GW1-2021-06374_Well Construction - GW1_20210915

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WELL CONSTRUCTION RECORD For INcrml UscONL:Y:
Ms farm can he umd.ror.sind is or m0tip)c wds
1.Well Ontractor Into roiatian:
M,AVATIEN Lp1vU
Rich Lemire FRt}3t T(i peSGtertrlte)1
Wolt Ci7r1tG6dw Nnm+r• ft. ft.
2593A ft. f1., l
NC WcJ1 Contractor Ccnification Number 15'.OUTF.i<t CAS fyG(for math 175)ORLINER if j `Ticahk
FROM TO 1 mitts-INFIRS MATT PLAT.
SAEDACCO Inc fL tL f ia.
Cnalv;inp'tdOW 16.1NNETt GA51'Mr OR TUB IT+ 'zt40116 3 clowdaj5i'
FROM To DtMff.TRR TRiCA'NESS I MATMAL
2.Wcl1 f;onstructinn['carat-4; 70002060 0 (L 21 ft, 2" :'bL SCH-40 PVC
li a tlprim0T far:Counrv;Stuar.lrorionex Tr +cdaq M—)
23 fl- 25 fi. 2" SCH-40 PVC
3.Weil like(chcel,well nSc): ii S(R1 F N
Stater Supply Well: -- -- - — - trr:eisi TO I.AtA+YEM SrOT517% I T>tuy NI SS IsrArParni:
toAgfkult ral DMunicipal Public 21 ft. 23 M2^ iri, 010 SCH-40 PVC
DC*othcnwl(ticido oli:ns Si ly) ®Residential Watce Su u. fL in;
n� i�h�(single)
0ltndustriall'ComnicFdal ORCsidctitial Water'Supply(shared) ttt,.GRO1F1 �-
FROM TO MATt{I"' 1 E1ttPt lCEKLNT.ME1T10D&AMOUNT
❑liar orlon 0 ft. 17' rL PORTLAND POURED
Non-Water Supply Well:
0moniinrin ❑itecosT k fL
1tijeclion Well: rL rut
0Agi0fcr Rcchargt 13(limi6dwaltr ltcitrcdiai on 19 SANblCtiA4 -11j,IAC- (i `'li�nbti
1 kr 1i, 1A9 Mf. FA7Pi Al�1rr)!Y Ar}i tl if
17A+7it`ifcr. to gc ursi Rcco tly 0salinq Barrier 19 M, 25 fi, SAND #2
❑Aguefci TcSt ostonm-atcr Dirty-C
131 C-mcnial Timbnotogy ❑6sid"acc Coritrol
2f1.•ORZLt��G` G(�IlYichridrliGdniai41ic2��?ifmccessnr ��
❑Gbtitltetllrtll(Closed Loop) ❑7 tsar r FPO`t 'To PES•CRIF"ON(*Aar.bmr okM e2%'r9ckh ,' n*mrit.t
❑C6othenual(Fleatil Xooli a MIMI) ®Other(-. aiii urwier#21 Recu &) 1 0 ft. 14 fL RED SILT/FILLDIRT
14 ft,. 25 fL SAPERLITE
4.bmc Weil(s)Completed: 8-12-2021 Wdl ID#ASW-79
rL rL
Sa.lirclf'Lticathan: (L rL
United Parcel Service ""
Fscilil)"��+v�rTimue Facilet)•>IJg�Ciatplc.�itiJe) ff. tL .a;�'.,.y•�
1600 Cottonwood St., CHARLOTTE, NC, 28206 r4 fi,
Ptgtkfll.Addmk,rA*.mdZip -ILR MAUK$
MECKLENBURG 07714104 BENTONITE FROM 17' TO 191 . ;7{wGg�l1•
i tJ
GivaLy ftfco or;t t,cnNo,spill)
Sh,x:iititudt Anil Lnnfiitndc in d,gr+ecx!nnnlcFJerindS tit tltimall(147,n i 22.Certification:
6f.,c11 is R+rftaCicril}
8/15/2021
Sigmiciii af[art' o Nctl Cnntrrciar' .Daft
6.15(iu e)the.well(s)t JflPormanent or oTemporary si oin Orit,fawm:1 lrcrelxy crejify fhad Me,r,rll s l µrrx 4t+rsl cWnymrered aft ac-cordmrer
ivi&15A NCAC 02C.01110 or 154 KeAe-,M,020 Well Srandards uiul dwr a
7.Lsthisarepairtoanezittingut'elli ❑Yes or MNo "opy.,faliT rermw ws Nmfrrm•1*Wrrihcnrlia;iMIM
t/Wilt:a reprlr,fill c"r kmot a u cmwritetioo hr/orrw Ml or md explobt rho owrore of the
reMfruAderd2l reinorftsm-fim or on dir.8or1'offhie fowl. 23.Site disram or additional well detailri:
You:may as tie back of this paw to provide addidorntil uvl site details or well
8.Numberof wells conmructed: 1 construction details. Yob-1mv also.atlach addi(itroa paw if tlecessary,
For Mkirde lgjea'ikm or erns-itWw0 mp r tuffs ONLY with rhe.s me,conatrad1mt,yew cam
9.Total yell depth belarle land surfam 251 ffl.)' 24s. For All Welk Subinil ibis fart utithirl 30 days of completion of tu%e11
For mdhipm We'll$UM OffRrfuOv fldl,ftreW(e V(M0k'-3@?AP*Omf 2@ ter} construction to the tbitonina;
1Q.Stafieu°star level below top Of casing: 15' { ,� Diii,kion of Water Rf4ource,Infirnratiofi Fractssinl Unit,
If s'mier h sad'V eve rastrag ram°+„ 1617 lFiait$ctwice Center,Psiciglrr,iC'276h9-1617
11.13nrichole diameter:8.25" (io) 241t.knr tntceMon Wells ONLY in addition to sending the fort to the address in
24a above. also sd"tit a copy of this.fomi within'30 dat,s of completion of utll
12,Well oottsft Karon method: AUGERS construction to the f6110m Inge
(i.e.miger.imaq,t�btc.dime tinsln c(c.)
Division of'rii'ater Resource.,Underground 16jectton ControlFrograni,
FOR WATER SUPPLY WELLS ONLY; 1636 btnit Serulice Center.Raleigli.NC 27499-1636
I
13X Ytold(m mi) Mcthrltl of test Zaic For Wateralilil) irtleetuin,VYetRit
Also si biAt ono cop?r'of this formi Within -10 days of completion of
13h.Di3infcxt on tr a Amount: uyctt construction to the county 16411th dcpadmcm of tfic cminh,u'IX-M
constructed.
Faris GW-t Nomh Citrolim Dquito*nr of Emimmicia outd Nirtirsl Rew -Mkion of VVmgr Rmotrm Revitsed August No 0