GW1-2021-06348_Well Construction - GW1_20210915

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WELL CONSTR[1G"l'ION RECORD For lr&n®lOseONLY:
Tlr6 fb con be u--wd For siv&or nntllip1cmvtls
1.Well 6ntracto r Infor oration:
IA.1':`ATE.R ZONfS
Rich Lemire FROM TO OFS(MIPTION'
Nrdl Ciantrtdtn Nano
2593A
NC.Wcll Connc-tor Ccriif=tian Nmnbra 15.OUTER. AL
G ir'�F Ills-f$EMIInIcnc OR LlN.ER of g' able),
FROM Ttr "Ill, EMI
rrliGFNR.�S PiATtPtAI.
SAEDACCO Inc (L fL
rrntgnaary Narrtt
16,iNNER CASING OR TURIM iheriW ileged-Idii
VROM TO DiOWTER TnwKNEs5 MATERIAL
3,tiVcl"t tanst tetionl?etlmlti*: 70002060 0 ft. 21 ft. 2" rn SCH-40 PVC
list0110,rgmllirnkre w-rtl pciamirx le•r.Crutrnra.MWr;Madarrer:Aft6cn etr:j 23 At. 25 ft. 2" SCH-40 PVC
3.Wiii.11lsc(ehrcic well irse) I?SC,tt>1 Nl
Water Snl►Itl%,Mlrelli--- - FRIi,N To uurr�rra SG4rcrr►; TtitCiCNFSs 1 MArRRrnr,
®Pgica ltilral DMunieipxal/Public 21 rtr 23 R, 2" O10 SCH-40 PVC
DGeothennal tHecatin ool.i. Si t ) l7Residential atet Su rt. rt. in
� nB` �Y l��'(single)
131ndustrialfConiniercial 101t.esidential Water.5t 1A CROtf1. :, it
�'(Sik9a%d) ,PR.OH TO iilAT L%L I E%XPLACEMLNT AWTHOD&AA1OUNT -
Ofrri ation 0 ft. 17' fL PORTLAND POURED
Nor-Water supply Weir:
C]htpnikerin l�ItncP�r ft.: ft.
Injection Well: � U
ClAgnnfcr Rctib*g& CrtirouAdvOltr RcntcdWioit 1
FRI,k3 RtA"tT iWt. F��ht Ci�tr�Y i�€t it
❑A+pri(cr,$tomge Prxl Recavc}' c3salinity 138mr 19 ft. 25 ft, SAND #2
❑Aquifcr 1-cst ❑Storinwatcr Drtinigc
rt. it,
❑Fxperitncat4f7ochnoto y ❑Snttsidcncc Coi4rol
2fr.�ITR11,1.7I5G'•1AOG'(sitaclr tiBtTitiraii"Rtalicefs3rreccccisrir�•
oGeerilietinal(Closed Loop) IlTmeer YROM TO D1sscRii'TI4� »tar haMnrrl tr RPmctttr �sbatla
oGeorllennal each rGoollueReim) ®Otter(: aiti under#2lReutaft) 0 fL 14 (L RED S i ILT/FILLDIRT
14 R.. 25 ft. SAPERLITE
4.Date.Well(s)tponiplojed 8-13-2021 Wdf)D#ASW-83
ft. f!.
51.Well Leteathini
United Parcel Service ft.,
fsai1}a'Crt wrNarus fnctill•)DO�f�rplicnt►lc) � O
1600 Cottonwood St., CHARLOTTE, NC, 28206 rt, fi. UtZj
Figsesnl4#rlrss Ci .andZip 21.REI►tAtrtf,
nVIIJ
MECKLENBURG 07714104 BENTONITE FROM 17' TO 191 .
Gttttiny 1%mo Wmiriewan No,(PIN)
sip,Latitude anil Ln,ngitude in dcgrcc0minutcsl c6onds or deciuml freer' 22.Ccttifrcation:
trtarlrt�lid,r -t��'Ipl�..rs"gridf3i;�e't11
Rr � t _ 8/15/2021
Si ufCath" cllantrirmy Dale
6.h(are)the:well(s): xPertnanent or oTenipor'arg
tly.srg+tbr}:ahit.:;ftuanr 1 herelry crrtRlPy rhrsr,ahr melF(x!wax(Firrrl Ctinrtrtrrterl,irrmctiuu�rlemc�e
tt*1 1 Sri t 0(C 02C A/W or l JA ArC,4C/T2C,r3200 Well Con trrtirilcur Srarudar*trnd Ova i a
7.ix this a:rcliair to an tAxting welk 17Vcs- or K:No r4ry 6,4'rhh nvonl list;Nev rtmvidivI ro urtw cull(i uncr,
if;t ts'Ito repair„fjrl ow±r tw4w xTl'l cc arrrif t A!tr/orrart kAa mul rcptabt the eraroure of rAr
rcpair remlrr$21 rcnamrkti:rrreetrtm oraq tie biwk ofrltfr/artlt. 23.Site diagram or additional well deta l.4
Yott may ttse tie back of this page t4 pr&dde addifloral well site details or welt
8.Number of wells cottstruclid: 1 consttuctiotidetaait: Ycttl trim'ala3o'apaeh add;litrdial pests if t►ecessety:
For uiruiftr/Jr ttrfe+rak�r ar arNt-n+arev�rplr tvrlls Q�t'f.Y ndrh rite srtrtlr sotrsta�ui'tiL.tr,ytnn-ccm
srmat nwrt forme. SUBAiCCPAL•ihTSmETCTIONS
9.Total well depth below land siirf8cm 25' (ft.) 24a. Far All Wells: minit thls forth-,t3ttin 30 flays of completion of well
Foroffmhiplrt i ev fs'lisrRldcleTibi ftd'1ffirrejo(e rm.0t-J@2vo,and,2 ?ld') to the foilonite
i
10.Stitle water level below top of casing 15' (ft.) Division of Water Re.4ourtrt,lnforntatiotj,Protessinp Unit,
t/ttwee leW&above rad ag,nth }" 1617 A1ait$ervice{'_enter,litalei#ht NC 216T)4617
i
11,$nrchnle dismcter.8.25" (ia) 24b.Eaic ireirrHt 'fir sWetls ONLY,' in addition to sending the form to the address in
24a above. also submit a.copy of this forth within 30 dm,9 of conipletion of%wil
12 V1'clr QD-Am- etl0it twhod:AUGERS c-oustntction to the followine,
(i.e.miScr.roiaq•,cable.dirm twsk ctc)
Division of Water Resources,ilndergmund Injec iou Cflntrol Program,
FOR W,4TER SUPPLY WELLS ONLY:' i636 Aiitit Service Center,Raleigh.NrC.27699-163t
tau,Vkdd(gluill t4eilrt4 of test' 14c.For Water Supply&inimt in WaLs
Also sub a.*oric cop} of this Reran ►i itbiit 30 da`'s of,completion of
13b.Disinfection h-pe: Amount: Avcll comAruction to the cmmty hcaith dcli6a ncart of the county where
constructed.
Farm GWr-r Narib Carali u D;rtr kiaofEn%1mnnicN and�ramtrtl Reso mes-TtWislun ofl WL11-;R050VOCS RcOscd Atgiut20i1