GW1-2021-06337_Well Construction - GW1_20210915

WELL CONSTRUCTION RECORD For Isrien®i Use ONLY:
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NC Well Comia6orCeniticationNumbca IS.OUTER.CMRF Gr(for iimli4-ca!aedrrelas Oi LINERdr7. 'ileahk
FR4A'1 TO PTAYIETBR T"tCKNESS ATATEHtAI,
SAEDACCO Inc U tt._ 4 fi 4" ia. SCH-40 PVC
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FROAT TO DIAdIETER TMCKNESS I AIAiLRIAL
2.Wdl Construction perrn t 70002060 ft, fL n�
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Water Supply Well: - ---- _ — --- FROM I TO I INMET99 I "1CX,'SPSS I ATATRIUAu,
DAgricalunal CimmiiapaliPublie 4 ff 14 fi, 4" in 020 ; SCH-40 PVC
ClGeoitenw!(Headnobojing Stipplyl aResidential Water Su f6 rL
01ndustrialtCotnmericial DResidentiai Water Suppt,(shared) IS GROUT _:.. 1
FROIld TO 74ATE1114 EXPLACENLN17AIRMODa4AMOUNi'
❑lrii trpn fL fL
NonrM'ater Supply Well:
b Monifodne plt nti ra
la)erilou Well: f4
tlAtittifcrltcGharge ❑ roltlidltaterRetticdiatirm #4.SANIr,�GRAVEIi,I`,+►[1i(i,.`rl,sine'
FROM Im MAr Itt", Nnn A w;rnxrM rir_n
pAgtt fir Storage and heir;, ' pS tlinit}flamer 3 rt. 14 ft. SAND #2
13AquI*r test OStommIltcr fhalbage
fi. ft:
❑>xperimcnt:ul Tcchnology ❑Sdbodemc conitiol
aft;.DRI1.I�11i�1OC'[e-mail]8ttdf9on"a'l,sti+retsl[hccessnr>�
OGI.cilienllal(Closed Loop) OTmcer .FR.OINT TO DESCRXF"03N ealow;ArRrdnen srrR'YtMk r Ot6tic.
❑Gootliemial Return) w0dier(eqAaifturrder#2IRecnatls) 1 0 fL 14 fL RED SILT/FILLDIRT
R. fL
#.Date WeR(s)Complaled: 8-13-2021 WelljD#VEW-24
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5a;Well Locathm. fL fL
United Parcel Service
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ft. to.
1600 Cottonwood St., CHARLOTTE, NC, 28206 tt fr. 1 5
Pktml Address City.and Zip 31 ItEM1fA1<KS..:
MECKLENBURG 07714104 CONCRETE FROM 0-3' , 11,(CGC tr¢
C'srarna' I7ascet tti^rttiit�,gtii#r]iVb,r,Fi1.) [� '.� ��.,J,
5h LittitUllC and Longitude n.dcgrustnrinU#cslsccantls 4r rltimgl degrees; 22v C ettiCecatittn:
(itutlufi,14,oft latnoir3i8'fii CiErri}
1\ RF `! '_ d+�-{• 8/15/2021
5i* is aTCctti Date
6.Is(art)the wcll(S): EPcrmanen t'pt or 01fempora
,� U1atgrar`n�rhi2 faum,114rred.}'aer*irhraz the nvllfs!carry(ia-eca%)cwsrrnrrtrrl ire;arcumrdtrnee
ndth`lit NC.4C 02G.Q/[k1 rir tSd tdG4C f>2G.4.ztM1 N2tJ Caarnrriredctn Srrrrartarals arnri'thnt a
7.Cc thtl a repair ib an&is ng wcIF ElVes' sir ENo copre rhh r"Ord has b nm pmvI&W q'!dw.urlic;wner.
fI Clefs�a vc�tarrlr,flfl oaar kRtnrut rvejl e+rroasrtnrevtnvt+frffgrann'ter'!tr marl.:tiataltr t1}e�urrnrre r,,f rTre ,
rcprnr1-um1rr,&2J remraiks.:wrfma Ducal die boil of tlus fnrut. 23.Site diagram air additional well details:
YOU may''use(file back of this paje tar proVide additional well site details or well
8.Number of wells cortstructed: 1 construction details. You may also allach additionat pages if trscessary.
For maifdr Pe lojeak-n uv rotwi->,tiatee s41pplr writ ttal'L?'erdrh rAa sanve comiradit r,,yoa con
saGwrit one Jorra. SQBl11'r7"PdIL,INST tJCT'IONS
9.Total well depllt beW land surface: 14 (il,) 24% For All Wills. Submit this!form A.Whal 31) clays of completion of tw'ett
r r maittlnle wctta piar rrNr out 7s trrrF!i re nx leras�+fc- C 2 t1'ar+ep 2N?if t construction to the fnttcming:,
10.Statie water leael below top of CaSi"W NONE ABOVE WATER TABLE Df*6ion of Water Resourtes,Information Processing Unit,
ff ftAn r levd is arbrtve wader,tom"+ 1617'MititSd iec Ointer,Ralcighi NC,'276904617
11,Dorehole diameter.10 5/8" 00 24b.Fttr Waft tln Wells ONLY. 'In addition to sending the form to the addnw in
24a above. also submit a copy of this form within 30 dm's'of completion of well
12;Well constmetion method.• AUGERS construction to the folloAvine:
(i.e.sug>r,rattily,cable.dirca Isnsk ctc.l ;.
Diviclon of Water Resouri ik,Underground Injec lon Control'Prograth,
FOR,WATER SUPPLI'WELLS ONLY: 1636 Mai[Se's'iee�cuter;Raleigh,NC 27699-1636
13a,Vidd(gpm) Method of test. 24c.For Water'Sup la&injoctum7 Wel1.c`:
Also subhift one cop}' of this fiirtil usthirt 30 days ofcoinpletionof
131a.t)iatnfixxtirrn tyjic Amount' well construction to the county[Health department of the caunty wirers
con.5trustcd.
Form MAI-L c�rrrrtlr.Caratfna GWpcttttr��nr or Etn itottnten9 ark oa�nreal Refatlrccs-Ili��stam of R'atar tt�ntrcxs Revised August 201..1