GW1--02686_Well Construction - GW1_20240507

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Tb D alit tTz TNICKAESS: MATERiAL
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�r°to t'.:i?JV FROM-- .:110 •DWA.RLTTEfl T1RCANt:SS: MATERIAL
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3 Well Use(chcrl.rteftuse) a •
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W tcr.Supph Welt YRON TO DiAMETFR SI.OT4171 111tirC'F a •_1.A14TRRIAI
' 30 .ft; 50 fi. 2" Ia 010' SCS 40. PVC'"
QA.grtcaltnral :*11 tcipa11Pitbhc •
• if Geothzntial:(bleatu gICoohng Sutip1}y t Residential Water 5uppt}(siagie)
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28 50 ft.: Sand 2
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❑Geolltmtal>FTt'auly�lCaoUn Renitnl•` �Otlier( platitutiiltr t Tttuart;s)
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d Dite Wells)Coaiplcted 4-26-24 • Mtn 11WT •MW-a:.
Skye Partners fl ft ..
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'Fatiiln}i:Qtti*14.artrc: ' . • Faaulia ID4(if appbeiblc) R •• ft::- • .. .•
.:11855::Mt .Holly-Huntersville:Rd::,.Huntersville.,•`NC., Jr.,. ft.: - . ' • • .
28078 • P.lgsX3ttMdrass:Cit�• mdZtp X f It�+! iRK �3
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Mecklenburg.: . 'Temp•well.for groundwater:'grab sample •-•01720305 - .
COttttty;. .• . . Parcel l. .•. •. , ,{tt••. •
ib,Latitude and:I tngitutic is deg Jrntnutestscconds or dct1mat1{biros, ;22 Certir- tiiFa
(ir:::.U h eld,Oht ti.ii.4lns is fiii,00 tt)
35:384485` < 80:854172 `r 4/26/2024.
. 51gtu Ct tii-4 44cllCoatra tar Date: .' .
6 Is(hut)'thi i'el(c) ;tiPe'rniatient oY : TenIporat•t :.:4-!: 1•;;; ihs fiinn;•I hiilll tCill/s hlit Ilti*uriE3j i :1.*lwieiti can x7nildc'tf h rtxv`404-tcc
ttiih 15ANC4CO2G: ?U0 or i5ti Note t?2G,4d1Yp.Dill COiuirutrlarr Skrnfertlstr+ulOAr t
7 ii tins,t rrpdirtn aneaisttnitii.O. O 'c.S or . 0 :00.'Afillkkrcu'onllil4'lfO(i:4?:' 01P1'I NIl usrrCr•.
1 iki fr cr,e tr ll�srr ii4it._ df evjartiucdvn! arunodan iwI ..a f �i{i ,,1� 'tf. a�tavi rJrv.rrarrae of ifit
rtlttrlririrr!er ii arL e&i ni nr iui ih b rL oftliis fpnir':' 23 Site dtatgrauttor additional tall.depths:, ..
You ma};uae the tbtie1 of ttiis page to pro►ldc addtoonat iced sire dea nis ar i>li
i cottsterrrtiottdet t113 Y8u-rita also dtwt h ad_iiitional it o .essa6, •
8 I1�IIDtbCi"of ttelts constrnercd ? 1�b
Fo•r ma►rlp1*irk.laic er•r•rrout iiu.i r, frl aelt.OTV6• t tit►li;rh a amr caitsfructlorr jir cnri. A�MST6C1100,7
rabmi/.a re form,•. . .. .. 1"C '
9 Total well depths be torn lanai£uifac .50 .:.. (ft) ;24A Pt}r Atl WcIKK} Sub�nit this,forth Within 3t►des of ear nplction•of well
Forurn#1¢rle.ii,:4Sl1►nitikis ff;:i. 'rteaiu(e rrniJik 30?00'iirxt20.43T) ;:Constnietion t4 t tollotcini `
' 10 Statte ttatct.lprel iieltitr mp of caslug:40 .••.•• •• - (ft,) 1)1 !darn of Water etc Sources,Ynf�trmatroa:Pr+occessrng Unit,
ljitsifrTr act a is ali i�o casiirg;ire +" • _ '1617 Mail Ses•t 1c4 C enter,Ri11Cijtit sNC:2.7600 1617. :
11 Borelsolc diainetcr 8:25' • (in.) 24b Tor in jettlt Weft ONLY in addition to senduig ifie form to the addrs in.
. 24a above.also submit :caps of this fomi;tt�06..;30 date f.o cotupletion of►tali
• 12.Weil constrnt ttou t:tbtid al HSA cOttstiit ki-ii tti tM folio►sung°
(i a sager rotary.cable.duvet p c1c is
• DEcision ofWaterResonrces Uhderground injection ControlPmdram,
• Olt WA R 1JI'PPL WELIS©NL•Y . I636 1i Settler CutterR. aleigh,\'"C 2.149:0.ib36 Alit
13u,lticld(�pnij av'"-':•d a••-•: : :3,Ic For Water.Snnn11&Injection`Wells
Also.anti t one eop}, of;this ibrnr ttnhni 30 daysofi.o mplelton of
13h Dislnfeetron tttpc .Ainpunf,. q cli consttuetson:to the county health department of.the CcuuityY 1 heir
.• • conslrticted '
•PortnOW i. ron i4:00t,Cai.:00.101104-0t.010ntnc nt�'.anirilltcmnrees.'..i?1 imn_ot`'l'iicrRtoitcw;_•; •':06iscd47 ia'00: