GW1-2021-00661_Well Construction - GW1_20210203

%NELLCONSTRUCTION RECORD F.,,In rnnrm Nn
Tbn tom.cxn h swd("belle nr nx,a,rA ndtw
1.W ill Contractor Information:
IJ.WATER TANFJ
Brian Swing lROso To Dr.M'RnnDN
N'cll(mans,N:,rn to. /t.
4240-B ft. ft.
N( tiNI Qn,Imnor Ccnue.atnn Mosher 13.0(frER CASING far awRFord odhi OR LINER (fa Reahle
rMON TO DIANTTFR TIII('ANrNS NATTRt\I
SAEDACCO Inc 0 ft. 12' ft. 1.5' a.. I NA Steel
f n N- r lkINNER CASING OR TL'RING�ew►rrm/ehned�oo L_ _I_. _ ... f_�__ _
IRON 10 DRN[TFR TNR aN[Sw I NUIRI\L--
s Well(nn%ovctnn Permits N70300399 70002483 _ ft. ft. in.
1 .rclyen dhL erlrrnxurli.la-•unr, s.c..(.r,unr /II1•R-DOf
3.W ell I use tcheck well Reel. 17.SCRE[N'
Water Supple µell: moN To m\NaTre st.frTSVJ rxtrRNlvs N\replst.
12' ft. 20' f1- of% K N1 I TF Steel
t.lAgrwuhural 1161tmicipal:Pubbc _
nGcolhemtal IflcatinkCathta;SlpplsI I lResidenttal Water Stppls Isinglel !t. ' to,
I IIRhlsoial CJmnRnial 11Residrntutl Water Stpph lslxiredl 1 eL GROLT
FROM To M%1TR1N. EMPIACTMENT N[TBOD IAMOt NT I
❑has •Inn ft. ft. -�-
Non-Water Suppis Well: ft. n.
❑Monitoring ❑Roemcn
Injection Nell: n. R
f lAlluifcr Recharge IICJmurdnmef Rcmcdcaion 4.SAND- EL PA(T( licatde
Ia11M i0 Mxrf Rl\I. Fxlrt A(FMFNT M1-loam
❑.Agatfer Storage and RtNmcn ❑Sahnin Ramer ft. h. -y
❑Agnifcr Tcst Cl Slommaterlhain9gc ft. ft. -
❑FNpenmental Tochnolo4n ❑Snbstdctrnc Control
14 DRILLING LOG allaeh additional sheaf,Y necessary)
DGeudwarnl l C'losed Loup l ❑Tracer FROM To IDr xpnnoNta r..6.dww.war.ln R.on.l
DCrIhtamnl(Hcaltng.Coolow Retuml ®0111efin nutdcra]1 Rentarksl 0 ft. 20' n.
ft. n.
J.Dale W'ell(sl Completed: 1/13/21 mail IDOA24
/1. R.
5a.Well bicatkon:
-y
Ramediation Manrgemeat Service Company ft. fl.
Fxdm Caw tier Name F.Il", ID=of spplrablc1 j
n. n.
2650 Shenandoah Ave., Charlotte, NC, 28205 fl. It.
Plnsaul Nddxrss(It,.:Dxi Zip 2[.REMARKS -
Mecklenburg 12710204 Temporary injection point through DPT tooling
t aa,q r 2et Imra,rab.Nn ,rl�I
Sb.I.atimdc and IAngimde in dt[rars/mimiteslseeonds or decimal dcar s:
22.
o F e f edlaW m 1:06.upu.,ditcuJl Certifratinn:
35.210533 N -80.801887 W Brian Ewing 1/27/2021
"prmnc o F('cmucd Wdl Con¢mmr Date
6.lsiaeellhewdl4si: Permanent or %Tempuras a, erh,� r..nn an.r.n. . ,rm r... ih. .�rrh. w �..•„ .e.. .. ..,r.,,,,
IqaA1 �I wl'1l nY' .tliv.••. I tA( I( uh ,Nv.tl.b(.norm n.ui G,unLvd..vrrl Ao..
7.I.this a repair to an exhaling well: 71tes or 8Nu •LO(�1`ttlu.r._•.nlhe.h.n pas..„ado.rd .„•......•
li.hi• ,row,.(Jf.x .. .x.�,a•..rNn..n,•n:npunarn.0,u.•1.4Jen.0., ru.M n'••r lii.
..rr:�.x.d..ar..,x,:rx.,,,n..n.•.,.,,dr,h,;,<.�r rcd,r••..,r. 23.She diagram or additional will details:
1"oar ram\ use the buck of(his Page to pm\ade addmnrral sell site details of sell
S.Number of wells awrutrmYed: 1 colwnRYlon detail. You areas also attach addiliotull pacts If rKtiessan
a..,m.,h..d. „m,., •,.�•.,..•.,, wri�.• •n-.ON/Y...... ... uwrru.surnnn ...
SC BMITTAL INSTUCTIONS
9.Toast well depth below land Wrfac. 20 IO.1 24a For AB Wells: Submit this loon anhm to doss of compktton of hell
I•.•m.Juph. &'h.:.d1 a.nth.Jerdr„+o..... ..- ra t.. .,M`•n n.n cortMnrcuan to the following
10.Static watrr Mel below sip of rasing: (R.1 Di,isiun arm-,ter Rezaursom Information Prucessint t nil.
/I .!. h%'!!."A."•...v.r - l617 MAU%m i v(-mter.RAlcizh,N("276"-1617
11.Borehole diameter.1.5 do.) 24b. For Inection Wells ONLY: In additoon to wading(hc form to ds address in
24dabo\c. ales subntil a copy of this foot ss kin :m da\s of cumplet, n of sell
12.Well dtaVrmYion method: DRIVEN corulnt wn to(Ito folio"mg
o c dale.r9an.cah1c.doill W sh ca I
Di,Isiun of Water Re,fooms,Underground Injection Comml Program,
FOR WATER St PPL'a 'A FILLS ONLY; 1636 Mail Sees am Center.Raleigh.NC 2 7699-16 36
13a.l'idd(gpml - _ Method of test: - 24c.For Water Soxld> 6 Injection Wells-
Also submit one sop% of this form within %0 da\sofcompletwoof
13b.Disinfection type: Amount: sell consmicuou (o the county health departmoci t of the comity whcm
conctmcicd
Fonn 6N-I N.mOl amluu Uyunnam of bn,mnnrm nil Nmwal kcx.nccs Dt.awn olNanr Reroutes it,,nil A,glnt H'I1