GW1-2022-10658_Well Construction - GW1_20221128

WEL.L_COLNSTRUCT[ON REC. Far Igcaa11sc ONLY: !I
1
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1.�Vi�l.Ctitttt:tcroc InfoiZuation: �
:14c:{VATERZONES.
Brian Ewing PnOM to I DFiCRIFt10N
1VilltlotitrtaorN;tn1e. R.
4240-B
NC Well Coldtacior Cenif aition Number t&OUTER'CASINGfNi vtiuttl-d6id 4d1s10R L1wKlX(1"fi ©cabk)'
MOhr I TO I 0IA3tr:TER" T111C NF.S.S.. MATF.tnAL
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SAEDACCO Inc (t. (L
(antgrutl Nautc. 46 lNNER.CASING'OR TUBING'OpeetkimA claid4o6'
PROM f0 KhMETER I TIRCK.VP.SS h1ATERIAL
2.Wc4 COgstluctuiit Fcrwlt#: 70003075 0 4h 5 d(J -1" i3e SCH-40 PVC
County; ,YUri—r.11 jlCdC13Flr_J,
i ire.
3.Weii;Iisc(chccl,i A-1 tisc)•: t7.CHEEN
Water Supli y Welh, _ - FROM To otthrt:TER I SLorswy, I TincxNrss I MAFRarar.
�Jdatirulnllal C7Ivtiiliicipa]lPitblic 5 rE; 15 ft. 1" i� .010 SCH-40 PVC PRE-PACK
flGcoth�amt(gieatingTCaolind Sigspty} ®Res'idciitiat�Yatst$uglily(single) ft: r +�
®ludustrial/Cottmurcial ©Raideutial Watec Su .11;CROUT
pPly'_(SIYItL'd} FRONT. MAMHAL EMPLAC01ENThiM011&A IOUN. r
131ni ration n,' (b
Nqn WaterSup'vl),Wcll:'
' Gdl4loilitnrinq. . Qftecmrty tt,. fl.' ;
Iujeclion well:
E AiluifcrRs6l rge 00kour daaici[Wil taitlou 19 SAND,GRtVEL;PACK-(if t"Ikabtcl' :-
'NnOhI• m• h1ATt»ttnl, R\IPIACF:\1�NT.NITnOn
glAgaifcr-Storage and Rcct�a g' ❑S71i01ty I"
3 R:• 15 ft. FILTER SAND # 2
❑Atitife -Tcst Q5toenni itcrt�rnrigop
❑EsperpmcnialTcohridtog'. ASubildcncc.Colidroi
IWORILLING'I:OG(atiaettaddifionbl sttcels if nec6srin•1
OG.odtemutl(Closed Loop) OTracer PRO,rr• To niSenEPT10�{mktt:h;udnrn.atiik++xt5 tr:'• do a+t.�tel
OGwillc.anal(Heatin&CcoUt1E Retnnl} 130dier.(expJoin und.ff"01-Retuaths) 0 :it. 10 (L FILL 'SILT AND SAND
10 ft:• 15 'ft. MOIST SILTY SAND/WET
•4.DateWell(s)'Coolplefcdl -10-27-22 Wc1lE #TMW-9 I _
Sa;1Vci1 I.Ilcntirine rt. tL ' �, _e U '
City %-Charlotte_ rt. TO. NOV _g R
Facililj•,'OivucrNarmc Faclliy II)k Ct,Eappliablc) �R, ft; _
333 Parkwood•Ave._, Charlotte, NC, 28206 ft, iQ �,' R7
F'lg3icul Addiesk City:uitd Zip ;zt:REM11AttKS'
Mecklenburg 68301126 BENTONITE SEAL 2 TO 3'
County Parcel ltkilotle:ttiOu No:(PIN)
i;atitudcanifl.ongitaiicin<tcgtccsllninutcs/sccandstir tccimulctc ccs: 22:Certiticmdcin:
(it et ellrw14 oitclataorigJ$-ji iJojU) {��
hi { Beyer Ewen 11/9/2022
Sig®tur of6eii,ha;dweUConttxtor;' -� Dafc
6.Is(#e)(he"tweq(s): operimuent- or »Temporai}'
Hp rrcnlni:rhi3 fonn,.P kerrb}'cerrffv rhrit the n•ell(s1 taux(wrrrJ ckrnYrnrcrerl Iv m'eonLmrr
tvhh'1 SA MAC OZC,0/A9 or l.5A NCrtC D2Ga)2Wi Well Coilatnicriat Srarsrlards crud Awr d
7.L9t6i atreiiaietir;tnezi4tin„�t'elli ®Ycr tir 23N) rmnjrltisieetinihriafinenprbtirPedi'oaha sn:llmcrirw
11 rhfs:G a rYl�rli,fill ocrrkoeitvi urlf enmTnrcrlaa hrfgrrnailvn emd etp2aht rbq tpyrare ofdie •
;ipair redder ti?I.ietni rb srcriun ai(vr the back-of if6fornr. 23.Site.diugam err adtlidonali weil details:
Yau may use de.hack of this page to provide additional,well site details;or«•ell
S:Nuntberofhells ' ISt acted: 1 constructiondelails: You nt#1"66atlachadlliGouaip'3g-CsIflxVicessaiN'.
For mnlrlpt�Irrfecrlon nr riiut-u�rrr sarppJy uWld3 0,9LY irJtli rhu.same eorrstrrrrleorr,ycu;r�
srrbmirnuafumr. SCtRIHITTAL MIUC17ONS
9:10hil wcll depth 6eloic iand stirilki-- 15 (fi.)" 24a. Fnr Ali Wak Stibtuit this form within 30 days of conipled6d'6f well
Porrrrul8ptcivrlfs'7rslalldeprhaifdiferrnr(eu+nrple-dd2fUr'errul.2@/AT) eonstnrctiootothefoltonin�:
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10.Static water.l6cl below top of casing: ((1,) Div siun of Water Rc+iaitrCes,Infttrmntiy'n Processing Unit,ljtrntiv level ivabove casfikg;iuc"+" 1G17.hiail Seraieel cater,Raleigh,XC•27699-l617-
Ili.Barthotc diameter.2.25^ 24b:Eak thilmil lrl MID ONLY: �in addition to sending,llw form t4 the addless in
24aab ie..also submit a•.copy of ihis foltil niihut 0 day's*of completion of ttell.
12..Well caustrtiction method:DRIVEN eattslmction tD the followine:' I
(i.c.9*r.id ry.cable dired push ctdl
Dwvlsiou of wateritesourecs,Underground InJectlon Control,Program,
FORWATER SUPPLY WELLS ONLY:' 163fiMail Senice'C enter,Raleigh,INC 27699-1636
/3:t,Yield 1k,For Water Suirplw&injiyion.Well,:
( rai} llcthgtl of test: Also submit olir copy of this_fonii trithin"30 days ofconipletion.of
13h.Disinfection,g#e: ATO'uut- wcil.constrmction to the'county health deparitnent of the coitnh'where
cotlsmictcd.
FanuG%V-1 tQnnhcomhiiaD.pilmcnt.ofEadrowttematrdyatarJi Rcsoumes-Dh3;Ionof%VatffFt toes Re.t,tsedAugust 1U1.1