GW1-2021-00706_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD FurlmemlUw ONLY:
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Brian Ewing y
wen coaracm Nano IL It.
4240-B a' R
NC well commotm Catifimem Nmoba
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SAEDACCO Inc 0 a. 12- IL 1.5• W NA Btaal
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12' R. 20' It. 1.5• 4 NA NA Steel
❑Agticuhnrl ❑Mmicipel/PrWic
❑Geed emwl(HeatmglCoohng Supply) ❑Residemel Weller Sappy(am*) e. a. to
OlodmaiaVGmmdcial ❑Renmod won Supply laheMl -ILMile 70 s470W. �MIa[OLLliamsao&AM
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❑Aquifer Recharge ❑Gnuurelaater Rmadialion
❑Aquifer Stange sad Rm mery ❑ ethaily Banter a. R
MAURM
❑Agmfer Tell ❑Snasmum"Dmiaage R IL
❑Elpelimaoad Twhoolos• ❑Subsidmix Control
❑Gemhemml(Closed loop) ❑Tueer noon 70 amtwlrre"tobrAWOMML wdemet •
❑Geothe®I Retain) MOdw templems order 4121 RemAs) 0 IL 20- a.
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4.Date WeM5)Cmmpkkd: 1/12/21 Wdl IDpA4
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Sa.WcH Location: R a.
Reaediatioa Management Service Company R IL -
faeSeyOsaerlaaa Fsdy and(ifsWlemble) IL R
2650 Shenandoah Ave., Charlotte, NC, 28205
Plasid Adem,c Ce).and Zip
Mecklenburg 12710204 Tewporary injection point through DPT tooling
cs"ty Prom eeahtka om No (Pm)
Sk Lagsde tad Lagade In deraeeslmYaMloaeab mr,der msel degrees 22.CertMlntlm:
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35.210533 N -60.801887 W Brian. Ewing 1/27/2021
sgmea ofcessaod wen comror Dine
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.iA 15A NCAC O:C.010,a,I SA NCAC 02C 02M Wed C,wrmrwx.Sine ewdj and A.,a
7.Is tW a repair to Net cxkftg well: ❑Yes of ENS ,.p`nJAi,,rranihwe ryw p nvidrd n dar»rod owwe,
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,.pvir eel,.n_l.e,waA,,..,„w a.ua tlr bm3/Aup... 23.She dirlQam or addlsYsel well dt'We:
You ma)else the back of the pope to pmYide addaoael will fee diteils or well
S.Nmmbee,of wells constructed: 1 mmrmttfon dembk. You may also match additional Pam d stamen.
for waMpk aej v"o,wrw-woe,apph wits ONLF xa h A.amr,mows m.yoa.m
,we.er w.far R IEMFTTAL IN¢T 17rMNC
f.TeW well depth bebw lead eadeoe 30 IR) 24s. 3tr AN Wslh: Submit thin fain within 30 stays of coopMma of well
Fm mabaplr xvlb lib n0 deawhf ifdrdir,enr reraml.fr-aP101'awl:F llYra romtaaclion l0 the farow1w
18.9tWewaterkeelbelea aspotcasleC Me DWkbe of Wow Rewrem letoreallea Praccular Usk.
//xva•.krel b ebo•e.else,. '. 1617 Mall Savi a Ce•tr,Rmk*k NC 2769946 17
II.So dessaft :l•5• qs,l 24b.For Mandate Wells ONLY: In addition to temdate ON fain to the address in
24m abo%c alw whiten a copy of this fora within 30 dayi of completion of well
12.war AemraellM method: DRIVEN ca amicb m to the folbwuag:
ut.ate.merry.d,k.data Pak tic.)
Dh blow.f water Resources.Uader Ile wed heJecWa Gnarl rropu,
YOR W ATER SUPPLY WELLS ONLY: 1636 Mar Senim Ceakr.Raklgh.NC 276"-16M
13a YMd West Metbod of deco; 24c.for Water Supply ells Islamism Welk:
Also snbotit ow my of this forma aithim 30 days of compktion of
13b.BkhJ,dish type: Aware: well Cwmnaalimn to the commy beside depsomrl of the comfy wbac
COrWncled.
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