GW1-2021-00692_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD Fw lMenal Use ONLY.
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SARDACCO Inc 0 IL 11- (L 1.5• 6L BA Steel
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❑AQuifa Recharge ❑Geamdwala Remedidton _.
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4.Date WeR(a)Caarpkaed• 1/15/21 Wdi IDOD7 R h.
Sa.Well loeadm. ti It
Remediation Management Service Compary It d
Foedmi ADwser Nsme Fcday Me(ifspplemblel b K
2650 Shenandoah Ave., Charlotte, MC, 28205 IL ,
PWSK'W ATheea C10.and Zip
Mecklenburg 12710204 Temporary injection Point through DPT tooling
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Ste.Loam*ad 4agedt in dgpwlmkmftsl mb er decimal dares 2L Certification:
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35.210533 N -80.801887 W .-. Bria.n. Ewing . _ 1/27/2021. .
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WO 15A NCAC 02C.0100 w l SA NCAC RTC.02M Well Cmemw me Smederds wid Aw e
7.Is Uda a repair to an eslWg well: OVer err WNe Top?Mori•rirnMMe Brew provided m der wWf awvr.
ff"its rcpWr,Jln mu for ww svf/.wearwna,e mjae•eeleaw aed esp(em 1Ae pewee M dw
.epvir.Me.cal nmer4r.e.v:w.err u dr bma of +h••• 23.She dIMl m or aNhmW well derma:
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S.Number of wel4 emunumd: 1 con MR) we
demik. You rely mchmtdeaddtloW wdlegesti. or well
my also Much addtlaad pages it necosary.
Fw wdwpk i4nrNon w wrm-wmrr upph wvfb ONLY wsA me rner rreMww(ee.ww.w
awswu Use fona ¢IIRMITTAI.IX¢TII['12I3N¢
9.Total weR delwb bekw lmd mrfwc 19 (tL) 24s. fw AN Welk: Sit tin loom wuldn 30 deys of rnmplpice of well
For mablple weflsale allkphr ffdff,"m fremwpfr J02m'mefT9 l(W) owAMMOOM to tin fDlbwiwg
14.Snde water level below top of tadmc IR.) Disi ea err Wmer Ramiro.bdWmmim prataalq Unit.
ywewr kw.d s alwr ewwe ww-'�" 1617 Mai Seniee Chatter.Ralt4814 NC 27699-1617
11.Rereiate diameter:!•5• for,) 24b.Per Imlmliem Wells ONLY: In addition m sculling the form to the addlaa in
Its above. also wlI it a copy 4r this Tom within AO days of completion of well
IL Well construction metbad:DRn'®T coagrxd m m the fdbw*-
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Dlsitem of WMcr Reserves,Umdwpmed Im*den Central Propi m.
FOR WATER SUPPLV WELLS ONLY: 1626 MA Sarke Coma.Rd dg%.NC 276"-1636
t3a.Vidd Wml Megmd of am 2dt.For Water Saaah k lamoska Wells:
Also aabmk our copy of this form widim 30 doys of eoo*ktion of
lA.DtanderWa type --___ Ammar. --- well to the coanly horns department of the comfy what
Per.Gw•1 Nina Camtr Dapenser ofFAneeee,m�a err NrmRem.oea-Iksmb ofwmn homros Maid A�gBml)