GW1--03125_Well Construction - GW1_20240522

WELL CONSTRUCTION RECORD For IMTcrnal(rxONIr•
Tun form earl IX nscd for sinFk or rnrdtirl,ac'•I.
I.Well Contractor Information:
IT,WATER ZONE'S
Stefan Smith rortsi t in f OFN'RIP,MIN
\' 11('ntrriclr•r N.int n. I fl.
3576A rt, (I.
NC Wcll CarsmclorCemification NnnlNcr 1 15,OUTER CASING fler m. l-card wells)OR LINER(if y1 Malik)
FROM to DtiNrtrk. TNN1CNt.s M'arm II
SAEDACCO 0 n. 9 n. 2 ie. SCH-40 PVC
la.INNER CASING OR TV RING
('anp:ut�Name I r)tRrstirrraiald(xa4la1)
*Rom 1 TO N RM.METER TBKYhYSS MATERIAL
2.Well('onstruetinn Permit N: 1000417 rt. 1 ft. le.
Ifu all applicable wellprnrurs I':r.County.Shoe.iAriae.Isle iat rl. ---
n, rt. IL
3.Well Use(check well user:
11.M RItN
Water Suppis Well: nano to DIsmtTret MOT till 11tKxalax I MATER!4I.
LIAgncultural OMvnicipal;Public 9 R. 24 ft. 2 iw, �010 SCH-40 PVC
t-IGeothenual diealing,Cooling Supply) °Residential Water Supply(single) R ft' its
I llndustriaUCommercial ORcsidcntral water supply owed) IL atom yr —
/ROM TO , M&MOA . EMPLACEMENT METHOD it AMOUNT
o ttngation It. It
Non-Water Supply Well: R.I n.
RMolutonne ❑R :ova) _ _-. -
Injection Well: ft. ft.
❑AquiferRecharge ❑GroundwaterRcmediation 1!SAND/GRAVEL PACKOfalytlkatk)
room TO Mgo-Hu%I. r'%IPI.tt EMT NI NIETt10D
❑Aquifer Storage and Rccm•cn ❑Salinity.Barrier 7 ft. 24 ff. Sand 2
❑Aquifer Test ❑Sionnst:aer Drainage h. ' K, '
-
❑Equrimcntal Technology OSrdtsickn:c Comoro!
2e,DRIILLING LOG(*twit addidaaal duets if Newman t
OGeothemial(Closed Loop t ❑Tracer room to INSCRIPTION(color.banter., IN Pr.rr.M..,r.tit.'
OGeothennal(Healing/Cooling Return! OOther 4explain under 021 Remarks) 0 rt. 17 ft. Silt j
17 IL 24 ft. Sandy silt
1.Date Wells)Completed: 4-25-24 Wd1 IDSTMW-3 n. f4
sa.Well Location: •
I. r
1
Metropolitan Redevelopment ft. n. MAY
Fo ns ctbn()wncrNa Faction Ink(if i plicabk ie ft.—" ft. 2 L' 2024
1200 Metropolitan Ave., Charlotte, NC, 28204 r rt ft. 1. ' ✓r:fi
Missies]Address.fits.and Zip I21.KLNI AR'!" Cr.c\^ .~_T.,
Mecklenburg 1 Bentonite seal from 5 to 7'
Colton I'.IKClkkrniti ut toil N„ 1 PIN 1
5h.l.atinide and longitude in dep iees&mhtratesharnnds or decimal degrees
Of soil field.out latlntrt is ardlkkrtl) 22.Certification:
35.211309 N 80.835742 W 4/30/2024
Sign atdrllof Cc.fled Well Contractor Dole
6.Ii rare)the wclltsl: 'Permanent ur RTrmpworm M signing nerd form. f hrrrh,srrIsfy that the reatA1 was(wrre)swtrMae•red in aarordmt,r
with I SA NCAC ON',OlIt)or I NA NCAC 02C.0200 Weil Construction Staadar4A rout ohs:a
7.Is this a repair to an existing,wen: DUN or ?IN° cops ofthir rrronf ha*here prorated CO'be roil owner.
II'Ars sac weer,(ill net CNVM5 well COMMA roll nif rrmarnrn rum/r'.panne The wrote of the
repair radar 121 remarks.Nrttiun or an the bark of this foray. 23.Site diagram or additional nett detach:
You may use the beck of this page to provide additional well site details or well
R.Number of wells cornstvwcted: 1 construction details. You may also attach additional pages if necessary.
for Makiple rje.-rso i ro of Nr.near,Nuprrls wells ONLY with rho suer ranAfriletMe, ,,,a<rrrr
stem ir<NM•fain. SiUEMITTAL INSTUC1TONS
9.Total nen depth beint laud surface 24 (f1.) 24a. For All Wells: Submit this tofu within ill dots of completion of well
for malfeplr I. lnu:oil rtvprh,rfdrftrrrru frrawipf.3*200 eiu 2Er 1017) constnietion to the following
1st.Static water l erel below lap of casing: 12 (ft.) Division of Water Resources,Information Processing I nit.
0 Mauer keel n ah<mr,snort.tar"♦" 1617 Mail Service('cater,Raleigh,NC 27699-1617
I I.Rarehak diameter:8.25" (in,) 24b.For Inked.*Welb ONLY: In addition to sending the loon to the address in
24aabose. also submit a copy of this form ninon 10 da)s of completion of well
12.Well construction method:NSA coo elruction to the lollowirig.
(lc.anger.roan.cable.direct push etc 1
Oh Won of Water Resources.Underground Injection Control Program(,
FOR WATER SUPPLY'WELLS ONLY: I636 Mail Sea ice Center.Raleigh.N( 2'699-1636
IJa Yield I1[Pritl Method of test: 21e.For Water Savorst.Injection Wells:
-.. Also submit one cops of this form stollen to (lassofcolnplelionot
13b.Disinfection hpc Amount __ _ well constntcuon to the count} health depeinnlent of the contra where
constructed
Fond GW-( \.rntt Carolina f)sTonnrni of Ens iionnrta aid Natural keroirees-Un man of W'aicr Resotrtn RCN road August?v I