GW1-2022-10652_Well Construction - GW1_20221128

-WELL.CQNS'B'IiucridN RECORD For tt2cmai Use ONLY:
:
'111is-ronncall bo uscA rur.srnbfecc rnohiplc wells'
1.WcU.CEintr tetoe Information:
4t&,AVATER ZONFS.
Brian Ewing FROM• iro 0FSCRIPt10N
weltCordtac(otgarw
4240-B
NC WellContractor Certification Nunwhet •'&OUTER!CASrWGtroretuiticivedrietisi'ORLiNERtifjAjj ficAbkl
FROM TO PtA51K, itt. TntChNFS'S NIATER1
SAEDACCO Inc ft.. ft. �'ta
tkraspvo}NanrC <t6'INNER.CASING'OR TUBitiG'('iroeYeirtroal cloud4coi
FROM TO 11101ETER =CELXESS•. MATEtiIAL
�Ycit Consttttstnin['ct•tilit t#: 70003075 0 R: 5 ft. 1'. SCH-40 PVC
• Li11 ri1J r,�ilirublc rsrlJ pc'm:fti fist:Cau»ty;SJalc,.lrnri»rrrr,IJ�E1�Cii�t.�) '
3.Wcli fist(chixi:`Wd.l uSc), t7:SCREEN
ly Wc WaterSuliplli _ FROM I To I DtAatl=.Tutt sr,OTSUS 11nICKN1SS I MATRarAI,
CIAglicllltutah iJ14Stt11iCIp4lUPttb)IC- 5 ft, 15 ' 'ft. 1" in 010 SCH-40 PVC PRE-PACK
®Gegtllalliatl(Heating Cooting'Supply') 13Res'iid6tiat AYaterSuoly(single) rl' (t
Obidustri-WConmtcrcial ®Residential Water.Supply(shatcd) ='tA.GROTJT
FROM 110" MATERIAL I EMPL.ACEMESTME"rrIODSt0101IVT
Odrri lion .. h.. fL ,
11'pn-W:atcr Supply Neff, I
1dhQ!onitpmng gtte>:titi'ct}' _
1n(ecilan Yell: h. rL
ClAgitiferRcctiarge., t]rjinumlttatefR.ciitcdiatiou �tv.5�1NbK:R,tVEPSPAC&'tifa'rrtlpbtc)"- :;. ..- =-� -
+vrcnM m-. arA•rt:nrar, EMPIAC.F.'VENT s7tTEinO
C1A jDifcrS rage and ttecaticg' l7S;ilitllf3'13 IIt1CP- 3 ft.; 15 ft. FILTER SAND # 2
❑AquifciTest ❑Slornn�•atce,&ni age
❑Exprinrcntal TcOmology C7Sttbsidcncc.Cal broi
-20.DRILLINGiLOG"(attieh additional shccidif iececssriovl'
OGeollicnlr►t(ClaseifGaopj "l7TPdoer FROM To' o:icxiPno�tcvar.haMocM.miR'nicti ^ "n.uatk:}
17Geotlieiinal(14cainelCooliti Rctut}i) E10ther,(explainuiWer01-Remarks)" 0 JL 10 tL" FILL SILT AND SAND
10 R. 15 (L MOIST SILTY SAND/WET
4.Date We-14S)Coulpietedi 10-27-22 FVcII iD#TMW-6 .
•
54;Well Location:
City of Charlotte ft.- ft, "" �•`
Faciliiy,OivocrlV Faciffi}'tb#ei applicable). !t, f(.
i, NOV�2
333 ParkwoodAve., Charlotte, NC, 28206 fb• fL i' i�trivft7c^1J71r^ .�.Y-
Pti*al Addicss.City_bird Zip 1.RE ni t rr
Mecklenburg 08301126 BENTONITE SEAL 2 TO
3"-Parcel l&,43`c:adou No;(01Ny
56:•i„atitudcaniil�inpita�icinIcgr - minut6l c6ildsar'deciinaldegrees: 22 Certifiratiou:
(if ttcll tfd;qir 1[rlarjti�iK Safii icmt)
• e
.an .E /'�rg: .11/9/2022
Sigma mill"Csnified Well Ce4mior: Dale
6.Is(are)(he Well(*.r,IVermanenf 'ai' ZTeni-porary Hp at0nt»g Jhii fair„)1rurLy terrify 4;dr,jhr irell{S)vvr(sate)carsrrnrried in:aveardim
. ri'irh l5.•t rYC,tC OZC,OIOCJ or 15.t.NC+le OeC,I)1P0 R'i•l!CorF:srrricrlar Starxlmdsmtd rlyrr a
7- thls areefii;! to an cxistikrso:l(s E3V�N :tit Mo. to'ir+r Sill mrrirr,
(f rhls.ls a rip ile fill ecrr lu74w the ikirar+of die
rer�airiaeler9?1-remarks srrrtAn ar an the Lark of iii6foriz. 23.Site dirtl;ram or additional weli'detaitA:
Yau ntay use IGe;Bach•of this page to proi'ideadtGGotlaf hell site details,-or tsell
8:Ntiutberof wells coustriteted: 1 collstruction details, You if ivvessary.
For Jinlrlplr tr;(Berl iJi orrnrur'-never sJrlrplr it i4h ONLY idrii fho.sami eonstrucfimr,.pou all
@trbnucauie farm SUBMITTAL iNS1 ETCT[ONS
�:Total iscll ilepilt 6etoiF l:utt[stirfnci, 15 (ft.) Nit. liar All Wellst Submit Ibis faail wilbiti 3o(L.kVS of CORI feliqu'of Well
For»rulaiplci6rllslisrnllrreprhsirrfifirehr(exmrpte-3@200'mW.20IM) eonsinictionto.4hefolfoningn:
10.Static water level below top of eas_iutH ((t,) f}i�bdup of-Water RciuurecY,Infietvtutirin:Prrieessing Unit,
11 1vaw/level is dLure edslgg,hii'•t" 1611 hiall.S61(ec'Ccntcr,Raleigh,XC 27699-1617
11,i3orcholc diametrr.2.2511- (ln,) 3ah.Foe-irolmtinn Wetfc ONLY:.4 addition to•sendilig tihe fomi to the address in
24aabo e,also'sobmIt a;capy'of.Otis fanil wiibin SO'da}s-of completion of iv&
U.Well construction tuiWhod:DRIVEN cotlstiuc(tonto`tli�fbl[ot"vine:
(i:c.augri iirf w dablc�direct push cic.)
01VIsloita -Water.Resources,;UndergrotiM In]erlion Control-Prograut,
FOR WATER SUWLY WELLS ONLY.' 1636 kill Set -iL-`C gnter,Raleigh,NC 27699-1634
13;a,Yield kpm) Mctfiod.of test: '-4c.For Waiter Sajrply&c 1nAectiiin.Weds:.
Also subliiiCOW 00y of this f-fin trithiu:O.daysof cotiiojetion.of
13b.DisiufeLtion ttylli:. - Aninuat- rued canslmction to tha county hetdth dcpatiment of the-coullty wkrc.
constricted.
Fanu GtY-1 1l011hLamlina Deparitm ai,of Eadmilmcrn and Nattual Resources-Divhloa of AYate R 2W=5 ReVised AuguA 2013,