GW1-2021-06370_Well Construction - GW1_20210915

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WELL CONSTRUCTION RECORD Far teacsr®11.rse OMY: �
T1ri3 knb can be gscd Fat sittglc at muiltipk nulls
1.Wett.6titractorinformati0n: I
T�I�i*�A1�Ri Y37fi _;.
Rich Lentire FnUyt ntt1f'tttt•tVAN
U101.tCprnr�et9arNir fa, ft 0
2593A ft fG
NC,WellConwit dr€eniiucationNwdics 15.4)UTERC"r G or-irhtFil-tsisl'recfis tf7t.Fal F.Itiffn fismCik
FROlki TO MMET6R MctctNES MAMR-TAL
SAEDACCO Inc ft._ 4LI
Cnffjalya:nw
icINNE-R, GDR`TUB 11�rrtatar)latcdliiti'
PftQ67 '1Yt titAAtEMR. Al'EA.L1I.
3,Wrl]tonsitmstien Permit 70002060 0 IL 21 fa 121, SCH-40 PVC
fig 011,gN)'Vm61¢wr.tlpehmhs tr;e:Grtarn v,Swur,,arariartar,Iiliettlrrd yr 7 ff.. 25 fi 2" itt SCH-40 PVC
23
3.Wet'I.laSe t;cttcsl..��cil 059)»
re Water Supply Well.-- - - FROM TO I -oL4fWtFTnR._ I ROT 517r j Tu1C1CXT*,5 I
-X2A1VoAt-
DAVIculiaral OMuii6p3itf'ttltiic 21 ft. 23 f1, 1 21, I
t%
.010 I SCH-40 PVC
06cotbvmral tHeating�Co0littg Supply) Oldesidcntial Water Sups)#•(single) fL JM
01adustria,VC01nniercial ORmidential Water Stt ltt„CROfff"-
pAl}'(sl t d) rl WN Ttt MATERL%L E5tPEACE+a1NTatVMGD& IOUNT
olrii thin 0 ft 17' ft PORTLAND POURED
Novx17lPater Supply WaR:
ft rc
❑N omlot n pRac0tc
Injettloa Welt: rt ft
G7r1gt1►fcr ltccli irge IGrotllid ter Itemcditrdi011 14:;SAND, pEI=fiA 1;, llc�ttti)
?4 tcNrrxa it
�1+t!�411I((cr$to,gc anti k=ovcv 0 VgIinity 13am-,r` 19 ft. 25 ft. SAND #2
0 Aquifcr I`cst p #omm-atei bla to e
ft. ft.
❑EXpr1imcntal Te:chnolog OSId idew Control
2tt.�lYiilLl.��ii�1X}Giattaeb��fitiihi�llrli€nis�faeecec�nr�;
❑ (Closed Loop) oTraceT A01%1 T [►$SGRIP7tO\co i:t�ardn it er it'Hk1t' i tM
❑Ceofi 'l(Rea it a till ,Recuto) ®0diert . aiq under 92 Retuarl�) 0 (L 14 h. RED SILT/FILLDIRT
14 ft. 25 fL SAPERLITE
4.Dual W0lt(9)Completed: 8-9-2021 NVdj jD#ASW-72rL ft pr
53.Well I ncathm: (L (L
4�
United Parcel Service tt, ft. 5
Fasitil}et3atr rTlutne Fsbititw IDk tJ(a tplrribls) �t
ft.
1600 Cottonwood St., CHARLOTTE, NC, 28206 fa ft
M=`kil,Alr-ss Git}•_aredi Zija g.ItEht,�Tffi;,
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MECKLENBURG 07714104 BENTONITE FROM 17' T0119' .
Cantny loll al tetcoltil`er ryryitpi§Ftp,�t1
Sl! I-otitis and Lein)itttdc in tl�lirrvtWsccnnds or•decimal u 32 Cciti#iaation:
(itas�9tSetd,or�Ltttadgt$$trtflei�lji) r
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W tom: 8/15/2021
5igmtorr brc iti ' vvcli Caatractns 3r Date
6.Is t 1 thewell(s): whermarient or 133'enetpr rare � V' � �y
. er' un�thdr 114,�r�}ier ifarxr tke vTll`s,e treat f�t+red tieirurtvirraerf in mxvMcrticw
rr0r t5hA NC.AC 02C.0100 op f FA N€`At:a :#, )We11 Cwtstrriur#wr Varadores anrr)',danr I
i.is dtis A repair to an ea;isfipg s°elii ❑Ves' or NNo r rt;3rhis retirmnl7an tairra Fn�r tdsud rri-�ar pe,aP+_uirrr.
1lxlets'€s n r ie; i7, r b, cn er 7a av:v�nv ar G farr aduu muf r Pwat:rthe outwore Pf r1w
re,va'i'k d�ml`cr J rciwrir&s.vEcd'am2�4raa4 t7ic brut r)/'tfirs fnruL 23.Site diagrarm'ar additional wdl d tlq:
You may use tk baek*df this pa&to protide additittiial civil site:details or AvIt
8.Number of w6ils constt•ttcted: 1 misituctiori adelmils. Irntt zwyaW siltrch addition a! i*if Ime rr`.
f ar m�fr►pte lmjc�rdnn cuF anti-rrtar�r 'l+�"ea�rt(a:QrVLY n�rh'r7ir anarlr caxtstgrr,ctfaat,:s�*i+.caira
a"I,miY pear Pr". SURHMUL INSAICTIONS`;
9.Total well deptli Maw land surra€c- 25' {fl,) -24iL Fbr It i'4r016: Submit tlris forfa iiithin 10 days of obtu awoo of iivlt
,For ita0pie ieelklisr irihfe ki ird'i�errarr 2@ twi Cemstnlciion to the fntl€%ing;
10.Static water 1mv]below top of casing: 15, ( ,) Dir'ucietn of Water#te�06ri6,Informrstibn Ftocessang[)nit,
7f rvrrse,kffl&nhdve rr d ag om"+" iCal 7)Hail Sdvice Cntcr,ltrleigiti 1VC 27G9a)-1ti17
k
11.Sore'bole diameter:8.25" 0 ) 24b,For Inlertfon Wells ONLY: In addition to selading list form-t0 the address in
24a abode, also sat mit_a.copy of this town c+itbin 30 dams of c6inpletion of emll
12,Mrell vorstrac0oae motbod,AUGERS ConstnlC601k t0 tilt fo110*i1rg, 6
(i.c.�e raaacy:cable_dingy pnstr cec:) t
DMsion of Water Res0urcei,Undet,graund Injetilott Control 'grank,
FOR WATER SUPPLY WELLS ONLY'' 1636 hinil Seivitc t emir,Raleigh,XC 376"-16 36
t3a,1Tdd(gpm) l4te4104 of test; tic.Far Water Supply&fWrxYi+►,aj Wctl.a'
Also subtAt one Cop}'of this�f rill w itbin,30 dads of completion of
13b.Disinf;x m t pe. Amount: -iced canstnictidn to floe core health departrinmt of the cminty w
constromd.
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Fann G)&r-1 e�nttb Carolina Depadaaapt or Emievanwit;and NanrsaJ €a�recs-Dig hian of VVaiar Ett t7ttte5 t3ci iced rot 1 I#