GW1-2022-07205_Well Construction - GW1_20220804

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WELL-C'ONS'1`RUC11ON REORD Foi[tecnud itsc oN1 v:.
This form can bc.wd for sm�k of mulupk uvlls
1.�Y0.6.nlrictor infortnatiun _ I
John Eisenman FROM TO "ll"WR(PTIO.
1QettCnnsilg6rniilw . . tG ft:
4439A
NC,Ct'cllConlracio�Ccitifi tioiitvttin ier .iS:OttTERC7ISiNG(tortnultiAii`srdmcffs DR NER(ila "lictbk
FRO.t1: 'To DIAMUMR• •' .TllH uNESS MATERiAL. '
0 ;tit,. 40 ft. 2" iu. SCH-40 PVC
SAEDACCO Inc ;•.
IG INNER ING:OR 11JBINt;ff eoltiermat ckised4l
attyran�:t;gnu r
FROM• ,TO DIAMETER TIrICA:YES4 MATERIAL:
2.�1cllGon tivctiotiPclTnit#: 70001826 All tb �
I.ifrYllnJrplil:ri5l�url(lixnn,ttttc.Gctoitt'rStiA:,•l°rrrinrict I��D'bl rt.�;):'
3:11 ell Ilse(chccl.tt ell unc)
Water Supply Well: FROM TO TitMETEA NATSI7E ;Tmctc�t s. ! MATERIAL
40 ' ff: 50 ft: 2" .010 - SC PVC'
1 JiSgrictilinra[i t�lriiiniclp:iUT'it$lib': `f�
QGebtttcmtal(FIcatin ,!Cool n£Spppli QRcsidenual Water Supply.(single)':
GihldiStriaUContuierbcil ` AK
QltcsidentialN%ratcl`Suopl (sha'wd)• -FROM ROUT .To MnTF.RLtt:} e.rvrAeesreNT.mrnroD cArlouxr.
Qtfri�atipn 0 ;fb; 35 It.- Portland Pour
Nov R'ftcr Supply♦Yell:
6dblofntorin�, QRcco�'cIp . fir ft. '- •
Injection Well: 4r•' rc ��
pftfifdr Rahn& Moll r►dt<nfer Rcluedl ition �.14s`SANDIGIt f VEL'1'AGK td i ilknl>trS
FROM 1 '10 MAIRRIAl" EMPIACCNti:NTMETHOD
DAr WfcrS ort&.144cco6, ry.• QS,1inln 131rnc 38 p:: so ftj Sand, #2
dAgW(cr76t. QStornmltcrDi:unige: ft. A.
l]l:q► nntcntelThhnolb�' QSuiiSidert�c�4rdm1 -
=2otiRiLL1�G'LOG:(attach.addifiooulslicets'itr►cciKwtni, "` •� '
t]t,eottterulal(C108etloop) !]Tracer FROM .To DESCRiP.TION(iubY.hardnLii:.ui'nMkti`xgrAin`sirc.de)
OG d n►za1(FCcatiftf lCaoliil_e'Retina)'! QOtlter.(ecpWi`under A!V.11 inarfs) o :fi.. 50 ft. 'Sandy clay
tt: ft.
41 Daft vell(:1)Col 16tC& 7-14-22 Wel11DIIGw-24R ff (l to
Sa �i't�11 LiiCa4i(iui tt. .tt.
Lyondell Environmental Custodial Trust f4- M:
Facth(tjpvi;wralamc Faciro�,lDk(lfappiiiblc) fl:' p ' t3u inAroc 94 URA
IntCria(t
3926 Glenwood.Drive, Charlotte, NC, 28208. p:; ft.
Mecklenburg Q6510128 Bentonite seal from 35'738'
(:tititdi`;: 1:�tLCl..f(4:itiiCre;41(in'Na:.(Pii11. i,
fi:I lntuilc,Ind T on{dtudc In dtgfresiminutcslsccnnd4e ticcimnl dc>:rres; 3,;Ccftiticitiund
(if ,ill licta;pt4 I:tt✓lotty in nJliti;.trQ .
•w d 7/24/2022
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` � ri,n?'1,5,1 NGAG U3C �-�.'��F�`:Lir.,.,�L;{)2!k)H'e JJ COtiS7Rlt-rf0/1 S47rsritTr[fS iplil rl�'!i7
7:1a thty a rc{fair to`an cantiD+itch ®Z°ice lr ®1�1(t,' coli q,clap recooW hay h eri jrraaT frl;i ro tile zrt ll mvwr.
ljit Is u a/6,liotr fill�tiA`avltm ncll-c-aiutn(�lior,tryorrrutieu,r'arll er�iufr(rJic:iuirrrre-ojtJa: ��' � •
itlur,C fri;ilri42J r.rnn`rkr t..:nrm aY ai the hrirt of tJiir)prur. :23.Sit(,dla{ram or addiuonol{\{ill details:
l'ou;m t� tisl {lw b!ck o.this pitgc to pro%7de aMliojtd We sue details or!cell
8.;hnfi)ticr'of ttal(s i`o►tstrtictd: 1 ,,,, - constnletioi itct�►b. You fu�t� Also attach addtlinlial.pab*cs ll`I►:ticssarl: •
P4r rnnlitpie.njccrrvn fit;»wi-ugh r ar pplr rvi!li 0,4r t'Ti J(Ji O lame cnirstrur`lion„}o r e ra
submrrgnr jnn.r. - • .• -. •S.�)a�ll�.ttl °�$.��i.'T('IO1V�..
9.To!tl Ficll do{►ih betott'I tail surfnce 50 (fO 2aa I or ail'1lrcllr';;Subnuf,lliis font( }tthuf 3U%i NS of cbvtpletiolf of-;Well
`or rttallipl e tticlld h craR dc./uJAs tj c(tt?r rrnl ikitrio:t?6%20w.rinll2 Ifk))' COnSInlctlOtf l411tC f0llotfln$.
1(1.StSftiCN'ahr la►cl:hclutc top oftasiug:: _(jI;) Ul'i,t(in of.)�ater Revovracr;Infnrfnsti is Pru r��tng. 3nitr%
Iif i.6aer level lr at 'o(c eiisrtt� u :'`�" :l6l7 Al iil �T iCC CcnfcriAocfgh;V( 2,699=1617
I Bnl'e114lC I1181nC(Cr'8 25" (in.) 2ati.Fn„X tj tion�Vclh ONLIV., in addition to sending the fom)to ille addresc4n
2 a abote also subunit'a CoM,of this form ttttlufi.a9 date`of conlplcuott of:is U
I2y ell construction method: HSA colutmction tnihe follotiing
tf c�n r[plan cob!-;drrat dusts etc:j
Dirision of�V:ttcr:Rc.ourcc }UDdcrground.[ejection_Gontml L'ingram, .
ROR1Vc�TERSbP.P.I:1'RELLS ONLY 1636 b1ni1 S�nice CCntcr R:ih.fghrl`C:2769)-163ti."
13a Yfc1i1 to IcNfod of feet• �Ac.Fol Water Sunnh k lntcction Willsd
Also sttb cop Ud mngt on: e. h ' p
33b Dlsinf�YKtonripc; amount:.: tictFcoustfiledon to.tlic caant. licalth'dcrrntni'mit',6f titc cai►nri`.1llfcic.•-
' CoiLstnlctcd..
Forn1G�°-1 NorihCa(ali,ia[ piinxtnnfEniirumrxftiaudV;dnralRcwu(ccs DnaiurofZLiler;Retotrces Rc%iscd:lvgi]lA21i13-
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