GW1-2021-06368_Well Construction - GW1_20210915

WELL CONSTRUCTION RECORD For lntcnml Use ONLY:
nis Corm can be'usod For-smile or oaultipic nclls'
1.Well Qntracto r Ltfortnation:
14,A VATER ZONES
Brian Ewing FROM Ttr bF$fskrP7tl}N
t1'011GtsdmNjrtic
4240-B
NCWcllCominrlart�nifocetionNvmbrr '15 it,nr nulii4aseilweil. "t3RLdKl:R.fir?$ Bcablel.
FRO31 TO f-TAPtETER T12iCt►tF�S 31ATERTAL
SAEDACCO Inc O' (L lia.
Canipaurr�'Nanic 16,1KNER C+4g1NG OR TI1BJ G ffiedise''mil dowd-16061
,
FROM TO DIAMETER, TMCKNESS MATERJ.IL
2.Welt - nsttgrctinn PcrTni#ar; 70002060 0 ft:. 21 ft. 2" ire SCH-40 PVC
13ar4r1l.Ri1 r11L6J1 urlJprhW?y fix,Ciaraty.'Sww'trariaaree.11�x Ca esr.) 23 fi 25 ft. 2" SCE-40 PVC
3.Wd,].li k(e";,well use): 17.S(
-- - FROM to DIX'"PTER 8tOTS10, '"IK CNns
Water-Suplliy Vt'cll; ' atnrlxRT�+t.
i�A91feuttil.ra ©Ml1RiCipall iiC 21 ft 23 fl, 2" in .001 SCH-40 PVC
DGeothemia:l(Hei dn000fing Supply) 01tesidential Water Suppb,(single) ft
0ltldttstFiaVGonitlrercial DResidential'Water Supp4-(siumd) e:GROUT,
FROM TO MATERIAL I nTPLACVdV9TAWFHOD&AMOUNT
Olrritmtidn 0 ft. 17 fL PORTLAND POURED
Non-Water Supply Well: � f4
❑ivlgn to614 C7Reco�r
inJeciott Well: rt to.
0Aqu*rRc0argc 0Gmlirsdvr11crRcotcdiolon t .SANGIGttA5l1.fA_ f tee la
i'HrlSf. IttAT'irCML F.aiv1.a47;rtr:NrMrr11 p�
lnAitni(cr Sto-fc Pnl tern mT)' p5aldni>ti�8arrit r'
17 ff. 19 ft, FILTER SAND # 2"
0Aglrifcr1'cs4 13MOMm'8tce1)i;1 el,9gc
ft. ft,
❑Egacrimcntal Technology bSubsidc ace Control
20,_)nRll l drti G ld3G iailaeh aiidiiidn'a9 alK e43if aicceasani
❑G,odtetoial(Closed Loop) FRONT:TO DrscRlrTt4 abr.l�artincr,x i#L!i+kk d rYrc�etr.
OGeorhemkal(Hegel*2oli Remm) 00ther4: aintltkler#2,1Remaiks) 1 0 ft, 15 fL FILL SILTY SAND
15 fL 25 (L SAPROLITE
A.Date Well(s)Cotnpietetl: 8-16-21 Wt111 1MASW-56
fL fL
5a,Well 1AiC2ti0n: fL fL
Q .•a
United Parcel Service fa 114 ^�
FacIt ilyo0wricrNamc. Facility TDO 416p0imbls) ,
tt, fl,
1600 Cottonwood St. Charlotte, NC 28206 Mecklenbur, tt ft,
Charlotte, NC, 28206 MikalAdldrTsidly wilZiP $d:"Nkt►tARkS, is _ n $ "
Mecklenburg 07714104 BENTONITE SEAL 17 TO 19'i'i Jr�;mot.ems' jg^llioil
Cdola s' N =i Id?MI'lle-i0ca No,(PN)
5h,Latitade'anil L+in);tudc in dcgircc dminutcViccor ds or decimal dcgr ms: 22.Certification:
1�' Wri, 1 EWQ .. 8/20/2021
5igrnln0`of Ccr11rwd Fell ConUmOr Date
6.1s(are)the:weii(s): oPe ntanetrt or oTemporetry
ll}•.+4galng,itrJ.t,kvarr;1 Aercl+t^ecrhry iderat the rFvll(s!rrdy CFti-&rr)irgt4fnreferl br"trtx+surlerner
rrdrJf 1 Mkt NCAC 02C.0100 or.15A NC.AC 02C.0.200 Well Conapricrim Ste.jmdards anrJ flare a
7.is this s npair fta an existing well 01 es' or E No copy i,ff(lik record liars henna prof"rir ji iirIl♦IArner.
if abixls a r'spsrlr,fJN Uwe krrf+irva t[�rl!caraarrrmirnv d�rfarK6niloar etrart r.�iataiar ilia n�rraare ref the
,emir W'.Iir 011 rmarkv arcfimv 6,",the bract-ofthir farm. 23.Site dinaant or additional wiffl details:
Yalt may itse the back of This page to provide additional vt'ell site details or welt
8.N"mber of vvegc cottstructed: 1 coustodetion details. Voitt'roav also attach addiGaitai pones if jecessaty.
For marlrlple b Wrka:r )i or aran-, nner sWply Irrth ON'LY wirA e�P mme ceirsrrart6ml,SX-m eem
xoNdi rrve farm. sunniTPAE 1NS7'UmoN3
9.Total well depth below'land surface. 25 {n,) 24a. Farr All Wiellw Sitbmil this'Anr a µithin 30, dpjfs of campletidn of well
For ain0ple'wWfr lift rri10epr Con5tmctiontoftfollotsin�.
10.Statie water level below top of easing: illy,) Divition of Witter Respure�ei,Information FrocegsAng Unit,
If wwre level h repave ctitdfgt atra"+" 161 'Mitit Sm'iee Cenjer,Rr 604 NC'21699-16 t7
11.Borebole diameter:8.25 (ia.l tab.Fnr IteiceNort Webs ONLI`: in addition to sending the form to the addn sin
243 above.. also subruil'a copy of this form within 30 dm!s of corntpietioo of Ktil
12, ;�cil opnctt9eetlotl tintxbnd; AUGERS
eonsinteddo tothe folla'�t�irw_
(1_0.��rolaly',d ble.ditett.posit etc.) 1 +.
Division of Water Ream rces,Unditround IRJecholi Control Pro rain,
FOR'WATER SG'PP1.Y IVELLS ONLY: 24c For Water 36 Ip K entice is!nler Raleigh,NC 2,76".1b36
1ra3b Alnil S�rr,let�c
13a.Yield(lgpm) Method of test Supply Wells:
Also submit one c*,of this Midi within 30 ftsofcompletion;of
13b.Disinfer tlon hTe: Amount: ,nxtl c nitr htc�hh dc'portmmf of the caarnty n•hcre 3�-C11 constntChon to the �mmh' l
Farm GAV-t Rcv sed Atgust 201.1