GW1-2022-10655_Well Construction - GW1_20221128

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WELL tCONSTRucrION RECORD For Imcnid Use ONLY::
This rorincaii be used ffir•sippfeor mdiiplc ncfis l
1.WcI1.6nteactoe iltfortuatiort:
-14:.SVATER ZONES
Brian Ewing FROM. 10 brWRIPtION
�t'c1F CufilfaclorN;,nfe. R. it, ( II
4240-B
NCWcilCo=ctorCcniftetiopNuwbcr t5:'OUTERCASIblGffbiaiuiticiidedri"e0s1'ORLINER iUh" ticabkl�FROM TO b,%3IFTEtt" TtnCI%NESS NIATEntAL
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SASDACCO Inc !t. fL i f U.
[6riNNER.CASING OR=T@BEd(1 ieoifrL,''
fRONI TO DtA.StETER TlnCti.�ES4 SrATSnfAL -
2:%Yclt"Constructinn['cttniY�; 700030.75 R. 14 It. 1" SCH-40 PVC
Lire lrfl nPl ACP6le well peimirf(i a Cpunh',:Sta e,,Variy rtie•ftea:'OV etr) ft, -
3:�VcIE:Ijyc(chef litcll ttsqi 47:SCREEN "
Water Sulip6v"Vileg-. FROM TO WJ%%IM. .It SLOTS173 THICHNFZS MATRnrpl,
�tlgrnulhfrll C1t41i1111CipallPtthllC. 14 ft. 24 ft� 1" " .ii> .010 SCH-40 PVC PRE-P CK-
®t7cotttetllctl(tie-itingiCooling"Sig3ply) C1Rcs'idential�Watcr Silpply(single) (t. ft"
®rndushiaUContnlcicial ® cs*nfial Water-Supply(shared) -.1&GR0UT _ ..
FROM - -TO. ' MATERML EMN AM,MNT MEMOD fi A`10uNT
171ti tion ft, fG
Noli4vakt,supiflyNYe11:
6dliftsnifgeinq []RccaticFy ft.. ft.
Injecliou NVell: R• rt:
QAgtdit f Rcttiargc Ordioumvi-flcf lZcnlOW1011 19:SA.NDIGRAVELVACW(if pidicabN1.'
cnrlu• TO 31RTRHrnr, HMPIACwENTXITlnln
7Alf 1 $tlihl acg imc( '
12 R;: 24 q. FILTER,SAND # 2
❑Ar ia(ciTcst ❑Slorniiiatcrl}r',iinagq
. fL• ff. ; -
❑E�q>cdtncnfal Tccbntafot,'v. GStthsidcluc Cold�l" 2O;DRILLING'LOG'faltaeh,additiodal shMsif fee 6san•1
13C.-witenriat(21osedL•oup) Mracer FROYAT- • to bFSen[t�nONlw�r.l,�,tlac xlarnrr .- ner,:ciGl
OCt3DthemMl(Ileatit&Cg0fiug Return) i]Olhettesplain under.#21 Itetuatks) 1 0 fL. 15, it. FILL SILT AND SAND
15 f6 24 1L. SILTY SAND' MOIST TO ,WET
4.DateWet1(f)Cao gdcletl: 10-26-22 .WellIDf1TMW-2
$a:%V di bicatinb: (t. (4 a
City of.Charlotte ft, ff, NOV.2 S 2022.
RcRy/ovNrNmue Facilit?'ibk'elfapplicablc)
333 PArkwood Ave.,- Charlotte, NC, 28206 ft, ft. r
BOG
P10-sicd Addipss.City-and Zip 21:RE(11.tItIG$
Mecklenburg 08301126 BENTONZTE SEAL 10 TO 121`
Couwy' Parcel Itkil iCfcalloir No,(PRO
Ste,it atitude Anil I ongittttli in dtgs",slminuffi:4 winds ilrilccimal 11MV0: 22:Cerfili�eation:
(itecll!">CW;quclaL1pualsa,ilPuic�d)
11' .A`Y nan-ft�n;g 11/9/2022
Sigmwrc of Certified Well Conlfactoii Dale
6.Is(am)the:well(s): 00ennanebt oi• zTemporary
fty.+iguing chit faim;-1 hereby eerlilyy Mar the uell(si fzur(were)emayiucier!!m>ca'oirlrrn�r
1 irh'im xaic 02G,0100 or 15,1 NC(tC 02C:Dian Well L'oreslreh'tlar Sturrdarrla antd Auer a
7.Iv thb a rreliaictu ad aistia;r ivelli byes fir ®No d,rrs- i�rrojdus irroiti beCn lirz+rGkd ln,lk m*11"crier,
Jf rhls:ftn ra?prrli.�ll ulr krrouvi tie(f cnnsrnr_rrlrui•brforrr,rrlon amd ctp(nhl fhe IIOn1rQ t7lfflC i. 1
relurirruinerbF2l:emudPssectionnermthebhi6njllfirjarnu 2l:Site diagram or,additiouIId.lrM'detaih-
Yilu[flay use!tie back of this page to pto�'ide"additianaf!cell site details at(cell
S.hntuficrof!cells constructed: 1 construction details,.You 1, ul�ii aila'cltadditlouak pages if necessary.
7corriruldjdL irdef rkvi'aiawi.rr�rersupplyicolds JNLYu'drli`rlm.artmesorrsrrrrediar,yauctr! GI-bII7TAL ITT5T1JCTf©Nq
m4mil nrie form.
0.TMA isel.l depth beloit laud surface: 24 ((t,) ,2".For Ail WaLs! Submit this'forin witbiri 30 days of-cc mptedon of well
For JKwxlpfe-icows'llsr all dcyrhslfdiffirmit&rrtn;Pte-d@?OD'mu1:201W) constnictionio file folioning-. 1; '
P(I.St:teic wuu•r Ic's'cI lieltlw tap of casib(r ((ti,) ItivEsid a of Water'Revatiri:6,Infitr matipn Prdeessing Unit,:
ljnpia1ei'�flrirboeecaa(ra;,use"f" 1617,MailSeitiiceemkir li:tli:io vC27h99-Ifil7 '
11.Barchofeeliametcr.2.25" (in.) .tab.Foe Itfieedau Netts ONLY: In addition to-sending file fomi to ilie adilms in
244 alibw.also silblilit a.copy of this fanit witlfib 30 days-of completion of iwll
12.Well eonstMeiion method:DRIVEN cofisinic6u totlie follotiring!: !
tic.queer rotary,cnblc,direct prier,cte.f ;-
I M4.1o11 ref Water Itimurccs,Uuderground ftijecyion Control Progrult,
FOR WATER SbPPLY WELLS ONLY:' 1636 AiA Scn'1ce+'QnIcr,Raleigh,NC 27699-1636
13a,Vicki(00 Medlod(If test: 24c.For Water stippil: rnieetinn'Wetl9:_
Also submit one-cagy of this fuifii n'ithin 30.daysofcotujlletiou.of
13h.Disinfection t}pc: Amimut:. %c11 constmctiob to fhc cdur4 hcahh department of fife connh'w here
corfsfn�ctcd. I �
FarmGl%'-L NonhCarolimD. anmcfuofEm'iiowocfuandNawralResources-DivhloaofWaterRmoutm Revised August V- 13.
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