GW1-2021-00691_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD FortMonalUwUNLY
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1.Wen Contractor ImfmrRedeo:
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Brian living - M 70
Well Coamaa Na" It It
4240-B a a
NC Weft Com motor Cemmcams Morena
FWM OIAaI[7Q 71Ia[KP[!m 74A7LTWL
SARDACCO Inc 0 A. 11' IL 1.5• hL NA Steel
Contain Name
FROM TO 7711rgra24 1 MATTRU.
L Well Coast 0Pei h. N103003991 70002483 a h. fit.
Lu ell apperddr ae0pawem li<.Cauey.Say.Varwrr.i�eylef ex.l
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3.Well Use(ebwk well sme)c
Water Supply Well: I PLAN. to MATINAL
❑Agricukmd ❑MuaicipVRdrlic 11' It 19' a 1.5• la NA MA Stool
OGW#Kfmw(Hating,Cookig;Sapph'I Ones ilroid Water Slgph(single) a a
10.
❑kdufaiaUCommrcial OResidenml Water Ssppl)island) FaOM TO MATUML I RNPtACtMRXTM[IBOn AMODNr
❑bri a a
Nan-Wars Supply Wen:
It a
❑ ❑ReTwa
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❑Aquifer Recharge ❑Gmmdwater Remadiatim
❑Aprils Storage ad Recmvn ❑Salinity Barrkr a a
❑Aquifer Tess ❑Sermwates Dro mge a a
❑6gMrimW Twhoolog' ❑Ssbadom co mi
❑Gemher®I ICIOred Loop) ❑TISM FROM TO pSOCFJF OR 1914,111104mok navwk WIL
❑C"&M l Revue) ®Other 4explahm coder#21 Remaaks) 0 a 19' a
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4.Date W'e*s)Cw,pkwd: 1/15/21 WORIDpB3 a a
Set.Well Intadoa: a a
Remediation Management Service Company a a
FsaM)AMAwa Nmr Fw dot 00(if appbubk) a It
2650 Shenandoah Ave., Charlotte, NC, 28205 0. a
Pbsld Adbm Ct*.and Zip
Mecklenburg 12710204 Temporary injection point through DPT tooling
Co+p Ps"IdelWiason No.(Pa)
Sk Latimile and Wgltude in dgpeeslmmuoealsaoeb or decimal degrees:
("CH Anti nee la!"a wlkrem u-Ce'Wltadow:
35.210533 N 60.801887 W Brian. wing 1/27/2021
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6.41arel eke weUUY. ❑Mm pnq'meut or OTear `U v ;� er,:aaa'a yak fo.w.I server re rsQs'dins rAr xrM.!are I.rrml r.arlrrrrrd a arwdm.rc
auk I3A NCAC OTC.OIM w 15A NCAC 02C 0200 Wr0 Cawnm non Smadards and Aw.a
7.Is thin a repair to an esidus well: ❑Ya or ®Net r qy Jdri.rrrrrMW Fnea prr,rded a.dv.MI m.w..
Ifdrk a.a repute.All err teoaa aWl romrnrra,r wfomewpn and rapiaM Far rehire of A,
relax,odes nl,..e.;a bai Jab firm. 23.Site dfapam or additional well detdI:
Yon tin)'use the bark of this page 10 pw%ide adthDoml evil site dam is or Well
S.Noarber of wells ewessratted: 1 construction detail. You on)also which additional page if en:asan.
For ralopk mjnlMn w non-scar snpph aelh ONLY.,,A I&sever ea wwsim wr.tar
.alas wet fb... SUBM TTA1.INST ICTRONS
9.Told well depth below toed mrf a 19 /R.l 24a. For AN Wet Submit this fans union W dns of complain of well
For.wk/pie velhhoothkprbrlfdl$rrea rrv.npk-i0200 and TCa I011•) 000l000n 10 the fogawiog
1e.Sadie waver kad bylaw cop of ewhav Ia) Dhiske a(Wow Rasartm lufiemMioe Processing Unit.
If aawr krrl a rimer r urea.u.r"+" 1617 Mel Sm'ke Cram.Rakish.NC 276WI617
11.Bwdwk diameter.!•5• fie.) 24b.For IolMaea Wells ONLY: In addition to seeding the fain m the addiers in
24o above. also wheat a cop) of this form within 10 dial Of compklion of well
IL Well MutrKd m emihN: DRrVZN construction to the following.
o e.eager.rosary.ubk drrea peak M)
Dh'YYm of W'amr Resources.Usder gain ed bojectin Control program,
FOR WATER SUPPLY WELLS ONLY: 16M had Smite CeuMr.Rddgh.NC 276"-1ilt
Ola.Yidd(spin) Method ofmse 24c.For Wake Supply k Islamism Welk:
Also submit one copy of this foem within 30 days of complains of
13b.Dhifrctles type_ Aewnt: well comhnclion to the cumay health department of the coon whew:
—_ corsuurtd.
Fans GW-1 Wish Carina Dapmoeml of Em Oom as ad NmrW Amomcs-Damon of Walt Rex rem Mead Aaglm 201.1