GW1--01246_Well Construction - GW1_20240229

.
r l- NONRESIDENTIAL WELL CONSTRUCTION RECORD
1- L' North Carolina Department of Environment and Natural Resources-Division of Water Quality
•. •< ,•fi,, WELL CONTRACTOR CERTIFICATION# 2717-A
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1.WELL CONTRACTOR: d. TOP OF CASING IS N/A FT.Above Land Surface*
Jay Little 'Top of casing terminated at/or below land surface may require
Well Contractor(Individual)Name a variance in accordance with 15A NCAC 2C.0118.
S&ME, Inc. e. YIELD(gpm): N/A i. METHOD OF TEST N/A
Well Contractor Company Name f. DISINFECTION:Type'N/A Amount N/A
STREET ADDRESS 2016 Ayrsley Town Blvd,Suite 2A g. WATER ZONES(depth):
From N/A To N/AI From N/A To N/A
Charlotte NC 28273 '
City or Town State Zip Code From N/A To N/A! From N/A To N/A
(704 )_ 523-4726 From N/A To N/A From N/A To N/A
Area code- Phone number 6. CASING: ; Thickness/
2.WELL INFORMATION: 0 To Depth
I Ft.2 DiameterSumFvV
p((a)8rial
SIT E WELL ID#(if applicable) ITZ-30 From
- — STATE-WEE PERMIT#(if applicable) N/A �� —
-- --_ -From-N/A--To N/ +--rFt-N/A - --Nh9__�-N/A_
From N/A To N/A I Ft. N/A N/A N/A
DWQ or OTHER PERMIT#(if applicable) SIP 70001078
WELL USE(Check Applicable Box).Monitoring 0 Municipal/Public 0 7. GROUT: Depth Material Method
From 0 To 54 Ft. Neat Cement Pour
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0 From 54 To 56.4 Ft Bentonite Pour
Irrigation❑ Other CR (list use) Air Sparging
From 56.4 To 56.7 ,Ft. k-packer N/A
DATE DRILLED 2/2/2024
8. SCREEN: Depth ' Diameter Slot Size Material
• TIME COMPLETED morning AM E PM 0 62 2 0.010 PVC •
From 57 To ,Ft. in. in.
3.WELL LOCATION: From N/A To N/A Ft.N/A
CITY: Charlotte COUNTY Mecklenburg in. N/A in. N/A
From N/A To N/A 'Ft.N/A in. N/A in. N/A
Mount Holly Road(MCK Terminal) 9. SAND/GRAVEL PACK:
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) Depth i Size Material
TOPOGRAPHIC/LAND SETTING: From 62 To 75 1 Ft. #2 filter sand
❑Slope :Walley El Flat ❑Ridge 0 Other From N/A To N/A 'Ft. N/A N/A
(check appropriate box)
35.2800 Maybe in degrees, From N/A To N/A Ft. N/A N/A
LATITUDE
-80.9428 minutes,seconds or 10.DRILLING LOG
LONGITUDE in a decimal format From To 1 Formation Description
Latitude/longitude source: xGPS ❑Topographic map 0 30 Silty Sand
(location of well must be shown on a USGS-topo map and 30 75 granodiorite
attached to this form if not using GPS) I
4.FACILITY-is the name of the business where the well Is located. _ r• ""'" -"''_v'_-3\ r—it~\:•
FACILITY ID#(if applicable) N/A N. L >i " `.Li
NAME OF FACILITY MCK Terminals, LLC (MHRG) FEB 2 0 2024
STREET ADDRESS 8035 Mt. Holly Road
Charlotte NC 28214 ltT -„ ^""'1 l!.'
rma:<a;;.l t 1 r.3...� a
DW017,
City or Town State Zip Code
CONTACT PERSON ScottJanashak
MAILING ADDRESS 1100 SitUS Court, Suite 100 -
Raleigh NC 27606 11.REMARKS: 1
City or Town State Zip Code Sparge well is direct buried. Water level is approximately 5 feet
( 904 )- 571-2011 bls.
Area code- Phone number 1 •
5.WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
62 feet RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
a. TOTAL DEPTH: �41-.Zy
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO�( 2 7 �_ `
SI AT RE OF CERTIFIED WELL
ELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: N/A FT. Jay-Little
(Use"+"if Above Top of Casing)
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-lb
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. j Rev.7/05
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