GW1--01776_Well Construction - GW1_20240320

. WELL CONSTRU('I'ION RECORD Fwt®remalttscONLY
'This(cancan be escd for sink or outlttpk twits
1.Well Contractor information
14 WATER ZONES • —s
Stefan Smith PROM ,TO I DEM;OPTION
Well.Corsrrcior Norm ft. ft.
ft. ft.
3576A
r6.Wit,"A'.1211t(f1fRlt w UNERiitamplicabk)
NC Welt CoNranor Ccniftetion Number -
1 FROM TO ai1'tifrRR Tttteti'srss a1ATFatst
SAEDACCO 0 ft. 6 ft. 1 ht. SCH-40 PVC
t'on;r; n NAM '-'-'ii311111101 lw G �i tototbeemalailed-hoot ,.:. •,........«, ::'<
/ PROM lU DIAMETER THRT1 NtSS MaTCRLaL
2.Will('ottstrecti011 Perak it: 70003186 ft. ft. I*.
13,r.11.qy.h.,rFf. r.rrlprotart tie:COMO.State,:Variance,lifectt'Qr1-<r/+•:J'.: fit.. h. :...In._ i
3.Well 1"sc(chuck well use): "fi~
Ns'Ater Supply Wait PROM TO 1 DIAMETER st.OTtilit TM(lts Es. NIVIINiNI
13Agriculturnl C:llstttnicieetl/Pnbl 6 ft. 16 ft. 1 1t 010 i SCH-40 PVC PRE P�CK
°thermal(Heating/Cooling S tpQ (single) is
Supply) water St h ft. n.
❑lltdustriatlCoritmefeta! °Residential Water Snook !Awed)
EA GR°FT
BRO!A TO UaTERtaI. � EMPLACEMENT MfTfiOUdAhtOt;4T
°ltettt:rttan ft. ft.
Non-Water Supply Well:
h. ft.
00Monitonng EIRectnrty _ ,
Injection Well: ft. ft.
°Aquifer Recharge (3Groundnater Remcdiation _19.SANIWGP.AVELPAOstifs Csbtrt —_
EROMt 0) MaTPRtVt t Sin Vt I%t►_yi METHOD
°Aquifer Storage and Rev.Cnrty °1Salinity'Ranier i 4 ft. 16 ft. Filter Sand t #2
°Aquifer Test [3StormwaterDTainage ft. ft.
°Experimental Technology flSubsidencc Control
`Ift DRR.LING LOG(attach addidaaaxt sheets if Rest an)
°Geothermal(Closed Loop) °Tracer FROM 10 DENCR1PTIOS Bober.Asirdpra,warm 1,pe,grain.ua,Ht.l
❑Geothemsd(Heating/Cooling Return) °Outer(explain under M21 Remarks) 0 tt. 16 ft, Silt
4.Date W'ell(st Completed: 2-20-24 WM'IDMT -5 1111
Sa.Well Location: ft. ft.
200 East 7th Street Owner LLC tt. ft. MAR ? 0 4024
Factlit Oui r'vanr Focilh 11LN(if applicable) - w .. �Y
,.*C442 Unff.
324 N. College St., Charlotte, NC, 28202 ft. ft. -• _- --- . .��J rW
Pinsicnl Addiess-City,and Zap 21.T m
Mecklenburg 08002401 Bentonite seal from 2-4'
County Pared tdcss.CicatuooNo;(PIN)
5h.Latitude and Longitude in de rresIminuteslsetOnd*9r decimal degrees: 22.C :
try uC I,ts;Id-otc lit•Ivry a%AI N:fe w)
35.228047 N 80.838796 w !'f^f ' ld i x �:., 2/29/2024 `
'.ofCt l --# .
WdlCo natator Dee
6.b(arti the went* :I lterdtancot or XTempararj its Artrtin,c this tram,I A<rebr.vMj(r t6ei the walks)swtr(ycrrr)(wows/tied kr otwordepice
w,ik I SA erne:t)?C,ol0'or l i.*NOV'02C,02100 well Connie Nan St0Rdo'4s out thru o
1.Is Wm a repair to as aiming is ell: I:IVesi of 112Na <,2pv of the,errs n!has hren p,on 6'd rr ibr srll mow.
!Phis it a repair fill oar know well eshontrion tn)urmar a t asd rAptain she aware cdf the 23.Site diagram or additional well drdtittt:
raptor under!:I ortharkr station or Gat the bark of sMs brat.
You may use the back of this page to prmide adtptionnl well site details of well
$.1$iRtber of wells witstreeted: 1 construction details: You may also rich additional pages if necessary.
For atria*fnjraikan or sari-tuner ISgrjn/s-welt ONLY with thr satire roastraetiort yam am SUBMITTAL C[1iS?[TC110
NS
aabnetoarOm..
9.Tow well depth below!rind snip 16 (ft) 24a. For AR Wefts: Subuil tins form within 30 days of completion of well
For m<dtapte nadir ata11 depoloY If tittle-rear fa rahtpl<:tif200`ent a 20.iotr) constntction to the foilowing:
10.Static water legal below top of casino (R.1 Division of Water Resources,Information Processing Unit,
rfkuse<kw;o obtuk,aw.1 a....', 1617 Mail Service C ester,Raleigh.NC 27699-1617
11.Rptldrole dislareter:2.2 5" (in.) 24b.Far Inicctlap Wells ONLY: In addition to sending the form to the address in
24a above. also submit a copy of this form within 30 days of completion of well
I2.Well constniellon method: OPT construction to the following,
(i.c anon,rotary.cart.direct posh,cdc.I
Division of Water Resources,Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Se..ice Center.Raleigh.NC 276994636
13a Yield(> ) of test: 2 .For Water'Smoot)&InjaYion Wells:
Also submit one copy of this form within it) days of completion of
I3b.Disinfection tape Amwtnt., step CoilsHucrinn to the county health department of the county where
w. � _ constructed
Tors(iW-i Saab Carolina Monument of Ensnomr/cm and*4ar<ua1 Resumes-Dn`uinn of Water Resources RCA creel August 201i