GW1-2021-00685_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD For lgemel l'cONLY
The form can tC owd for wank ar"hook Rtils
I.Well Cootrsdor Inforvatiom:
Ii W'AT[R ZQYM
Brian Ewing own to ec4('ambv
Well Cmumw Nacre
n. n.
4340-B
NC Well Codmier Ccrlfiuron Number Ida.OUM CASWO Ew md*cam6 OR lKwIftm
F"m TO mAM[TRR I rit"was MAWML%L
SARDACCO Inc 0 Or. 11' It 1.5• ♦L NA Steel
Cagmn Name 1
room TO elaM1TRR TMKXN O MAWK%L
2.Well ConWnetWo Per"ll, w20300399f 70002483 h Or. is
l�u d!upplirubf�urll ynwvs I�r.Carnn.Tmm.1'oriaw'r. b1 nr.l
h h is
3.Well Use(chedcwed my. 1 -:a ,,..:.......
Water Sepph'Wed: FROM To mAMRTRR Eta T"ICUNISS MATRmAL
❑AgrKllhum) C1MunicipehPllMic 11. h 19' h 1.5• NL NA NA Steel
OGemliennal MemingKooling Supply) OResidentnl Water Supph (single) n' h h
OIrdMDtfl/Com11CIC1a1 ORe61deN91 Wow SIgph (shlRd) MM TO MATERLAL IMPIACEMM MrIROo t AMOGVT
❑Im no IL h
Now-Winer Supply'Wed:
h h
OMooftnugORecm
lojectfift Well: h fl.
❑Aquifer Recharge OGmundwater Remediasion 19.11ANINGV2LP
❑Aqudw Storage and Recmirr% OSallnlh Border IeOM MATRaW. RM ENT MR
1100
fl. h
❑Aquifer Test OSlotmwmer DnWoage h n.
❑Espermcnud Twhawi*% OStbsidrn Control
•eau
OGeorhesel ICbxd Loop) OTaed FROM to 1pe4wtrrmN eWr►.rans.,.wnet Mr.
OGeolhermal MeaungCooling Rehm) ®other( - under#21 Remarks) 0 ft. 19' n.
It fl.
4.Date Wed(sl Completed: 1/15/21 Well FD/A19
ft. h
So.Well location: n. n.
Remediatioa Management Service Company Or. f.
Facn6y On,vr Name Facile,WN(of aWlkabk) h It --
2650 Shenandoah Ave., Charlotte, NC, 20205 11. h
PhlSWA Address.Ou.and z 2LURMAM
Mecklenburg 12710204 Temporary injection point through DPT tooling
C at, Paa'm himmilkalbe No (PIN)
Sb.Latitude and LoegWtde is degesalas sbsalseewds or derimal degrees: 22.Certdritlnn:
wf well hM,.ore bllows is n/Mcenli
35.210533 N -00.801087 W' Brian Ewing 1/27/2021
',_U it 24i�ahnre ofarJiw Wdl CoWacar DWe
6.h(ate)the wdl(s): OPermasem or ®Temperer) h-,;rrc:rx rk.m.,rc.r Ar.ra.r.rr h rhm rAr».la.l.,,�, »t,ti.rs.vnmrre m m,,ndarcrr
net!SA NCAf 2M ol/s7.n I fA NfaC R:C a2m WrL Cue#.w neon SmMn..k all dw a
7.Is this a repsir m on cidwit t well: Oyes or SNa
ll rhu n a rrpur.Ill wrinuxn»Al r rMrw lain Irc/.menam ant/rrpinm r!a curare..J rhr
.rrw:..w/r.s1r.rmaAr,r,rarc a.,n r,r teat r,l Au�,.m. 23.Site diagram or additional w'dl dltads:
You met'Bde the hack of Ihs page to p rode additional well site ddals on well
S.Nowber of wells coesrrncted: 1 t ne'tion details. You only also■wl;additional pages if recusant.
Fur mW+gdr mjex wm.a won-xaa•r wPl+1,.rlf,Oh'LI murk rhr a ime rwarwtkw won r nor
,abmn a„r N,� CURMITI'AL INSTU(TIONS
9.Taal well depth below bad surface: 19 tfL) 24a. Fer AN Wells: Subont dus form wvhm 10 days of conyletron of well
fin ma6lplr ariflli.rnfl Annals.r/dglrrcnrlramipfr rpo.'W'„M.'Blfa)'1 otmainwYbn to the following.
10.Stack water lend below top of casMG OL) Miami of Water Re mm Information Processing Unit.
1/.err. .rr". 1617 Stall Smice Center.Rakigb,NC 2 76 9 9-16 17
11.Borehole diameter.).5• fill 24b.For Inked"Welk ONLY: In addition to sending she form lo the address in
24a abm'e. also wbmil a croy of this force within 10 this of completion of well
I2.Well M mr elli"method: DRIVEN construct"to the follow*.
tic.auger.marl.cable Area psk do 1
Oltlatest of K'aarr Rewrtea,Uederpwed Iekktloe Control Ptept®.
FOR WATER SUTPLY WELTS ONLY: 16A Mel Sai rive Center.Raleigh,NC 276"-1636
Ile Yield(spin) Rtelhad of dud: 24k.For Water SnpplT d:Injection Welk:
Also suborn ooe coy of this form within 10 days of completion of
I3h.WWnfeailow hpc Amount:_ wdl construction to the cotM been department of the comfy where
constructed
Form GW-1 NonhCmha Depmm¢ .fEm,m,e =d NWaWRewaraes-Dnanaof WWerRearra Mwd A,gmbll1