GW1--03124_Well Construction - GW1_20240522

WELL CONSTRUCTION RECORD A Per Internal Use ON I.X-
Tills form+oan be used to single or multiple wells �S
I.Well Contractor Information: \
la.wATERzO ES
John Eisenman PROM Tp omOttPTt05 }
Weft Cor#rxtar Naas ft. ft.
ft. ft.
4439
NC Well Conn ttor Conifculon Number :..:3S,OUTER ASING(fur atutti{,s cot ecLi OR UNI R(if atvlika►Iri 1
FROM TO DIAM.LTER Tl(nrk'.rs' I M.ATTRI�1
SAEDACCO b. ft. W.
Coltensy Name ,;u 1Ni[u cASI+1c Oft t$$C iahsthera fsi cited-tonin a _
FROM s To , D4t.\rfTER THICKNESS MATtR.1.
2.Wdi Constriction Permit d: 70003163 0 fi. 25 ft. 2 i SCH-40 PVC
Zia all opplinable seer prnsltr tin:County.stokt,Variaacs,ItIllarY4 rt-.)
ft. ft. M.
3.Well Vic(check cell use): r r ',4 .__. _,..._.___.___
Water Supply VLell: MOM TO , Dr1MFTra 1 MOT SEM = TVIESOHEIS M NTEHIM.
f1Agrieukmtat C)MtulicipaUPubblir 25 ft. 40 ft. 2 ia• 010 SCH-40 j PVC
CIGINAilefmal tliealinglCnotitsg St rpty} [.Residential Water Supply.(side) ft. n. M.
❑indusitiallCommerciat OResidential Water Supply(Shoed) )a.GROUT
TRO'rt TO u1TER1xt. 4 I%MI sIEME\T METHOD X.1MOt.NT
❑hi"igatiun 0 ft. 20 ft. Portland pour
Non-Water Supply Well: ft. ft.
MMonitonng iDRecovet .
ln)eedon Well: ft. ft.
°Aquifer Recharge °C.rroundwater Reatediation ` Ill.$ANDK RAVEL_PAlei }
FROM TT) sl1T'F.Rtat. I SIPI.ikt I NI \t Mi''M OD
CI Aquifer Stot geamlRecmrn• DSnlinits Harrier t 23 ft. 40 ft. i Sand #2
°Aquifer Test DStomawater Ulainage + —
ClEatpetirncutal Technology ClSubsidrtrcc Cotttiol 1 1
2a.DRILLING LOG(attach additional sheets if iseermar i)
DDe hertnal(C> Loop) °Traecr most t TO ' ntsourr10\senior,Aardm,r,,wtl maI,h= ..sin aft.,cbt.t
° eotherntal(HeatingtCooling Return) °tauter implant under Ill Retnadis) n. ft.
ft. tt. -
4.Date WeE(.$)Completed: 4-29-24 Well IDNla-8 ft. ft.
5a.Well Location: ft. ft. t 2,, 2024
AERC Acquisition Corporation ft. ft.
Faitist. Ii) t1a livable) }f,:i. - �'4' 4'.
Fati1 ,Clwrx r Name FF ft. ft. x
4132 Pompano Rd., Charlotte, NC, 28216 ft. ft.
Piasical Addass Ctn.and Zip 11.Rent♦tiia:S n. . _.�_ ,, - ,. v.._.. — ...,-..-.- -w
Mecklenburg 03910102 bentonite seal from 20-23'
I
('woos Peed Identification No (PINt)
5b.Latitude and Longitude in dei;rees:minutesf%cond*erde l dqweett 22.Certification:
id welt fr;;id oat:Lrislong is sit)lic._tdi
N W _.
----- _— 5/12/2024
Sigtultov of; 1:;.'u !tt:: U:a.
.,t 6.Is(art)the well(s): X'Permanent or Temporary. ay Arlo,:,h:s),.,.,<.' ': 61:7:.it ., of: 'w iea»racvedtoaecafestee
%Irk 154 Ai C 4C ire •u..•r' t ,•.t t. -..zC:OM wen Cnratnavloa Showier*aand than a
7.la this i mole to an existing well: ON or XNo ropy of tkit record hits hero paarnit•d tr.the ssvll ownwP:
gOctsIra repxdr.,fillteu knows an*construction nftxatrttiow anti esatain hist nature of the 23.Slut diagram or additional well details:
avair ware Int nranaeks section ores the back ofshit Prat
You may use the bad of this page to provide additional well site details or well
0.liu ber of well anstanretet 1 constitution details. You may also attach additional pages if necessary.
For nsititi It interim ora-war er stye wilt ow wtdt the rants.construction so.,(VW
rwMxi►onefornr(; Sil$Ml T/lLIlf'STtJCT1ONSc
9.Total wdl depth below load surface;.. 40 (D,) Zia. For All Wells: Subaat'this loots within 30 dot's of completion of well
For nw&tptte wens list ail dlrptl.r if different feniyt ...10200'and 2P It7 constriction to the following.
I0.Static water level below top offer (ft.l Division of Water Resources,Information Processing I nit,
1f wow ksue)is above rasing.use"a" 1617 Mail Service('enter.'Weigh.NC 27699-1617
11.Borehole.diameter:8.25' Do.) 24b.For Iniectlon Wells ONLY: In addition to sending true form to the address in
2 aabase. also submit a copy of this form within 30 days of completion of sit 11
II.Weil cea trectian method: NSA constniction to the following,
tie.magi.rotary.(able,diwct posh cni n
Division of Water Resources.Underground iniccties Control Pr gyam.
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh,NC 276994636
Selection Weller:
13a Yield(Wm)) Method of tat: 2k.For Water Sgtpl}&
Also subunit one copy° of this furor within 3(t days of completion of
well construction to the county health department of the county whets.
13b.Disinfection type::. constructed
Poem at-1 North Camera De munau of Emitonmcn(and Manual Resanncs-Do ven of Water Reams Rertscd August 2013