GW1--06403_Well Construction - GW1_20241025

WELL GONS'I'IRUCTION:•RECORD
' 'Ciia:raaiItc#nk..0.01for,stIWOI. nultipktiCUs:1:. ' '
I,Vdt.ContractorInforiu:ttlou
."Rich':Lemire W clL FROM:' -TO.. . DESCRIPTiOON'
G w raortens.
c .. . FL;. fir
,2593A. ti tL.. I. .
5::'OiLTER GCANDIG'horn ic3tileiiii411►s1BFOR=AVER firppltriibtel ..
ISC CI1.Chi[IJJGtOYCCt1IfiF31lORNiIIpDCf' FROM- .170 .151A ET.tt _'.•'[iocKt£ss: .. �rATERIAL.: .
SAEDACCo . .. • • IL'... ft is t°' -
I6 1�1YED CA61�I#x(.1R�'[ltili�t,'("' r�a.tC.t
l 4itsgr t�t3 t Yns :. : . ..
...PROW TO D>ANrETER. Tttlt'Ky> 'MATERIAL.
2 SV:di'Cvltit i iron PCriiiit f '
0 `rt -5 'FL --4" w - SCH90`•' PVC
lrst 01.4:4 xtthle It 4i 0 fr a Gniinu S1ot,0'anarrcr..160/at_rAN:;
3 ♦1ci1<Lse(chcci ncll nae
Waler'Snpph Well • FROM i TO DM 1%1t TFR biO74ITh 1II1CK' S 1 M4TRRrAT
5 fi 15 R. 4" • ��' 010` SCH40 ;r PVC
'. l5A t.killtnial C lvtumclpallP 1:k.
DCreotbrernlal(•13eattngx'Cooting Supply)• 1•1Res&de•nttal Water• Supply(stugle) :ry i+- in
DindustuatlConultc>tial ' OORcaidctitialW'itet-.S ippl}'(struFd) FROM- ..ro `.atnikRixL a-,z+arP[Acsxi r:usrnoD.c ►lounrr
•
.
.: Dlriias tioli•'. ' . . .... ... . . . . . d: rt;::
?on i.4 dter:Supply .011::, ..
n (t ;
C7t4onitonIK . . CiRecar'ei}
• Injection Well ft
- C.9Agmfcr itccharrge ••t:lCiroiiiiid�iicr Re l ctb.�tia�u'• • '19'�iAl�lUlt"rttr�� 111G`f►;(flriltt ieAliTi 44- - r, x 4' �r
FRO'x1:: 1o'= :ItATPttt.11 F.►IPLAEFAIr\TM11110D
l;Iqui;ftr Storage anti Rcc lt�ely. t $.al n 1'4 6arncr .
4 ft.. 15 ft, SAND : #2
• lJ Agturcr TcSt t Stornn to Dia;tape'
.. b1,:.}irnlncy*lTOhn(1lop°: rj. li6sldci1cGCoatipt
ACDRIGt,RAG:tdMla firb irdition9filreetil iiccccaii) r D '
• QGe01ltenaal(C16 .41eopp. tITracet, FROST: 0 :DESCRIPTIONIt-dlot;bAidnitt:: , tmelit�t* risim tc.?.
Eity:OtilEttliat(l1ea ii !Cuottn$.Rattiml` I. Otliet( 1.Iln Iliki6 #2:t'.RRemad s) 0 _.ft.: : ft 7 ,. SILTY:
- 7 •.ft 15 ft,' GREENISH CLAY/SAND '
k Mite:Well(9)einuplcted .,,9-26-2024 WetiID#:SVE--l10 ..
5a.Weil Location h 4 �. 'Imo, h , _
• FXI. INC • , . ..
F 11Iiy*E.N.t nic:. • • Fai1111$JP#Cif apphlcab1c); - . OCT. Z
It r,. T.#'.; 4
18801:.Old Statesville-Rd.', .CORNELIUS., NC, 28031 xR, R
:Plnstcat,lddress . and p4,21, LIM ARKS *,, k,:t ",... s :ter . a. •,. = x..t t S��
e,
MECF:LENBURG BTNNO FROM'0=4 : .
a.
•Cahat`:. 344iiC1 W.ntititior,tsp[i ) •• ' •
;b Lnntudc and Lonbntiiile to cleg ces/mll utes/f�ecopdc 4r decimal.tic t0s' 22 Certification•
• (lt`i.44.titId,tiib 114,4o b ifi; ietllirhf) : ,
' ,':,: - .
`�r. `� tn�t/ 9/29/2024
$ a rCciti clt Comm tair r Dat
6 Is(arc)the'tiril(s).l?$iPerntalient trr 'r..L1Tcinporare:' s istn ahr1 ¢Fm i hciell•,cart ttnr thr lints ism 1w 1 rs./..* eraiiii 10 tKi'krclm,t
uuh f. t 0Vc aCO2C 41b0 or Ifct NCitC 0''C 02O n',J 1 to.iist n rIon Srco do'4c rout rl,rir0
7 Isttus n epairtf atieai%Unjt1Yclt. €7Ye5 or. 0+No -. • ro?offl frrrrnndf rya tncr,nrssiodid rdjJac*srr1 Honor.
1/this£r a;t'pa r•fll�cu sr,irrtJer,r,�rr,t1&.rta In/;ru'inns oii ml rapta)n thl;>srrsri cV.Iti
rtlmirunderu2I rrrrrwiAs teai3n or,'iii YGn b. .0 otiiii.r/onir_:- 23 Site diagram o f nddttional O`cll detstitN
You may uye the baeb of this page Io pttiii.l addtuanal wcil site deia is or well
$ NN'ttmberaf wells 06,0im ted 1. canstniettaudctails Ybu may alsoattach ddiittionaIppa cs ttitri i a aiv:
Far 1 ilaplc t ifeeifuti ar nrii n nit r airp selfs OI L1 iiitJ th1 same colistruclian,it�a chit'
• • SIIIIMITTA1;.fj�TS`CITMONS.. .
sabnr,ra;,c forrmt.
15 21a.:l?ir Mt Wallet Submit tliis:Boni within 30 iliitis of completion of welt
9 Totat rt'tdt dcjttit ttt,(a1r`lattd�ttrfitce" (ft)::` .
Farmalit}�Jcr<ci[s'lsttittrli tkifjdf tiiirt(rrinti l e�2!?2`.nb'l2t$lAti) conslin tionttilhefoilossin ,' i•
10 Stli ienater;,le el behet to oft sig.NONE... tfY? Da S+enofSVaet Retours,Iii•f•om4tioiitae=st thuI ee P
pa : :
1/letterra-4I. Uiedsg<da 4"' .' :tat I :Set ice Center 1aichNC:276911613: t;
.
i 1 Borehole.diameter,10 5/8" •::(=n;) 246 For•1nicctiipl Wellc ONLY to addition.io scndmg the form to the•address iu
. 24a above,also submit a_:cop\ of fonu_willun
tiiis .30 dabs of eofipie to n ofwell;.-, _
12 WeJt 004E- coon nit•WOd
AUGERS ccmua odout•o:thefollowitig.
(i.e au". m cnblc.ducc#pnsh.ctc} `'
Division of WalerRemurccs,lJkidcrground injection CoidroiPrograni.
• FOR WATFRSIWP.LY;\VLrLIS-ONLY 1636 Msiil Bienlcc Center.Raleigh,`"C 277i90.163(i
' 13.t.7l titl(npnij: 1I thod of tests
24c.FiirWYaterSupp11,&'.1ntcti n Vdtc
. 111sa si buvl.cik copy Qf thls•01,1 iuth,a 0 d�tSt ofcotup)irpotl of
I3b IlisinfiiUon t i Amount,:_ scil consfnuf on•to The cow its`i ealth depaitment dt the.counts~nierr<=.:
k:.
Fenn tart i Noriri Cagilili.Aryi3)rt i ciu,ot`Emiianmcat`and t3aarra]ftesaurecs-1 h 1sion.oflViicrRe,in. —, "Raised.August t(11',: