GW1-2021-06369_Well Construction - GW1_20210915

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WELL CONSTRUCTION RECORD Far litt at use oxcir:
This rorin can be used faT sinrls ar oatipk Hells
1.Well Contra.etnrinformattion:
.
Rich Lemire PROM '10 1 pE'S(ttW1,10It'
V001Corcrttet7tNamc ft. fL
2593A
NC Wcii Commcior Certification Number 15.OUTER.CASEW J01-1s'OR'L1KER 0 s fieabk
F OAT To DTAMFTER TfrrCKW--s I MATUTAL
SAEDACCO Inc fL ti
C00gttnra N Art Z6.1NNER CACING't1R.71T61T1G tlrertiit l cloficd irlh` ,
rROM To DIAHETER T#rICL\WSS MATE UAL
2.Wtil Construction Permit 4, 70002060 0 (L 21 ft. 2" 41L SCH-40 PVC
list allaq�'trrrtSle wrllpr.'imltx tr_r.:G'punry;SNrM,trnrinrrar,Ir�afi�err,.}
23 ft 25 f#. 2" SCH-40 PVC
3.Wch[use(c"c wdl u sel: t?$C,hItL!tY. „i i; ....
Water S6pply Well: TRt�M TO uiAat6 rt 6t�rn'srrt: wtsr civxs5 afAta tat
CI11Sa`itu tiiral M40*6pa]IPAlic 21 ft. 23 ft; V, iib '.0id SCH-46 PVC
MootheTniaf eatin ooli. St l ) CResidential Water Su ft, fL in
(H !! IU3 R>P Y PAh'(single)
0Industcial/Com-m trcial 01tesidential t'4r:iter 5i h-{sba'red} A CRO�t u
1rROAt •TO MATEREAL "TPIACn TAMMOD&AA10111W
Otrri'4tion 0 R. 17' tL PORTLAND POURED
Nor-Water Supply Well:
❑?vtgnitrrrn plt�csve h' fi,
Injectlan Well: A fL
0Aquikrltccharge ClCaroundmitcrRcntcdiation {ir aivi. i.
FROM TO IAXJRYCAL 1RAr#'1'Am"�I►NTmt.Tn(ft,
17Ataltofcr Sto�agF Atxt RtGtilry' p 5alinily 13airiz r 19 R 25 fL sAND #2
DAquIi(FrTest ElStornmitcr bimnagc
❑E-xPFiimcn 9l T bnotogy ❑suhsid WC C 6141D
20,'ifRI1.T�l�GLOGS'i+ft�cbailififiana�lA'hcda�ifi►ecesrnr��
❑Gwiltei al(Closed Loop) OTrocer FR03T To MCRTr'r901 Color.%Pfrd"m j!itt'mdiO 0 Alt�0
❑Gbolheil4#itl2LCati#g20li: Remm) ®Other(explaiRunder#21 Remarks) 0 tL 14 fL RED SILT/FILLDIRT
14 rL 25 R. SAPERLITE
4.Date Weft()Contpleted: 8-11-2021 *d1,jD#ASW-81
Sa.Well Loeathin: tL R.
United Parcel Service fi, (L
Faci]efy)N,ncrNnmc Facmh�im(`if hWpl eaibis) 2�
1600 Cottonwood St., CHARLOTTE, NC, 28206 ft. (L t jylj�
PlpsacnLA:ddres'aty and ZiP ?fd'N'EMA1tK6` ;r` t 11 w
MECKLENBURG 07714104 BENTONITE FROM 17' TO 191.
Cainrrtp' Pmtti 10,a riciumi No,(1'i1!)
Sh,a atitude'and p tinfiitndF in degrees/minuteslsecnatistir4ccimal ttgpws: 22.Certification:
(Ifnclt f�td.`rgrc l;ttllcr�lR'fi+diltit�rt)
i\ W 8/15/2021
Signildie 0fCerti Nell C0n1ry T} Oats
6.b(are)the we11(3)3 mPe tuanent or f7Temporar} signing,A* 1 twrrhi•ter rhtar shr arll.�)imy{nrre)mnsinrered irr m xmrddhee
�1' 8 6' J r3�}'. - �'
tiirh IS4 NCAC 02C-.O.10n of 154 NdAC V-G;0209 WAg1'Cnimrrx1kur standalds a ndTarr a
7.Le this a repair to am existing!welts t71re_r`" for NNo 'tvlrr of ihir rminf has t!'nwidavl r�ars•w,wrIl4nwrom
if Aria is n mpair,fill owr 1mo4vi Imil and r;�l± br thrormrure of rbe
repairunrlerP21 rernorkir.ree anon Me brkk of-t.1is fnr t. 23.Sitediagranvor additional W,01 demits:
You may use thi,back of this paip_to pto8ide additional mA site details or iiell
8.Number of Fells constmeled: 1 constmedott.delails. You may also attachaddi6oatal p#ags if a cessaty
For marldpfe lmJet:rkwior erNr-tocirer r4pplr arils ONLY iw1th'rhe smmle consb*ion,y4 iw emr
Udwrit a me forme. suamirmumsTtimoNs
9.Totalwdt depth bed land surface. 251 {ft,) 24a. For All Will Sub#nit oils.bub urithin 30&,ys 0f completion of Ttrell
Foramota�pJeriue'tfa`lisrarfl ohs ldl�Prrrnt(�ramiiaP€- �?i "antl2�Itkt) constriction totL-feolkmina;
10.Static stater level below top of raspn� 15' A) biVision of Water Re nurces,Informatiaa Fmcesmna Unit,
11 imier level h ahm-e radar.alto"+" 161711 nit Serviec Ceriter,)f Acigh.NI C 2769a1-1617
11,$nrebr►(k diameter 8.25" 24b.Ear 1nf on Welly ONLY: ,In addition to sending the form to the address in
24aabove. also ptbmit a copy cif this-form within 0 dabs of conipaletion of ha
12-,doer(v orArpetion umbod; AUGERS Construction to the follotvilig°
(i.c.sager roam;•,dnbla.dircd push ctc.)
Division of Water Resources,Underkround(n1eciion Contwol 1'nogram,
FOR WATER SUPPLY WELLS ONLY: 1636 Malt Sm-lee 6filer.Raleigh.NC 2U"-1636
24c.For Water Supply K lnimtbim Welk
13,'i,1t Cgid(gpm) Method of test: ,
Also submit one 'of this f6ni ii within,30.day'sofconiplet ion of
13b.Disinfce#inn tjVe.. Amount:— evctl carntnictmu to fhe cmmcy (i 1th de'Psament oaf the cmrtihctvix-m
cc�nstnicicd.
FonnG4u-1 KDah.CamftmDcparlu tr6ofEmimrtnrcmmidNnrrimWResnumes-DhtslmiofAlatcrReAnro&s ReviscdAt*iM1011