GW1-2021-02701_Well Construction - GW1_20210512

WELL CONSTRUCTION }2ECOL2U FarrtttamnlUscLINLY:
This roan con be rtccd for single or multirke wells \
1.Well Contractor Information:
1i.A'A'1'GR 7diN ES
Zach Thompson FROM T(► Dr$t,Rtwtrtx
))'e11 CUttmelor Marne ft. ft.
4478A ft. fC
NC Well CornmctorCertifemt ion Number YS:OOTERCASINNNG rut'iriuRracined ►•cli. OR`A,RtrF.R(fi:s'tkahk)=
FROM TO DIALMETF.R I THiCi;,IE,CS ttATLRIAI,
SAEDACCO Inc 0 rL 11. % 2^ in. SCE-40 PVC
teng3:inp Nana: .361Nh1ER Ci1 G`OR'T1)BIIY'C 'citbetttlal i".btedati�ii'
--
FROM TO DiAt1tFTER fltrCit\B.SS MAt9:RIAL
2,Well Cnnstru Lion Permit k: M fL h►.
List t11 o*1irablr.twit pwnvf s(ir Gotmrv,,Steer .lrnrintxt,Il1jl4 dOi en;j
ft., fl. is
3.Well(use(ehrticwell d5c): 17$itiRLCtY�ir. _ utra��r;. �_
WaterSupitkyMM1: FROM TU 1 uiA+rM—st :1AMS11r TMWKNV—%S MATFR1AL
©Agftilt 7ral OMunicipat ilublic: 11- ft. 211 rt, 2^ im 0.010 SCH-40 PVC
Meothenwi(Heatingtooliitg Supply) OResidenWl Water Supply(single) R' & is
O indusfrial/ComDtercial OResidencial Water Suppl}'(shated) t VROUT
FROM TO MATER" I MPLACEMM r1EMOD A`AMOMW
❑Irri adon 0 ft. 7' R. Portland Ce Mntection
Non-Water Supply Well:
00Ivlortitoh9 ❑Rtxo)c
injection Well: ft tL
ClArinifet Recharge QGronndnntcr Rcntcdiation 9: it (tAYE1 ACE.(lt. '►kieiihtc":
�VROM 'f0 MATFRIAr. _ '_. ftNMAf.'i]HIr.Vf391Tt1O1r.
DAgoEfCr.Stor►gc And RrCcotiery ❑5ilir►iiy Barrier 9, R, 211 ft. Filtered Sand #2
❑Aquifer Test 11540mamer Dmimlgc
rt. (t,
❑ExperimcnMi Technology ❑Sidlsidcrtcc Coro rat
2R,URILUNG`1:4DGYa0sch:aitdiflon'til a6eelstrpccc::fnn
❑Geothetnral(,ClosedLoop) ❑Tracer FRo.t ,ro Dr�CRLPTtU\(4ybr:pn+Ancrr,vtt5i+ukh n!�&[tcl
❑Geviltermal(HeadnLvfootineReturn) ❑O,heri : ain under 921 Renmtits) 0 fL 21; fL Brown{Silty Clay
rt. tt.
4.Date.Wells)Completed: 4/22/2021 Well 11D#MW-18R
n, fL
52,Well Location: R. k.
t!�
Brownsfield Site ft. A. V
rid1h'10uvttcr Nuic Facilihy iM(if ttpp)icnble)
ft.
4800 North Graham Street Charlotte, NC, Charlotte, NC, R p
28269 Plnsacnl-Addre.ss.City.and Dit 2i-ttEM1tA,7ttC$ tion c i illy
Mecklenburg Bentonite Seal from 7 1-9 DtiPtfR geCT•Of1
County 1?arr¢l Identiro'c iionNo•(PIN)
;h,latOlude and I.crosiraric in dcgreerlminutcs/sccnnds nrdecimal depecs: 22.Certification:
(if tell field,(as I:tLlot ie std(;cicm)
35.872706 N -80.804618 �� �""' 4/22/2021
igrcnocc ofCeitificd Well Conmear � Dmic
6.IS(are)the well(s): $IPermtntent or ❑Temporary •sigithX Air Juan,1 herein-cerNf)'dui Mr Mill(.)"s(kN/Y.)et m imcfed irr accordemee
a•irh IM NCAC WAVY)all 15A NCAG lrzC,02(h)ll ell Constrnrrtat Struuktrds wiel dial o
7.Lc this a repair to an existing.it•cll: ®YLs or ❑No rkfy nfrijif reexo rt has ltrrv,prt,r14Y ra air atrllrntvter•
lfibts If a ezfxdr,fall ant tPoitn tvdf&monrcAm firfern?nidwi and t-selfa a rbe mmyre of tins
repairrotrlrr921 or rut Mir b"I offhfs ferot. 23.Site diagram or additional well detaik:
You may use tite back'of this page to pfovide additional well site details or well
8.Number of wells constructed: 1 construction details. You m;kv also hu ch additional pages if ii:cessary.
Far"U114#e M.Wrhm or prat-nvtrer SWrh,rills ONLY itvrft fin:Mane Cmrshruetiorr,uat VIM
xae wtir our fi mr, SUBMITTAL.INSTUCTIONS
9.Total wdI depth below land surfaces 21 (Iq,) 24a. For All Wells. Grbtt»t ddt forur vdibi t 3i1 days of completion of tt+cil
Fnrnuffopirwelts;braffJepihstfdfjjr•riot1,exmijpte-3@209',ind20-1Ami consiiictianio the Cottoning;
10.Static water level below top of casing; ((y,) Diriiiun of Witter Roo:urcet,Information Processing Unit.
1/tilfnptw levd is m?otle eeitiuy;we"+" 1617 Mall Service Certter,Raleigh,NC_27699-1617
11.gorchote diameter.8.25° fire•) 24h.Fgr flt lloa Wclis ONLY:, in addition to sending the fans to.tie address in
24aabose. also subritil a cape of;this foci within 30 days of completion of will
12.Wdl construction method: Bored constnrt iDU to the follouVim:
(i.c.sub r.ralaq.cable direct posh eec.) Division of Water Resources;Underground Injection Control Program,
FOR WATER SUPPLE'WELLS ONLY: 1636 Alull Service Griller.Raleigh,Nk C 27699-1636
24e.For Water Supply&injoditm**VelLq:
13a,l'ir1A(irpni) Method of test:
Also submit one copy of this forni1within 30 days of completion of
13h.DiAtifcxtion type. Amount: well construction to the county ht el>t alth drtmcut of the county where
constmcted-
Fonn GtV-I North Carolina M-part.tent of Em irunmew and Mirtirsl Resources-Dity Ion of Water Rya. Revised August 201.1