GW1--01773_Well Construction - GW1_20240320

WELL CONSTRUCTION RECORD Forborne)Use ONLY
This fern can be used for siugk or multiple was
1.Well Contractor Information:
14.W ATIIR ZONES
Stefan Smith roost TO nE I UPtlov
Well Gprntrattw Naeu ft. ft.
3576A ft. ft.f. 0
NC Well Contractor Cenific tloaNtmaber t5.OUTER_CAStAi{Hforpulti.crsedaens)Oft ILI( R'#lt ,
FROM TO DIAMETER TKWK.\ESS MATERIAL
SAEDACCO 0 ft, 15 ft. 1 )a. SCH-40 PVC
Cttt or.1.Ime 16. ORTUt3t140igrei ereialelosert-1 1} :
FROM 7'0L1MFT1:R THK,'KMFS4 MATERIAL -�
2.Slit!Construct n Permit#: 70003186 ft. ft.
Lig all applirabdr writ p.,,,wu,rr County,Stare Patience,11re:ticrl ear:)
3.Well l`sr(cheek well uccis It
Water Supply Wei:- FROM - TO DIAMETER SI.QT::I7) IRR t`1f's• tl1TFk1Al.
OAgricuktlal I hltmlcip+VHtbIIC 15 It. 25 h. 1 la 010 SCH-40 PVC PRE-PACK
OGeothermai(Heating/Cooling Supply) DResidential Water Supply( � r. ft. is
Dindustr)a/ omntefc ai °Residential water supply(shared) is.GRO1.t
FROM TO tt►I&R1AL. strPP.trEMevT wormd A N04kT
❑11rigltion ft. h.
Non-Water Supply Well:
ft. ft.
QOMonitorinl; ORecovely
'rejection Well: ft. ft.
0Aquifer Recharge DCaroundwater Remediation s°Ile ' '" P of atrlsl..i!Ml
ClAgtlifer Storage and Rcettirre� I1Satinnh Barrier 13
TO - MATERIAL F.MPIA(rurNt 1)THOD
13 ft. 25 ft. Filter Sand #2
D Aquifer Test OStomtwater Drainage
ft, ft.
OE/menalcaat Technology fSubsidrncc Contort
20.DRtt,IJIG LOG(attach additional,ihetrc if neeec*an)
DGeoitirtnnal(Closed Loop) OTracei FROM TO nsoPti(i\,i w..br,bard ,M,K'nhk h ea•p..grain u .cea•r
DGeoibemnal(HeatinglCooting Return) DOther(explain under 421 Remarks) 0 n. 25 h. 1F: Ri
Silt
IL. IL
4.Dale Wetlf!)Completed 2-19-24 wd1 IDN Th-4 r - . ,
R.Sa.Well Location: ft
• - :-
200 East 7th Street Owner LLC ft. ft. MAK 2 0 [UL4
Faiihts Oi,,r.r Naar Fe i1Ih ink(if applicable) +
ft, h,
324 N. College St. , Charlotte, NC, 28202 ft. ft. �-- " ^~�
Phsss`MAddress,City,and Zrp -1------------.......__...�_.-.-..-. .-.._.v......._._..,.,,.....,.,.,
1 1 t.lt!'lNARKS
Mecklenburg 08002401 Bentonite seal from 11-1.3'
Coast! )'arcs l ltk nl it SCAR C NQ:(PEN)
Sb.!attitude and Longitude in devecsiminutesisceonds or decimal degrees: 22.certification:
wive)!fletd;cm:ls41otfj ra sutl'u,:.,t
35.228047 N 80.838796 �y ,+'/7 2/29/2024
S .' ofCe. Hiked Contra for Ualc
6.Is(are)die w ell(s): oPerinanent or 3lTemporary trr srgrling clef fa r+x„1.herein certify rhai the xr1Ns1 um!starer)consini.red an ors'mb:o ce
wok 15.4,NCAC 02C 00)or I,CA'%CAC tt'C.021)0 Well Gnratnierion SkMndmrla and thsua
7.Is this a repair to ow existing well: Elites or MNn a am°far owent box braw rn-.,dried an M r.rvf me %:
grhls it a repair,fill over Krona iota noiartnierion b ftonnariaw 404 rra$tnin the tonne of the
"pair under f21:marks seriisn or on,isr bark of th t form. 23.Site diagram or additional it ell details:
You may use the bail,of this page to pm%ick additional well site details or reek
8.Mwarbcr f welts a i 1rnete4 1 eonsttuttioa details. You may also attach additional pages if vestry.
For pl r luje Lion or non-voter iaar&wefts ONLY with raw snare carratraetlon true con
solront one from. $11110ITTAL I'NSI'UC I1ONS
9.Tot l welt depth below load surlrt 25 (ft.) 24a. For A Wells: Submit ibis loon within 30 days of completion of well
For mar n&reeds test eilde its if(Woo termite*,307OO nnf 2@ I1)O) conctmetion to die following;
I8.Static water level below top of rashly (ft.) Million of Water Resources,Information Processing Unit.
If Hofer level d abeVt awitv)t:vac^4' 1617 Mall Service Center,Raleii;h,"'('27699•-1617
I I.Borehole diameter.2.25" thl.) 24b.For Iniretlon WIC ONI,Y: In addition to sending die form to the address in
24a above.also submit a cope of this form within 30 days of completion of well
12.Well cunsitactiom method: OPT cotnstntetiof to the following:
0 c.over.rotary.cable.direct push.etc.}
Division of Water Resources.Underground Injevtinn Control Program.
FOR WATER SUPPLY WNLLS ONLY: 1636 Mall Service Center.Raleigh.Y( 2"vier)-1636
13a Yield tom, Method of test: 24c.For Water Soli!)it Injection Wells:
Also submit one com of this form IAithtn 30 days of compklionn of
13b.Disinfection ttl/e:..a_ », Amount:_ well constniction to the coma} health departmrnt of the county where
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CODWUC14:d•
Yorni OW-t Horst Carotins bemuse*of Ein lmnmcn*and Nam)tesouroca-btvision of Water Rearms Ire.red August.1011