GW1-2021-00680_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD For lorwl Usc ONLY
The farm can be sued for smak or mApk wens
1.Well Contractor ln/ormades: _
II WATER ZONES
Brian Ewing ►ROM I to iRFEF qN
Well Commas,Name h ft.
4240-B h IL
as LSM
NC Wdl Cemaoor Ccaikmion Numb" 1
FROM lO MAMMTMR TIINTINMSOS MAl2nIAL
SARDACCO Inc 0 h 1 11- h 11.5- is. NA I Steel
Coapa)N.. 16.Off=
FROM Im I DM%m MR I TMCE.NMffi I 11.4makt.
2.K'eN Cenwrserbn hrnkF WI0300399; 70002483 it h 4
!Ju ull upperuhlr uell perYw,!v.Cmmrc..yam,t4naw,,ijaroon rs".I
ft. In. is
3.Well Use(cbtAlcwell nrch
Witter Supply Well: WIMTO I KAalttMR a TNt(xntgT -MA =:. At.
OApfcakmtol OMoniaapaLTsblic 11' h 19, h 1.5. Iw NA NA Steel
OGeothenrol IHestingCodirlg Styply) OResikoW Water Supply(single) R. h is
Oltdrmrud(Commetcfal OResiderml Water Supph (shared) room To 4#ATZM4L MNw MM:mm 1ACT1,MT M[INOn A A
131nigianou h h
Now-Water Supply Well:
h h
OMnrtto ORam
laJecdom Well; B. R.
❑"der Recharge OCaoudwaler Rempha ion If. UM iffamecAm
❑Aquifer Storage and Reco)en ❑windy Ranier M "A w aT
NVTPOD
In. To ft.
❑Aquifer Test ❑Sionmrma Dminagc h rL
OEsperi ussal Tmbw§M ❑Subsidence Coetml
OGCmbetml(Closed Loop) OTraar /ROM TO DZKTIFMN ware. -Work r..we.
O(Goodiermal(HestmiWorthic Return) MOther 4explans under N21 Remarks) 0 h. 19' h
ft. h
4.Date Wells)Completed: 1/15/21 Well lDRB17
h h
Sa.Well Incatlos: h h
Remediation Management Service Company R 4
FscuMA3war Nurse Facile lWlifisplinble) h h
2650 Shenandoah Ave., Charlotte, NC, 28205 q, b.
PIPS"Addles 01).out Zip
Mecklenburg 12710204 Temporary injection point through DPT tooling
uosol) raw lorwihtme No IPINI
5b.Lathde and LospWde in degree Buis steaM1Lcwds or dectoW degrMes: 22.CL'rtMeadou:
(if..It tiew.one Iaetolw it sum-to)
35.210533 N -80.801887 W Brian Ewing 1/27/2021
Sign ofCMlned W'NICommeW Dm
6.Is(are)the wen(aF. Ohrmasest or ETetoparetry t,u„4 M.fin .I A(rrM"no rAm;Ir Yrly.r! W ur nxn.dm,r
�l �) 2i�I SA NCAf 0:f.011e)ur15ANC.4C(CC
IS this .nMal Wrfl C,wrrw Mr Sa,Mur,4 uM Amu
7. this a repair to an eaisifag well: OYe or KNe `-U "' l54N AC 0 ha.burn pmreNd M,w+elf,M'nrr
If Ai.„a rrfulr,fill rv,i......It,,w nsM.Mforssu*.,od rrphnY sir mrtarr of rh(
,rfw;,YYdr,021 rrawA.wrmm n.,„eh,hm3 ref AI./.. 23.Ske diagram or addMaool well detaliv
You maY use the bark of this papa to provide additional well ste details or well
s.Nssiber of wens eseMrsur": 1 caway fn iw devils. You my also aftach additional paper if oaemn.
For YwarMr,Mr<'rMw o,MM-Ysxr e,,h Y(IL ONLY n'wh Ar Four resverarw.
,Yfaau mr fn,r.. c IRMITMAI.INCTIICMIONS
9.Total well depth below land tsrfocin 19 (h) 24L Nor AN W'ena: Submit this farm within 30 days of completion of well
FYr YrdaP!(wrlfslinaadrPA,f/J,grr(n„PnYWPb-JF:M'uM:¢lwn construction to the following.
Is.Stail:water Ind below asp of costing: (a) Dklalon of Water ReswrveL,Informalw Processing Usk.
O NWM,kr l l5 phU„C,Jlm{YY ♦ 1617 Man Sersice Center.R&JcW NC 27699.1617
11.Rordwk dbtmaer:l.51 (iL) 24b.Per lotasiw W'elte ONLY: In addiuw to seeding the form to the address in
24sabm'e. also nlbmM a copy of this form nil im AO days of completion of well
12.Wen mmrnetlon MdW: DRIVEN compaction 10 the following0 c=W.mar',cabk diva pink e¢1
gin blue of Water ester Resources.Underground lojecsian Control Program,
FOR WATER SUPPLY WELLS ONLY: 16M Man Service Canter.Ralelgb,NC 27699.1636
13a.Yield(Spin) Method of tesi: 24c.For Water Sapp!)d:foliation Wells:
Also submit one cop) of ibis form within 10 days of coppletlon of
13b.DWmfecdon type. Answer- well communion to the coouy health depamam of the count)where
constructed.
Form GW-1 Nonh Cmohr Dapaprnacm of En wlmnar and Neural Renmces- Dn sue of Warr Rusnura Ro ued August 31111