GW1-2021-02433_Well Construction - GW1_20210615

2XIL CONS'i`RU-MON RECORD Por lntertual Usc ONI Y:
'Mis form can be ascd(ar sin*or multiple uvMs
1:Well Contractor Tntormation:
Brian Ewing ama 1H t3FCklt+fl(}\
'+1W CoAmtW Name 1 1 9 � ft.
4240-B f!,
'C1R� .5(lll7'fl1ZAS ff of i�eaeeil rell i1RIra ticab
NCWdlCommaor..CenirkmWNumber � � tiCR �, R
;tom 3: ,tA FROM 7tp ntA,51MR "CIMM MA7MAi.
SAEDACCO Inc 1!' ®�' 0 IL 16 fL 2.25- tie. NA STEEL
t :lr 1;1G3 RJYtfk: .. ,
Ceapttgrag Nam .
FRO TO II)MAIMR I TMG7aCK35 MAURIAL
2.tVfll�ainstta#inn to rmitA; 70002885 fh ;t hL
list ptl avpptirtahtc,srti pmglts ti e.Crnmtp.S'msr.11�nrinn�Y.11�Ctti[ti di°J
3.Wcll.iisc(etgxlt vveil nss?: ���.:
`VAterSnpiily` I: 16 ft, 20 ft. Silm 'rrpt tMA7txtpAt
r PROM 01AM TO AtAptF'rtiR r,
C]Agli€ttittual t.7Mutiicipai/lttdplie -4a' .004 NA STEEL
CICvod meal(Hentirotooling Suppty) DResidential Water Supply(&4ft) a; ft: to
DindustrtalfConimmial 01tesit pl WaterSgpply(stored)
FROM TID MATPRtAL ffifPt Aif It71�tT btBlilt}D S A1RlOUlC7'
of di lion (t. ft.
Non-Water Supply Well;
�Marpitar+ QRa;so�e
ention Well: fi. ft:
[Aquifer ltecharge DGrnundmter itcowdiatiam
"1ra'+
OAquifer5torifeundR=ooM 0salinitrBarrier F w A toit rr irr9'iNtPrtr o
0 A quircr Test 05termhcater ilmft zap,,
ft, rt<
DEAW imentni 7oclmvloa RSohsidencc CAX*M1
'30:11''Riil2A'Cl Chat tt�?��litotiit� �fif{�ecaa�
Meotletmal(Closed Loop) MrAcet FROM I TO P 9 8 C Rt®rtos 6n4n. 5oILgivIt ett
MeathemmltReafitl lCDoli Rem) 00thett Wnunder#21 Rma& 0 fL is tt. FILL SILTY SAND
15 (L 20 ft. WET CLAY SANDY
4,Date Weil(s)Complded: 5-27-21 WetjM#TMW-2 ft. (L
SIL We"Legation: It. (t
Touch Down Auto Services to. tt;
FacilbylOenerName Facility iDil(if eppiicablc)
ft. tG
1022 Woodward Ave., Charlotte, NC, 28206
Plosiml Add>v L City;and Z10 '7 Itl At.
Mecklenburg WATER SAMPLE W/SP-22
t°um�,; 1�ted tttt:aufleatton Na.{P�l)
rkt.l Atitodc:sand f onglt sdc in dcgrmsWnvte0qx6nds,or decimal degrees; 22v Gertifecntirtn:
(tfatll fieW one la ttU t„ftttiem)1< W Br, r ' ';seam ate. 6/7/2021
5igaM1s of Ccattiiicd Well Cumtaetar Dail
6.!s(Nre)the wdl(s): 0P;eamanent or MTctmporary By 3*i- trdr foram,t I?ir�l+ rho the n ell(t;7 cav,tterrri 4vtri truried to c and er e
,caper i�t rvcAc 9zC.tpinip or,,ist pt'C,A>r'016,tpTflfl Iteri coAit►axrnn 5tnratistrrls ti+ate
7.h this a repair to an existing well OVe'S Or ENO r rr,mn + s t�r� trt et fn iar nrtt , «r,
lj+hti+ ra rr rir tl cast krar,�a ivrit ostmakfs Warmationap4rW&M the anwre of the
,t+ ixoxater l,emutrFxaNctrnn ar ra tl�r brarP of rhla f¢rm 23.Site diaommor additional well detnttc:
You tnmyuse the bacl:of this page to ptrnide.additlrr W%vit site details or null
$.Munbcrofuv:llseonstrncted: 1 consWcoona9etails. You May,also a6chadditional piggesifnecessetti
far xrmltrplr In/rcrlon Of Ar't-umrerzn*krils ofty ndrit.dta ttrara coastrwtafaar w rwxa
sab"iifomform SIMMEMUMUCIONS
9.Total trdidepth hebw land surface: 20 {fk) 24a Aor Ail %llo: Subs t this;i'onn utithin 30 detil of compWon of neU
FormaaitWr weUs hsmiidrp9a ifdi srem tcrtrr aft! M(tA'attd 7 JtA'lf ecpnStntttt;ln tSl tip[fPltccsi
10.Static oyster Imet below topr of easing: (rL) Division of Water R006Mo.InfonvnAtion Ffteeasing Unit,
tf nstOrr hW4IsObOLY rOAt site"4 1617 Mail Se ioe MCA ter,ltaleiglr.XC 27699-1617
t 1.Borrhale ditunetW 2.25- (in.) 24b.BE lniectien Weill ONLY: In addition to sending the four to ftaddm in
24aabom also submit a copy of this fompnithin 30 da)s of completion of Atmll
12.NNW constrtmdon,mo bod:DRIVEN constmetion to the 11ollordalg:
(ia:.stWg mmy,cab1tidh aposhc0c)
D hislon of WiLter Rem me&.Undet"vand tojecrlon Control Psngram
FOR WATERSUPPLY ti'<'i U ONLY: 1636 MAi4Scnite cenitr,ituieO.NC 276"-3636
f3a i"irld{dpm) aicthtld of test24e.For Water$uRWX BSc lNoctirm 4 ells:
.Also stibnpit of t 'of this foun t, thin 30 days of conVelion of
13l,Disinftxt3nn hfl Atrtnnnt: well constntction to hire county heifth deMornatt of the county what
Constructed,
FarmGW-t AMAhCmlinaDgvfttentofEwimmmmwd)btwaiLReww es-D1hisunnfRraterR UM Rcvi;edALCU9t2013