GW1-2021-00701_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD For Intermit u:roNly '1
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Brian Ewing FROM I TO ses(wIFhO%
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4240-B R. Is.
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SARDACCO Inc 0 h 12' (L 1.5• l
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FROM To suMrreaN ns MATMAL
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OAgtisvbuml OMaicipallPabllc 12' Is. 20' is, 1.5• 1w I NA NA Steel
OGeodcmtal (single)
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trgK' tp SopplY) OResidenttai Wager S
ObdugrtaUCotnntMtctal ORaidettttal Weer Sappy(shared) IL
FROM I To MATIMMI. I WNW ACZMM raram AMOL7e
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Naa-Waver Sappy Wee:
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omommingOReros
Injection Well: A. h
OArlu fe Recharge OCaomdware Remediaion
OArpuder Sloege and Recaen ❑SaliRih eerier h 110 h
❑Aquifer Test OSRor mats Drainage h Or.
OEVviimenlal Technology ❑Sobsidwce Control
OGeothetnral(Closed Loop) ❑?lacer FROM To DZKI rrM air,bawiosw,w%nA err.
OGerahemd(Aeau Remm) ®Odw toomas order 021 Rrmrmkr) 0 h 20' N.
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4.Date Wei(&)Campklyd: 1/13/21 Well Ip8B3
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Sr.Wen tsation: h h
Romediation Management Servica Company A. as.
Fx1Im AOwxr Nomc Fargo)ON FL I A.
2650 Shenandoah %vs., Charlotte, NC, 28205 w I E.
PMsiral Address fin,sad Zap 24
Mocklenburg 12710204 Temporary injection point through DPT tooling
Coast) Parch Idemlkeba W.(FW)
db.Larhde suet Losglmdc is degreedmkmushwmWs K dedmal degrees 2L Certification:
(a wen few,om Imlows w wdlse")
35.210533 N -80.801887 W r��S��Brian Ewing 1/27/2021
1 CU X, .) 20
L I of CMgkd w'dl Corocbr Drk
6.Is lare)the well(Q- `J-Permaaeat or ®Temporary B,.neNne Fla,!«..I Araby rrrlo rem rAr xrlavJ xw Ixr,rl s wrrw.rre M m.o»im,.r
.nk I1A NCAC 02C 0100«I M NC.4C(PC ON?Wro C,xumx ww S."wd,unA Frey u
7.Is Ws a repair to as taiNiq well: OYa or KNa .,y,.ywr.rar,M 6a,(wra pn,rdrd n,w xrfl rwwr.
ry,Au„orepair,fill fw•xa.Nl,~.H,.1,0r ,e ,.drrpeun dw,wwrrofrlw
.rrw;r wdrr r_I.rararks x.r ow ar,w dw rent/rw F,.w. 23.Ste diagram or s"deaal well defies:
Yon me)we the back of Uis page to ptmbe addit erval wed site detail or well
R.Nomher of web constructed: 1 comma liar retail. You ny also mach a0ditioeal pages if ntxeasan.
Fo, wdror*ij.rkw M n,.-xYw1 WpM•eH,ONLY xvrh Ow Y1M ellNafaOa.V(,x,Y.
raewu awe Few. SUBMITTAL RNST'UMONC
f.Tatd well depth below lad rsrlarx: 30 (D.) 24s. fir AN W'e16: Srbml this form within 10 dins of completion of well
Fnr ard+tplr xrlL tin nO drper ifdghrvnr xruwpfr- i@?(AO and;W 1W) carmnschon to the following'
Is.Stade water keel bebtw tap of cashF OL) Dh kiss of Water Remrtes,hdorawies Processing Usk.
ll xawr Ir.d er d.re wear ax .... 1617 Mae Service Cate.Rakiglr.NC 276WI617
11.Borefok diameter.1.5 (ta.l 241L For leirrvtos Well ONLY: In addition to tmdisg the form to the address in
l4a Am e. also slbntit a cop) of this form %also 10 dn's Of COropktion of well
I L Well aMrwtlla mefhed: DRIVEN Construction to the following.
o e.wrgr.rarer).cable direct pest.Ac,
Dirllos of taster Reeaan:es.UsdegraN Injection Control Pagram,
FOR WATER SUPPLY WELTS ONLY: 16M Mai Smite Create.Raldgb.NC 276ff-16M
13s.Yidd Was) Merited of set: 24e.For Water SopdT i Isleelioe Well:
Also subma one cop) of this form within 10 days of completion of
13b.DWnfettlon rac: Amount: Wen construction to the comas h kh rkpnamal of the cmmy wba:
constructed.
Nona Cambia Dominica of En noncom art Nasal Rtwrm«s-Dwama of Warr Re ems Rr wes Atpmt 10ll