. well construction to tlia coam '
cntasttnctt�i.
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Form Crw%r-I -Notch Carolnaa tk*iatiacat of Enaas wmiti aim Natmal Rewurees-Div is.to of C1 atea Resovtn Rsti iced taaglNt 1C41 t