GW1-2021-00679_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD F—hwml!I IONO
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1.µell Contractor Infornation:
U WATER LANES ----
Brian Swing FROM Trl Firs-RIPTION
Nbll('nnmcua N.,,,. it. fl.
4240-B It. ft.
N( Ncll(omrvnar Ccmfrc anon Nnnbct IS.OLTERCASFNGffornmIg1,_ d $C LtI(ER1lf asa4aY4
FROM I m i m\NrTFR nafYsrss N\Ti RI\I
SAEDACCO Inc 0 ft. ill (I. 1.5• w NA Steel
(' p.un hmrc Ile INN_FA 'ASINGORTL'RING�awYer�aldndJmPJ
mON TO Dl4NRER rMK A�rtS J NnT[RI\I
2.µ'ill f anstmrtion Permit 4: RI0300399; 70002483 (t. ft. �.
fl. ft. i
J.µ'ell I:sc tetMek will net: IT.SCREtN
R ater Supple µill: mow to Fi14xrTr¢ sm RlrF T¢RRs" x4rml a.
f lAgrrcuhmal I.Atotiktpul Albl+c 11, ft. 19, ft, 1.5" is NA ',NA Steel
I ICiccthm4il(Ilca(ouCoolim Soppl+I Il Residcnta R l 'atcr Supph kinglet ft. IL a
I Indusinal Conunercial I IResidental Water Supph Ish7rcd) It GROLT
FROM 10 N%URI\I, E MPL\CTMEST METHOD A aMOl'NT
❑Fite rtmn ft. fl. —�—
Non-µ'ater SupplJ µ'ell: ft. n.
❑htontlonng ❑Rmarcrc __�
Injection µell: II4 IL
flAgw(ttRcch:ugc flGmundtwmr Rcnudi:nion Is.SANDNMAJTSL PACK III I'raY4)—�---_--� -
—--
r¢nN rn sl4Truu. rxrurrwnr xrrtmo
❑.A(pufcr 9orlgc old Rmovcn ClSaltnin Rnmcr h fl
Ll A(THICF TN Cl Stommmcf Dniouggc /t. ft.
❑Fspcnmcntal Tochrmlog\ ❑s'bMdrnc Commi
It DRII.UNG LAG dtaeY of iG•ad s4e1s M aEeewn
❑Cicutl+enrwl(Closed Loop ❑Tracer mow m Firsranrms N.rr,E.d.r...u,•.En :+r..w.i
0ccuthemRtl IHcanne Coolow Rcmnll M01hn(nplarn under aJ Remarks) 0 ft. 19. ft.
4.Date µ'ellUl Cumplrled: 1/14/21 µ'eit IDa B15
it. n.
Sa.µill Lrmalion: ft. ft.
Remediation Management Service Company n. ft. —�
F.nam ON vcr Nanr Facvlm IDsn(atplcahlcv ft. f1.
2650 Shenandoah Ave., Charlotte, NC, 28205 O ft ---
Phtaal 4ddmss.('in.and lip 21.tCMA1IM5 --
Mecklevbara 12710204 Temporary injection point through DPT tooling
loom• Panel ldcl4fulx.x Nu 'M I
Sh.Latitude and lAngitudc in tkgraes+minutesfsern¢ds or decimal degrees:
ul Nil!field
me I:a7n+p n.Wl'ccvul 22.CertiFrltkm:
35.210533 N -80.801887 µ Brian Ewing 1/27/2021
4pmtxn of Ccmhcd W'cll fmnr.Nror Doh
6.kurclthe welllsl: :-PrrTnanent or XTemp(lran
8• r rku h=� I hrrrm uv(•rm:r vb,x : . , :.,.a. �. .� N.m.e• n , nN• • v o-a v.r,r:
.::4 !°( K1( u•(' ��hY.,.. I41 Ar JE ui rv'ir)tW1( Am..Lu 1. nN 1&.1.i
1.b this a repair to an eriding well: _;Yes or SNo y::.a 0ll...::.nl h::• .......
li rk:.,:e•.l*'vn (dr.,.r...,,n:.v� ...............,. .r n.......:n.. -y:l......... ,sour
.u:W.•F1f r,:n,:.x.•+,.,,,.n ,m,m.n:::(:.r nu•n�rvn. "� /�J i 123.Site diagrom or additional well details:
YoD nut use the back of this page to provde additional well site details or cell
M.Number of%elk constructed: 1 comincoon deans. 5'ou m:n aLw stuck uddrUel+al µtges d nnrssan
SUBMITTAL INSTl TIONS
9.Total will depth bekm land wrfatt. 19 (ft,1 24a. For All µ'dls: Sublml this Pore Nnlon aU ens of conipktlon of Nell
I:,..,,,,burr.—n9. ......v.L- rm`io -W`a twit Construction lO Inc 1101101%ang
10.Static water Ind below mp of casing: (h.l Ill,hion of Rater Rrmurem Information Processing,l nil.
t,-0 ,1, ,l,•.d.,n.::"v..< ,.. • 1617 MAH Sm ice Center.Raleigh,NC 2 76 99-16 1 7
11.Br rdwk diameter.1.5 Jiml 24b. For Inkedon µ'dk ONIA: In addnmo to sendooz the form to ere address in
j4aabu\e. also submit a Cup% of this fonm willow to dais of coolpi rwo of Bell
IMA ell construction oeghod: DRIVEN ccmlmclion to llw follooule
tl< anger.man.cahle.dimct rush m v
Dhklon of Waler Resources.Lithe-pound Injection Control Program,
FOR µ'ATER SUPPLI'µELLS ONt Jr: 1636 A4R Sm ice Center.Raleigh.NC 2 7699-1 6 36
24c.For µ'at"Sapid,d Injection µ'
IJa.\'field Igpnq Nlcthn4 of tevtL' _
elk-
Also submit one cups of [his loan +t ilhnl to dais uf vnnpletknl of
IJb.Disinfection npe: Amount- \Nell corLumc ion to the cmmn health depannlcnl of the cmnm arhetc
Corwinrctcd
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