GW1-2022-10651_Well Construction - GW1_20221128

WELL:CONS'[TRuc'rION RECORD For h1criml Wc ONLY:.
'iL Form can be used f ff-sinpJo ar mW ipk mils-
1.�Vcll.Ctintt:tetoe'Inforrt3tiou:
G(zWATERZONPS
Brian Ewing FROM. 'm KiCRIPTIOK
U'cllCoitrsclorN,lml
4240-B
NC Well ComlactorCcttifttatlou Nwrber IS'OIJTER CASIA1GYtoe auhtfusrd r►etls'OR L1NER'(if.a' tkabk
FRRO31 To Dri�tETpia rttiOKNESS ' 37A1IRUL
SAEDACCO Inc
Congrut�Nauir• 16.'INNER.CAStNG'OR-TUBING jjj tkia1:li'ciuscil
FROM TO - DIAMETER TdDCKNESS MATERIAL
2.�Yell�onsttVCti6npcttititd: 70003075 0 'R. 5 ft. 1" •in. SCH-40 PVC
lirf udlnpplrabd¢+scfd prmrrfc(ir:fn'ou�W;'Statr.,lrnrdamr•ft�eCb'Or1 cry J
3.PVC uilsc(Chtx)c*41 osc) -17.SCRELN
Witter$upli y MM' FROM I TO I DIAAIOT6a I St.0TS17F: .1 Trnt.'KNr-Ns I-1.11ATMTA1,
ClAgdictlltll[al C1I4IpDICIpabPfRbliC. 5 ftc 15 R. 1" in .010 SCH-40 PVC PRE-P CK
Meoiltellml(IieatinglCooling Supply) ®Residential WatcrSupplp(single) ft.. ft;. in,
0Industrifal(COn to tercW ®Residential Watecsupply(shared"} tBcGRt)T]T
FROM' 'TO. AIATERUL 0%1PLAC NFLNT3IMOD A310UNT
Dirti lion L
Nuu-Yatct'SupplyNVcll:
6dlvtpnilgriu� I7t�Ccntct}' �� ft. `
New[on Well:
ElAgteifcrRcctiargc C1CicrufidiiatcrRenlcdi;iliou tsCSAND1GILtVEQ PAc[irir lllienDtey;' _
'NROSt Tdl MA•rrumt. •.E2Mp/-+ti(:wHl:wY H6-rN(In
nAijttifcr.Stgrage ottd Rccrivety 13S11iriity a ir�gP 3 R. 15 ft. FILTER SAND # 2
QAgnlikiTest CJ5lvririilatcrDltiinago R,. f_t.
C7Experimcuiil Tcclinoivgt A5nbsidclocc Goudml
'X DRfLLtNL G LOG'(attach iddiiioWdJ stkets if ucc6s4iml.
oCeolllenn rl.{Cltised L•uup) oTrdcer FRONT To 1105CRIPPON(mbr.hioJim"i u,un,ca tjpC,'%xw11.Qjz.Ne.►
E]Geotl►etlnaC(IieatinilCoolilieReturn) OOilter(esplaiDmuler.#21 Retuat[;s) 1 0 fL l0 f4 FILL SILT AND SAND
10 ft. 15 (L MOIST SILTY SAND/WET
•.,Ditto tiYeLt(sj Cautpleted: 10-27-22 'Yell ID(1TMW-5
�t
Sa:Well Lalcatton:
City of Charlotte ft, tt, j
Factlify,OnncrNarac Facdit)•101 t6ppi6bic)
iFlt`iiS'a-t�BfiDti.t�i.^:55:3al.^1
333 Parkwood.Ave., Charlotte., NC, 28206
Plry3knl'Addiess Cit}:aiNdZip' 31:R"TAnKS
Mecklenburg 08301126 BENTONITE SEAL 2 TO 3','
Contsly WanCl ldriniitSc:;ido�yNt�;(t'1N) 1
i -
56.•Liiikeand-L ongituda in dcgrccs1miuutWgfCnn4156r dmiriral dcgr`ccs: . 2L Certification:
(itsrcll r�e1,J;qip i�iitloug 15 fitrdCiLictu) - .. i
n w Eria._.n;1�.E wingi 11/9/2022
Sigmwm:rCertirvdwellCommo.r, DOC
6.Is(:tie lhGWell(5):LIPermanent of ZTemparar}' ' sicmn this omr..d hrrrb rirt!p thru Flux ued!(s1 tvvx ritrC eitr xtrirrrard iu mc'onlmcr
Ii'irh"IS,A A!C,LC QZC.0/(t9 yr l.S,t NC,tC,02C;+7ZUA R�11 C�tratr+afar Srarxlards�nud rlvtr a
7.Itr tkk a reliaiHa ad c sting ivcllf Mcx• sir Mu.. r �1d�i�7reond kris J;cz�a prorirlrc'ro lrc s�t:ll mrii�r.
d%rhfs:dY a ripolr.ffd cru krtmyvi w�dd arrtsrnrwlari hrlrtrrnr+rloti mul ct�laln the tktutrc of rPic
relutit ryider.��f:icmadCs serj&d gran the bare.of roils farm. 21 Site dtagram or addItionul well detuits:
Yon tray use lute back of this paw to.pro�idt:tddilonal well Are diaaila or isell
S.Nttu berof ivclls constructed: 1 Commuction delails.You i114;66.uiCidt addiiiouat fiat ifta'ccssary_
Fvr riiLlrlpde,lr;(ecrlril orn6vN-rvurrr strpnJ}•iveldr OttiLY ir)th rh�!snmecoJrstrtcrFwt ycu a�m7
submicn+ic fora.. SC1Rt11[TTAt rNS'E UC.TIONS
9.TotA W�ql depth DL401V land sg&facei 15 (ft.) '2ra .For All WaLm Submit tlus'fnnn within 30.illy$'Of t6mptcti6ti of ivclt
For JflHltlpf i''elis-Wxf elldepths ifdlffemq(ermipls-8rN?fAT anil.2 109) congfuctiontott-foltoeting;
' I ,
10.Static water ILvel lielow tap.of iasiicgf (top,) OhIsion of Water Rivapricey,Information Pikessing Quit,
if n virr let',+!1s nLdva caa(tt ,iiu"+" tGl i hl tit Setnicc,f titer,Raleigh,NC 2T69'J-Ifs L7
Il.Burch dtc diamcter.2.25^ (iu) Inrcetiau`Ve111ONLY: In addition to-sending.the fomi to-ibe addrm in
24aabo e.also submit a-copy•of ibis fortis nithirt 30 da}.s'af.Completiou of well
12.Nel1'Coustcuctiou.method:DRIVEN. plistiuLdonto tile Pollaiti°ipg
(ix,auger rotary.enble-direct posts etc.)
Rivislott of Water Resauries,,Undet'g'ouud fnjectiou Control Program,
FOR� ATER SUP PLY WELLS ONLY' 1636 M;dt Service!Cenier,Raleigh,N. C,276994636
13, Vicki(g'im) 3I0404:vf test: 24c.For Watei Su Ulv AL Un mtlon Wells:
Also subliiit one Copy of this'fpna %Vithin 30 daysofcompletionof
13b.Disinfcettiva a31ie Amount: well:cbMtmction to Me county health departntrnt of tin.county where
• constnictrd.
FennG%V-1 RonitCarolirlaLkpantattu.afEm3rottnxniartd3JatutJRcsourcc9-DivitlonoPlVatcrR otrtes RaisedAuglnt2013