GW1-2021-06338_Well Construction - GW1_20210915

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FELL CONSTRUCTION RECORD ,For rrt¢rnol Use ONLY:
nis Win can be us_dl:rot si rigk or multipic vml s
1.Well Contractorinfor'nmation:
14:-WATER ZONES
Rich Lemire F.R()i1 Tti bFSCkIPT10\
yr�11 C�rttctdixrNSttH:- ft, ft,
2593A ft. rL
NC Well Contractor Ccnifa 66h Nwnbca .I,OUTER. TMF19 s nr�nnhi-casrif h-tens DA LINFR ii a `Iicable)
YRO1t Ttr lthAAtE16R :MCKNE$9 MATERIAL
SAEDACCO Inc (L rL
CMVUMl-Name T6: M.EA *G Jkt BING `"�tthc tiggiJ46661
PROM TO DEAMETER MCKNESS M.ATERLAL
2.1VV4lC4n5ftttionpc,7,iit#: 70002060 0 (L 21 rt, 2" 1L SCH-40 PVC
fixt�rldwgfirrIrwrdJ,trc+amimx(irCnvnrv;S&rir;-1+nrirsmer.li[artcn-.j 23 ft. 25 ri 121- iM SCH-40 PVC
3.Weil Ilse(tho;WCil aSC)':
Water Supply Welt: ---- --- — TROAt, To 01AatF.T9 t srxrr'stly.. TNnC'tt,MS'S 1MATRaiAL
®, rxcu ttrral Min itilx11i t lIic 21 (t. 23 (t: 2" JM •.0ib SCH-40 PVC
®Geothermal(lieatin ) aR.esidential Wetter Sii fd- ft iir.
�oli St l� ilrA 9 )tpt}'(single)
0lodustir al/Conuncrcial OResideatlal Water Supply(sbared) R. �ItorRr
•FROM 40 MATERIAL E,%TPI CURLiTAtL"MOD&AhlOtNT
01tti' tion 0 rt. 17' r!. PORTLAND POURED
Non Mlater Supply Well:
❑Mpitit4rin Ql;ccp� ' ft rt,
IaNeclion Well: rr
C3Agttfier RCC1ir c IGrrnaritcr Rerttcdiiitiott i9 kN6 25� ri, srArro iC:s I >'
Atl S
rU
AA1. larva n��u;-q t�Trt(iti
p rrifcr Stpr+ c antd pS ilia'' Rarrict #2
❑Aquifer Test OStomra tier DMi ,9qU
Mxperimcntal Tochmi gy DSrtbsidcncc Control -
2ti.=liRlL�lt�'G,ti06'ftiiimch�i8dliiuria"Isl�ds�raeccc's`sar+
❑Geot(tetrnal(Closed,Loop) ❑'racer _FROM TO n>ssckxrrro� rota►,F>t�dnc: .n'r,catr +� tV�i
0GL+Ot11Ct111a1 f7Ie8t11 glCoalit a Return) ®()diet{ ain otnlitr#21 ReMaff s) 1 0 ft. 14 rt. RED SILT/FILLDIRT
14 rt 25 ft. SAPERLITE
4.Date Well(s)Complefe& B-9-2021 WdII ID#ASW-75
ft. rL
Sm.Well Location: B ry LJ
United Parcel Service
Facf1iiy0t,mrNorms facIt hy F'DR ej(gplicaiblc)
fL I rl. I
1600 Cottonwood St., CHARLOTTE, NC, 28206
fu fi,. r.�AFSii1t] i
P1g3icnl.rlddres Cif.acid Zip ;2t lt!
MECKLENBURG 07714104 BENTONITE FROM 17' TO 191 .
Outlaw Paftel wil irkolion No,(PIN)
$h,l.:tiout and trinotude(ndegr'eeshninuteilsicondsordecimaltlppreF•
,t -Lrirlci� idHelfi�t} 22 Cct4if$cadt►n:
(ifvselifitld
N Wrt _ �s..v 8/15/2021
si 3tocr ofC iVcll Contristos bate
6.Is(are)the rcell(�): xiPermanent or oTernporary h�-srgrniirg Ws ftom I inerel�t•c,rq#ih r ahe well(.rd my f vere)cprwnrcred br mvordemew
ii*)V 154 NCAC.02C.OfM or IJA NQ°.AC 02C.0 M WWI r 9M.trrir�thut Srctraa'drro's cruet dlkrr cr
7.L�this a repair to an cxisfingn�clii 0Yrx fir KNo rrpirifrlik r"onihnh-Novi pnwl/li,i r'J*urli'{nrmer,
l/r/rfa ttrr repdr;fill one kpoim rirril coun nm?rnu hrforrw liar and exptabi the rurnire of the
repC.r Miler 021 mwrarkV 1eW60M ar(M ncg!hra k of this fnrJUL 23.S-iie dijgram or ttddittional well detf ik—
You tt 4 itse dk back of this pad;to pw ide addidional well Site details or welt
8.Number of wells constructed: 1 C°oilstrdetion detaik You imay also attach"aldiliotlat pages if necessary.
For rrwtrllnle 1rrft+c40)1 or rjrra-itMee ATPjr lrrtls ONLY nvrh Yhr,same constradion,yaw CAM
ArrNnif wie form. SUBAJITTA .'INNST ti _TIO C
9.Total well depth below land surrACC 251 (ty,)' 241L blur All Willsi Submit this:form Within 30, dsys of completion of Smell
pur antKrlvte rirtls`tist Rlld`nprft il'd(fervna(evmii+tn-Mtv°w,c+2@ ldAO') c(mstnnGticn to(ludir4[racring;
10.Static Witter level below to easiu_of 15' 00 Division of Water Resoui rt66 tntonnation Processing Unit,
p �
tf fFwpr level is above c•eish*'Usti"s" 1617 Alait Service Ccnicr,kaletph,NC 276"-16 17
11,Borehole diameter 8.25" (in-) 24b.Far Lai don Wells ONLY: In add."ttion to sending the form to the address in
242f abo e. also submit a copy of this fottii within 30 days of Completion of icell
13.Will�gstrctlon t�Thpd;AUGERS constntetibn to the fd1loiil
!e= s
(i.e.anger.iotaa},cable-'dind gursli etgl 4 }
Divisluu of Water Resources,Underground injecilml ControlF'rogrAm.
FOR WATER SUPPLY WELLS ONLY: 1636 Afait Se'nice 6 enter.Raleigh.C 27699-1if36
130,Vidd(gpm) Metlrnd of test: 24c,For Water Supply&[Weaion Was;
Also submit olre Cops' of this f6nil within 30 ftsofcompletionof
13b.Diunfititipri il�•pc: Amount: A%Tn construction to the cmmly hea'Ith dcpartrnrarf e f the court trtxvn:
t:Dnstrtuted. C
Farm G%1-1 NoRlt Catalina DgkwM muDf Emim wrens slid varurA Rcsomms-Divk1on ofWald ReutrKet Iicrised AtguA 2014