GW1-2021-00671_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD For Imer d Uw ONLY
Thar fan can be used for Musk or mAWk Welk
1.Wd1 CNtrww Ipfermotise:
Brian Hiring MOCKlUrM4
Wen com ov r Nape ft it.
4240-B k' at
Ne Wen CormaYorCertificates Nweha -
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SARDACCO Inc 0 If. 12- is, 1.5• 4 NA Steel
(ieapei3 Xame
ADM 70 7m[7Qaa8a MA3L14L
2.WCRCepmrwelba Perreitd: N103003991 70002483 p1 R. 4
[ur W apP6reble wrnprram.fir.CaWr.SYwF.Wrion'r.byKtl01 rA.l IL R. ice.
3.WaS Use(rhaisweR ese):
Water Sol Wel: M TO Isupr
❑AFWuft nl OM Yplimk 12' ll 20' IL 1.5• la. IA NA Steel
OGwdor al(fhntisg,Ccohng Supply) OReddeoosl Waler SApii'(sipgle) IL R IL
❑bxkwnUCouwmnisl ORaidemW Wren Suppl(shmW) PpOM 'fo -14Ta71AL Y¢fBOo AMOUNT
❑(m R fL
Nos-Water Supply Wen:
R R
O ORews
R. 111.
❑Aquila Recharge OGfowdemser Reaw"on
❑A"W Sump sad Recova) OSdrapy Similar Mail R. M.
OAgMfCF Test OStormwsan Dreimp R ti
OEepwimrmhl TeclmolM OSobsidesce Control
OGOahMapl(Cdred Loop) OTsker ►roar m pOl�ms err. .evma wc .
OGaidmind OtesmusWCookilli Ream) MOdler(cloots eider N21 Remade) 0 R 20• R.
ti 6
4.Doh Welts)Completed: 1/14/21 WeR11DOBe
It. is.
58.Well Loradw. R R
Beandiati.-n xanageaent Service Company p• p,
Fwdlls /OWem Nwa Facdae WO lffapplicibk) IL R.
2650 Shenandoah Ave., Charlotte, NC, 20205 R
Pleeaml Addam.Cfly.and Zip _
Mecklenburg 12716204 Temporary_ iniectios point through DPT tooling
comply PaoM Ideeelkalam No.(PDI)
56 Ladhlde and Lsegkiede is dspmlmiaphshetaads per derlmd degrees, 22.CertMesidea:
fftweg field.ire hUfo"issslBNrm)
35.210533 p -80.801887 W - Brian Ewing 1/27/2021
SWEMM orcewfad Wee Co meow - Come - -
6.h(amidieweR(s): OFlrrommus or MTrmperary
A.fyiwa 0.), .1 Arrshr rrmfy IAm rAe xrllf.*I war Iwrrrl,wwrrwud ur nroMeere
xi1A 1Se NCAC OZC.01O0 W 1.41 NCAC OIC.OH10 Wr0 C~wa SaadWd,a"d,A,If o
7.htW ertpelrb b a wv'wdl: OYa or d'm, s '1 n .op.of�Au rrrord ha two WaAkd n*,wfl m.wrr
ropi,prr 011d rkx nw xrN,oeanrrknm/anemn.w/.M'iloi ak.i�
.rptir n.drr n/.emorfm p.ww.W o.ehr burl Mddrinrx 23.Slue dlspu K adalaed well defab:
You=5 use dat
of
ID
s.Number of wells comstrseted: 1 compaction details Yon �pop
aes h additlmW well see spy i a a�dl
mp' )mga Jeeraeaty.
FornWlplr onanp-xmrr uopA wilt ONLY xwA N.•IIMeawsewram.ww.w
rwApd ape frorm.rm.. iLORMYTfA1-pVSTII(.•IIONg
f.Tatr well dip h below lead smr1, 20 (tt) 24m. M AN Wel�ls:rr..S,b��� t this dimwithinw 30 elms ofco�blluan of well
For x.abWk w1lrbl at/depAf ddl$rrv+ulfl axPfr-i®:fal'owd 20 IW) COUSMXDn 10 the fORew9ug:
1s.Stade wehr Ind below hp of taaMC (RI DhAdims of Waaer Resources,hfontmiee hsresdq Vok.
If a ,kwl a abt w,..r..-.- 1617 Mal Semite Ceske.Relsdgh,NC 276WIG17
11.Reid le diameter:1.5• pml 24b.For[aimed.Wdk ONLY: In addition 10 sea ft file form ro the address in
24m above. ado submit a copy of this form within 11 dns of completion of well
IL W eR taselrmafom adbod: DRIVEN coosmntiom to the fonowdg'.
lie.mom.men.uElt anf path ac l
Dlsblss of water Remen am Us derpwd hs ecddw Capital Progreso,
FOR WATER SUPPLY WELLS ONLY: 16M Mel Service Ceehr.Rdelm,NC 276f9-1636
t3s.W"(gpm) Me16ed at arse M.For Water Supply•Isieetisn Web:
Also nbme one ropy of this form within 30 days daompktnpd
Ub.DMandde IYFC Assumed- _ — wail construction to the coaoty bodith dcpammmp of the comoly wham
cononucw
Pam GW-) Nonh Caolms Dapm of Fa,rmmeerand Nram Rmvmas-Dmium of Wmr smarms Re.and AL46.r 2013