GW1-2021-00673_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD F«I..�.Iu�roNfv
no(amen bo won far sagk«eabpk wens
L well CON racear hdormatim
Brian Ruing room TO R
We0 Cam,apr,Naas It. IL
4240-B I• 16
NC WeB CemnY«Cewdb=m Nmdm
room 70 mAm[RR TBI'kflaffi mAT L
SARDACCO Inc 0 I. I. 1.5• te, tIA Steel
Coega)Naas
rpm to nLL�Qioo TeR'IQIfla MA7RLLLL
L Wd CaawtMbn Pertak h. w103003991 70002483 IL FL 4
liYWf apelire6lr wOpnwin(is.Cauar..Tam.Veriwse. ar.J
a a k.
3.Well Uoe(check will Essex
Warr Sepply Well: I Ina
oASltvkmel OMmictlidTimic 12 IL 20' IL 1.5• hs RA RA Steel
OGe &Mal(Hanst#Cookng Seppl)) OResideatkl Water Supply'(nogk) I• IL h
DladoormwCommeeeul ORpideeosl Water Swpb'(slimed) �a TO -amATmAL I ltmrucnteTT k¢medo AaIODRT
13huymo R IL
Noe-Witmer Sepply well:
& I.
O ORxm
IL IL
❑Aquifer Recharge OGmvndwoer Remedialion
❑Agdfar Sldage s d Reco%m OSali lop,Barter is.
TO IL PKAY11114 "rum
❑Agmkr Tea OSmmwater fJrsmgc
is. IL
OEgrensisa lTmhwlm, OSebddemc Codml
OGtolhemW(ChaKd Laopl OTraar imamm room To. /attmmw.. . , .wwwee WC
oCeMhem it - Remm) Wilms miler$21 Rearms) 0 IL 20- I.
I. R
4.Dame Well(s)Coetpkted: 1/14/21 WeBB)gB6
IL a
5a.Wd iaratbn: a I.
Itemadiation management Service Company R IL
F=ihq AOwewNme Fecnity[DO(ifapplim6k) I. I.
2650 Shenandoah Ave., Charlotte, RC, 28205
PbaW Adlmm City.and Zip
Mecklenburg 12710204 Temporary injection point through DYT tooling
Come? Paw Idraatkatioe No (PIN)
36,Latibtde and Loost'soolo fa deReeesfmimkolrew.b or dteiaal dWvm 2L CwWkM on:
(if-ell hat,oa times Is rrikkm)
35.210533 N -00.801687 W Brian. Ewing 1/27/20,21
sig,rnr o(CaetakA W'cn Comoro wr Dow
6.Is(are)the wd(sx OPerataaem or ETemparary ^ 2�21 Br,:so,p aW 1„—.I Ar,rd.,.my.,ea,Mr xvgaJ ea,/xr,rJ r.w,,.rad a nroNm„r
xu*1UNCACW.O1W,<fiANCACO?C,WWWr0Crwrmw Smidurd,und'Awa
i CG
7.4tW arepatraredatingwd: OVn or eNa � rup,olal..r<.,ntna,Arre Fmtikdm,lr xell,nwer
ry,Au 1,a npWe.p6 ar fawxw xvU rworrrkw I•/a,w•ex+,.oil rxpdaw Mr Hume,�,lr
.rpv:.wdrrnf,ex,vrb,..tiu,.«ae Me ere M,kir Jorr,. 23.Sltr dlaQaat or addNYW will deals:
Yon moy'use the hack of dtia pop to Is mile addiftonal will aka dusk or will
S.Nomber of welb enestroeted: i commction details. You win alto,arch addihounl pegs if aecemm,
Fw mwWpk AW,Mm m mw-x«r,„Wh xefb ONLY wrw Ow err reere'v Am.row„w
,.,twh we fixx,. qllBMrffAl.INST m'ITONC
!.Tots will depth btfow kited wrface 20 (tL) 24a. For AN Wdle Seb®1 this farm within 30 days of coegluion of evil
For .hW,WeOs li,lelf&pdr 44d,nnr trrmxpir-?@.100'eed 7F lrrr) Wngmumm so the fODowing-
II.Stalk umm ins belt M of easlats; IfL) Wilson of Wan Resewrtn,bdeeoake PreceWag Uak.
//vow,krel U eke '.,we.xr..... 1617 Mal Service Cem ar.Roldgh.NC 276WIG17
11.Rardsole diameter:i•5' (lo.) 24L For[Diced"Wilk ONLY: In addition to seeding Ile fom to the addreea in
244 Am e. also submit a copy of this fom wkhin 30 days of coatpldion of evil
IL Wed nnarwuW methe&DRr4ZN caomcfbo to the followast.
lie.ago,.inlay.ink•shoo peel m)
DI'kiow o(Wocer Reesoxn.Bedettli m d iayecdoa CessuvI Propaa,
FOR WATER SUPPLY WELLS ONLY: 16M Mall Sevin C. it. Raleigh,NC 27699.16M
13A Vivid(Win) MdhW of som 14c.For Wan Supply«lalxtise Weld:
Abo anbml one coy' of tl tom within 30 days ofcoagldiva of
13h.DWAlleeden mype ___ Amaret• well contraction to the cooly heath depaemeat of the aunty when
___—__ come.
Ferro Ow-1 Nook Canal lki m omm of Em,wnnem,mW NNWW Ree,w«e-Dwaa,e of Were,Reowm Mil A1lgllw 201 t