GW1-2021-00669_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD Farinemalf woNLN
The form can he used R,,stngk a mul,pIc ttclls
I.Well Contractor Informallon:
IL WATER ZONES
Brian Ewing FROM to DLH'PIPIIO{
Well forvacbr Name
4240-B
NC Well Corrraclor Ccnlfcmum Nulbcr IS.OUTER CASING f1for wetkoMd wags OR
IRON /n DI{N[trP TNK'RRSS NATTat{I.
SAPDACCO Inc 0 n. 1 12- f. 1 1.5- in, NA Steel
t of,;m,Neva 16."Oln CA41NG OR TLIRING
mom TO DLANTTra T1/I('\S[56 MATTmLL
2.Well Construction Permit 0: N20300399; 70002483 ry, ry, low
Lu uf!ufgli,uhlr wrB fsmem v r.Gwnc
n. n.
3.Well Use(cbcMf well o{c): It N
Water Supph'Wen: 7 TO DI{H[r[! {IAT61[a TII('KNr55 MATRaNI.
UAgncutural U klunictpaLPubltc 121 n. 20' fL 1.5- 4c NA NA ! Steel
ClGeolhattgl(HeatinpCooltrtg Suppls1 fJRcsidemtal Water Supph(single) n. tL is
❑IndustrtiabCommercial I1Residcmtal Water Supph Istmnd) IE' ' O
Ur
PROM TO I .MAnIH.U. [AfPLACTMnT MG-TPOO/AM0t NT
❑ion twit n• n•
Nos-Water Supph Well:
�Monton ❑Raman
■ e W' rt. n.
i
❑Aclutfer Recharge OCmourdwater Rcnceliation 19.SAND7CRAVEL PACK IN voldhodde),
❑Atpltfer Smrage and Rmax cn ❑Salmtty llama PROM I TO MAT[llAl. n1PIAC"ItNT141"HOD
❑Aquifer Tot flSlommater Dminagc n t
DExpenmemal Tahatalop OSubsukncc Control 21.DRDA3NG LOG additional rtrMY
❑Geutkmwl(Closed Loop) ❑Tracer FROH I ro IDTa(Tttmo{w«4r,awaww..ah�sn ie.rlrl
OGeutha red IHcati ,'C'ooln Return) ®Other 4eVimn under#21 Rctirr►.$) 0 (- 20• n.
N. n.
4.Date Wells)CompMed: 1/14/21 WdllDDA20
n. rt
51 Well Lne atiore n. n.
Rearediation Nanagemeat Service Company IL rL
Facdm Ow ter Nanc FacIlm IDrrif applfcank) ry• ft.
2650 Shenandoah Ave., Charlotte, NC, 28205 ry (L --
PlnscAAdtwss.0hn and Zq) 21.REMARKS
Mecklenburg 12710204 Temporary injection point through DPT tooling
('omm Piece d hicufaxme Nn (PINI
5b.lAritudc and IArgtude in de[rees/minmt%twcoWs er decim■1 degrers:
(It well fold.on La,k.gg In alrtrcetl n, 22.Certification:
Brian Ewing
35.210533 N -80.801887 ') W W' 1/27/2021
5fgrubrc of Ccmficd W'cll foMracbr Dec
6.6/2x)tbewell(s): 11Pawrianem or ZTempuran
B, .,cmm•rh., Inmr I hrrch, rrrrh rhm rhr nrlhel x nl..•,uw.rrd m •nhm,r
x uh![1 �C:IC'IL`( JI fM)or lCA FGI(il,•f u`I41 w'v!f(nXVOilnn Crurvfnr•f,'Niubl rinl..
7.h this a repair to as Writing well: 7Y'n or K No ••{».,r rb,rf..•nf h,r.hrrn......4Jed N,IA. .,0!,.Nnr,.
fj rh„»,r/rlxilr,(Ill,.vr fx„xN Nrll.,Nl.....n,.... 0 I41 rN/(„/rhr
rrryx xwfn 021 nmxrl.er.-li.m.N,n Ihr h.4 M lh,a r„nn. 23.She diagram or additional well details:
You nmy use(he buck of this page to procnik addiuwml well site damis or ttell
8.Number of wells constructed: 1 sVIW nKYnm details. You may also attach additional pages if n oecsser,
f.,,mu41141,mr.raw.N non x.rtr.,vr•M. +rb,0%L) .nrh rhr sour Far raraaa ,•.N,....
,Nan,r.N,r h,/m. SUBMITTAL INSTUCTIOYS
9•Taal well depth below land mrface: 20 fft.l 24a. For AN Well: Subnot tlus fomr Within i0 loss of.nmpldion of well
f.x nuhlPlr r,lanipff- Iv`O) and"N 1i4T1 cominKtion to the following
In.Stack water ksel below top of casing: Al Didion of Water Resowrxn,letnrmado■Procnsing Lat.
nxoro!r•d,.„hrnr„urnr N,r . 16t7 Mail Sen'ice Crater,Raleigh,NC 27699-1617
11.Roreiok diameter.l•5 N (in.) 246.For Inimtkm Well ONLY: In addition io selling the fans(o Ik address m
24aabme. also submit a copy of Iles form within lu da)s of cromplelion of Well
12.Well counteraction nnethnd: DRIVEN construction to the follow Ing.
I1 c.auger.man.cable.choxi push ex I
Dhinion of Water Resources.Underground lojectlow Control Program,
FOR WATER SUPPLY'WELTS ONLY: 1636 IIIAR Senice Carter.RAW0.NC 2769946.16
13a.Yield ld(RPM) mahod of teat! 24c.For Water Sapid,6 lnjaairm Wells:
Also submt one copy of this form wilhnl :ter daysof sromplaionof
13b.DWnfection hpe: Amount: well construction to the county heath depanmem of the coumy where
Celwtnlemd
Form(,W-1 Nnna('amluu bryannrlia of EmrmmlNm{Id Nafwal Rcz,wcrs Ihswnnof N:rfcrRcgrca Re,sod ugust sl In