GW1-2021-02429_Well Construction - GW1_20210615

WELL CONSTRUCTION RECORD :`��<<; 1'aracsrntlu�cc)xly:
Ws form can bs axd ror single or mattilik was
1;Wdl Gintmetor Information:
ry�'�01 tx HtAt�t:zc>•
Brian Swing
1l�C1FCotttiftcttir t taitts '- C �J �. rt.
4240-B ��ta<<�.3-',y
NCWe)IColuuworCmtirecaitonHntiber o 1i:OlTfFdi f3iltt o 4mttlitiafetl.' ORIL&Ii M lkgb
FROM I TO DTAMM.R THTt'iG1TM MA7"TAt,
SAEDACCO Inc 0 (. 16 (L 2.25- In. NA STEEL
Cantp;stty Nanse
ia: tttert>i laced
FROM TO I 91MAIFTF,R I Tn1MTSS I MAW.WAL
2.Wc�l +lnStrticihln:l'crtn## 70002885 ft. rt h►
14-f all11murw6lr krilpemd"ax.Coumv,State,Ynrfawt.,Irp den or.)
rt. iE. ie.
3.V4Wd)Use(check well a sc):
Water$Uppty Rfdi: FRriM TtI - DiA1lfiTl RI IqjAT 51.V. Ttltcics s MAT Ali
67Agtictttniral l7MtmicipaltPttbtic 16 n. 20 M 1.25- 11L .004 NA STEEL
Meotttenwl(HeatingCoolins Supply} Mesidential Water Suppl}(save) ft. iTM
QlndustriallCcimmadil OResidemial WaterSupPly(Shgmd) iB tOUT .
FROM TO MAT6RtA BhtPL A MMF METOOD A AMOM.
Dirri ration A. ft
Non,%later Supply Weil:
n. n.
06Monitori2 I]Itecat
bjeetion We":
QAquifrx.Rcchi%T QGnnindtrntcrRcrosdiatiolt
QAgtlifcrS(oinge and R=otery 13Salinityi3arrier FR M 1MAr1sR1A1 RMPiAt�:HrYt�1tTH n
R.
0 Aquifer Test oStommater nrainmgc
(JEWTimcnial Tochnotogy ❑Subsidence Control 40 1)R.1,111 1 t1G 7etts iiiti((tm al atteeis'flrcccstat
❑Geoftie-tntal(Closed Loop) oTracer FROM TO OSSGRtPITOr cabrtfutin M 10WAV;tty pt,mo W-1
oclootherntal(Henan -oAli . Retunl) o0ther( buiunder#21Aern ft 1 0 It. 15 (L FILL SILTY SAND
15 n. 20 2 WET CLAY SANDY
4.DateWetl(s)CampidW: 5-27-21 WdIIIMTMW-3 n. IL
St.Well Location:
Touch Down Auto Services n. h
v4ed tylowrer Name Facilil)iDt(tf appticabky
rt. tl.
1022 Woodward Ave., Charlotte, NC, 28206 n n.
Pkliml Adds-Py,End Zip 21itt 1
Mecklenburg WATER SAMPLE W/SP-22
CodatY Parcs1 ldsmirtrsnion Na.(PIN)
Sh.latitude and 1An$,0Mdc in degnm%%In atcslscc6nds or decimal degrees: 22.Ctrtirmurdnn:
(it'Atli 60K(wit lxtdogfiasslink(d)
>� W Brun Ewing. 6/7/2021
sigmtnjc of Ccrtllicd Wctl of Carl= vats
6.is(ore)thewell(s): i7Percrument or MTemporary Or*oin#sib fwm,l here6g zero thak the mrll(sl wrr(Krrr)owvn r-red sa tmv dmre
rrlflt MA NCAC 02C,01M or I NCAC(72C.0200 Well O)minrr tion SMndards and Ova e
7.Is thin u repair to in existing well: oyes or Elio rr+PsaprhAt.rronl tiaa tx�n pmtddrd m tf r arl(r,K�ner.
!f fhtr lx a/eprfir.,f(A axf 4rtFrrw+sell iro+arrnrttirmlitJr/rrsadvn anti rxptaln the nntkre nl tom'
repeirweder'd21 rnmaAx.Arrtimr er an the burl of rMs farm 23.Site diapram:or additional welldetalls:
You may use the bat:l:of this page to.protide additional wdl site details or well
8.Nunlberol'wells constrneted: 1 constriction details. You may also anach additional pigs if sect ssary.
Far it~f lr�rrrlorror nrHr-xtater iWf4y WWI$ONLY h�tiA rlrc roan m»sbvrretlarf,uotr ran SUBb ITCA�(j��CTtONC
sapurironr foal. -
9.Totnt welt depth Belo*land surface~ 20 (it,) 2JsL Par All Will Sublydt this Yonn ttithin 30 days of completion of rtiil
For,altWe we(is l{srrat/Drpakr(fdiderera constntcti9n to drrfolkm ng;
10.Static water itt el ltdow top of easing: (ft.) ilivhlon of Water Ressotr gees,tnfbrmation Procening Unit*
l/mVer kVd is dnwe cutting la€e "+" 1617 MAU Semite Center.RAWpb,NC 27609-1617
11.Borehole diameter:2.25^ (in,) tab.Far lnleetlrsr►Welts ONLY: in addition to sending die foal to file address in
24o about». also latbinit a copy of this fomT tritiun 30 days of completion of well
IL Well coriMlVedEM mdbod:DRIVEN constnnxion to the farming:
(Le.auger.rotary,tible,direr*pusk ec:)
IfMsion of Water Resourtxs,i)ndaground Injection Control Ptugtutn,
FOR WATER SUPPLY 1VVU S ONLY- 1636 Mail Semite Center.Raleigh,NC 276"4636
i
13a.Vidd(gpmn) Al'"hod of teak 24e.For WaterSapplf&tnjcction 11dts:
Also submit one copy of this ford iiiiifin 30 dary'sof coVelionof
13tt.'Oisinfection h`p'et Amount:
well construction to the calmly health ds:m#n=d of the comity whcTc
�ttiStTllCtOd,
Fonn GNr-t i�onh Camllns G^p�rrrt�nl of£at imrtmcrti and Alnnual Resowocs-Ditiislun of lVatcr Rt trlrcps Rc%-IsM ALVA 2013