GW1-2023-02078_Well Construction - GW1_20230307

-ELL coNSTRucrcQ'ty RECORD i For_lutcnml Usc ONLY:.
T11i5 ronucan be used fm single or Inuhiplc wcus
1.Well.Contrattor Information:
=fa AVATERZONIS
Brian Ewing FROM. 'M DFICRIPTION
1�'cIl Courragor l`tnra. ft. ft.
4240-B ft. ft.
NCAS'cllco=ctorCcnif=tionNunber '.`15:OUTER'CASiNGifbrtnuftirived'tsctlslORliNER'lif [l;u' cybk
FRONT To nt.a t/ETUR TFnct:N —, MATEnrAI.
SAEDACCO Inc 0 f4. 6 fL 1" In SCH-40 PVC,
Gnntirun N tnk. 1 INNER.CASI NG OR:T1'BING'l•eoih6i=A'ekird4oii ;r
FROM TO D1,41NIETUR TMCKNESS MATEKAL
2.Welf Constu'actitin l'er•tnit i. 70003116 R. It,
List lrff rpPA7able WOUP61"P's cr,.Camq%sttr:r.•ISirirrrcr.118:'664 r1r..1 R _ ft.
3,'Well lisv(chccicwdl ore): 17:
Water Supply Welk FRONT f TO nIA%tP•CriR sr,orsrrr Tr11CKNTS6 I MATRRLsn,
6 ft, 16 it. l" In. 010 SCH-40 PVC
Ctlgtfcultutal MilinicipaMblic.
©Geothctmal(Heating(Coolin3 Supply}. ®11esiden iA Water Suppl}(single) ft. ft,
©ludustriiaKomnterciA ©Iicsidential WalcuSuppl}•(shared) I&GRO-UT_ -
FROM TO. MATERUL t EXPLACE40ThiElil0DS.1M1f0[INT
oi�i itinn ft. fL
Note-Water Su pit ty Welt:. tr. tl.
�hlanitt)ring C]Rcco-cry
bjeciton Wrll•0 n. rt
G]A41dfcrkarge Wrouii maicrRciucd1ition 19.'SAND1GILIXELPACK(if 11lietbte)" -. -
.'FROM TLj W%TPRIAL' R�IPLttIF.Vr.Vt'!Nta'llrin
l7Aiiuifcf=S.igrdg9 and Rcco�'c�' l7$OlinitY R:Imcr, 4 R. 16 ft, FILTER SAND # 2
❑AgnlfcrTest t7$l6rm atciDrainngC
I3EXIcrintcntalTcchnolo,*• r3,%bsi&-ncc.Cur4m1
_ -20 IfRIL1.li1G'lAG7ull�ch:iiddltibonl s5cels if ieccc"ssnn•1
OGeodtennal(Ciused Loath [:!Trai er FRO"vT I To nest RtpTlON rtnbn tn,nlnc.H,uaA'nnk fr x,+ "n stt�dui
[3CWthetn al(Heating Coolitle RetmO 1:10lher(explain under A21 Retuatks)j 0 fL 5 ft. FILL SILT AND SAND
5 ft. 15 fL MOIST TO WET-SILT/CLAY
•.'.Date WeE1(s).Cam pleled: 2-7-23 '%%q IDaTMW-3 15 fi: 16 It. WET SILTY SAND
5a:1Vf.•l1lfrcntEtiu: tt. R. '_:_.; - a'�3,:,?mot
Space Craft ft.. ft.
Facilily,O►vncrNa>Lc Facility II)k kapplicabl0- R. ft,
525 Parkwood Ave., Charlotte, 'NC. 28206 Mecklenburg
Charlotte, NC, 28206 Plns>culilil&M_City-aitdZip '2lbREM1L1RICS'• �-`�,r'i. �i'.i�-'
Mecklenburg 08304212 BENTONITE SEAL 1 TO 4'
Ccmt,h• I'arcC]1,tadiCiC;dlpu Np,(P1.'4}
Sip._Lititudc and Longitudcin at,
dvcimalcicgr'ecs: Ccrtifration:
(if n ell IwAd,orb htloij is yrdnr:krd)
r
W S ri a n. EW n _ 2/14/2023
Sigmulr�arcrniricd PJcll Cantnator Daic
6.Is(Sue)the 1YeIl(a)t LlPenuanent ae SlTemiloruin' ay,;�,dng thin ju,rrr,.f hrrrh,eerrtfv ryru rhg,-eflfs)Pau lsstowj eurslruclerl lrr;rxrarrlrmcr
tivth I SA NGIC 03C,t71w or l;A kalc oX' ,t.)20A WWI Cotinw tital SrdWcraels mid fiyrr a
7.IS.this a rejraiir fu ad E-dating tivelli Mcs fir ENo tcipr.�frliis rrrrii7l hers'bcrn�rasritFid rn���� sit lP rireri<r,
ffrhis 1t n MpcTir,fill riser krrrmai wolf ma3wifMon hrforawrtcn cad e p(ahr rile mrnre of the
repair rurder L02L F vnarU serif to or cvr rl,e htuk off .ill for»r. 23.site diagrain or additioual.Weil MAN:
You tray use&back of this page t6 piovide'addilional%yell site details,or►sell
S.Numberof it•e1Ls conalntited• 1 cousitdctimt delaiLs,.You ittay;*41lach additional Vibes if necessary.
For rirulriple_ftdeerldnoram-nnrer supple ua't7sONL1'mirk rho.a,rtrrgcorntructiwr,ynlrema
.snlrmlrvne form. SUBMITTAL fNSTUC.TiONS
9.Total Well depth betaw land surface.• 16 (((,) .IU-Far All Wclls: Stibutil this fond wiliitt 30 days of comptcdou of ivell
For inuldpleicelhIfst fill deprhsifAlaPirenr(excgrptc-5n2t1(!'mul2@UP7'D rnnstnrcttontolhcfoi[anin�r
fo:Stltic water level below top of rasinW. Divisiun of Water R.otturces,Informadun Praensing Unit,
!f Itxuer lerrdl is ikove rasing,ew"t" 1617 Alail.Serviee Cctitcr,It:ileigh,NC 27699-1617
Y1,Barcbfile diamchr.2.25" (ia) 24h.&C jit lglj ft[U ONLY:, In addition to sending the fomi to the addrm. in
24a alx,�e. aLo subunit a copy of this fame within.10 days'of completion of twit
12.Well constraetion mUliod:DRIVEN colistinctimr to the folloa'iner
{i.c,auger,idarp•cable:direct paslt etc:}
Division of Water.i ilsources,Qtiderpround fil]ectlon Control-Prograto,
FOR WATER SUPPLY WELLS ONLY: 1636 Alhiil Service Center,Raleigh,NC 27699.1636
13.14 Yield(Vim) "%'fantod of test' 24G For Water 5uu it O&Inicctlon Wett9:
Also submit one copy of this font ►Vithiu 30,daysofcompletion-of
well-consiniction to the county ld:alth department or the county whoa
13b.DisinfLetion lh-pe: Amount: ctlnstnnctCd.
I
Fvnn G%W-i Nanli Cmalina l7rpmz a of EndroRwts and Natural Resources-Divis Ion of Wafer Etmo= Revised Ate UA 10I3