GW1-2021-00709_Well Construction - GW1_20210203

WELL CONSTRUCTION WORD F«I.�mmuxmnv
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1.Well Coal Kot Worratloc
Brian Ewing pp�y
wen Coatacw Nam R R.
4240-B R R.
NC Well Comamr Codrotiot Number
PROM 10 7MMlDelm MAlA1pL
BAEDACCO Inc 0 IL 12' (L 1.5• 6L NA Steel
Coupe"Naoe
ROM I MATERIAL
LWen CenMrwctbapermkp: N103003991 70002463 k. ft 4
lid all gq rabk cell p,•ata fu.Comm.Saar.Variawrr.dpadat etl
k L hr.
>.Wen Use(ebwk well we):
Oft=drwal ❑ C 22' k. 20' L::...1.5• as MA NA Steel
OGMtkille(NedirlglCoohng Supply) 0Resi&49W Waver Supply(sinslo k' 6 Ia
❑hdowavc0mmercid ORank"Wow sopply(Show) -
ROM to MATEm.LL I ETTIW AMOM
❑tii R (L
NOWWakr Sappy well: R. It
0movolonas ❑Baca
lojecdon Wen: k R,
❑Aquifer Recloup OGmmdatow Ramodutton
OAqutkr Stooge and Rae v) OSalwy 9Mrier R k
❑Agorkr TNd ostormwrer DAOFAF R IL
❑EVa:epeoal Tchnologr ❑SubsW%oa Comm) _
OGeothmad(Cksotl Loop) OTaecar .YTamT to .s®[7•nnDu wWnN"
❑Geo mat OloottvCooft Remo) MOdw japhas ander 621 Remada) 0 R 20- (L
k R
4.Dwee Wdkj)Cempkoed: 1/13/21 Won[D#AI0
R R
So.Wen Loearioc (L rL
Remediation Management Servica Com2any w. k
FrdaylOwc Nap Fwft mr(if w1sm6k) R k
2650 Shenandoah Ave., Charlotte, NC, 28205 R IL
P*=W Adhere City.rd Zq
Mecklenburg 12710204 Temporary injection point through DPT tooling
Cwmy Paaetl I6nMB:MM ONO.(PIN)
Sk LaakMn awd' gid la depealriwskw's cant w dmbW depsec 2L CerTlMtlon:
Ideea tklL oae hglaeg n sdikkall -) n
35.210533 p -80.801887
�`G x. J Zw2 Brian Ewing 1/27/2021
sie�o(CCROWWadi Cerrew Dne
6.Is(ari)tW wel(a): oRrmsnewt or ETtrperary
A aiAu,ar,hi,fonx.1 M,ebr rerr¢v Mal Nr xegfrl w,Ixertl ay.rrarred ur mwoNmrar
wrt 1 Se NCAC 02C.0100«IM NCAC WC 020P Writ C,..mraiar SamAwds and dw a
7.h dds a rgWr m as esMog well: OVa or MN* ,api Mduaw dto been P-n*W m Aw Mlaxvr,.
It"u o npd,.fig for baxw xrn,mwo r em mformOom and rapffm Mr mm,,of Mr
.qm;.radr,rl.,.art+,r e.r a,.a Me bra ofw.)b.. 23.Ske diagram or aidlllswal well deWe
You away use the belt of be Pogo to pmYide aMMonol well see dotals«well
k No bes of wens mwwerew: 1 rnaetnwiioa desk. Yogi a" each sladood pugs if neceswy.
F.r .Mpk rjeatlan ur new-xawr aerh writ,ONLY 4WA r&rave aeaaaerrkr.ww r,w
.werdr xwe p•,m, s IRM17TAL INCT MONe
f.ToW well depth belaa land Meals= 20 (R) 24s. Par AN Wells: Sa6mk the foam wkhln 30 days of comWimon of well
For axdupk writ,gnag drlel0 lfd*d (r.0ampfr-30700'uM 20 1(vi concaucdon 10 the folowir6
10.Stok wow intl balm top of eulsC IRI Dhbba of Wow Remsomm hdolmdlsw Pnenrwg Usk.
1/xam,kavf b above amanR.ax"a' 1617 MOB$mine CnwW,Raleigh.NC 276f9-1617
11.11 dhremw:l.5• (h.l 24►.Far lekedew Wells ONLY: to addition to mat!"the term On the ukhoss in
24a abay. also wtbmn a cape of the form wkhm 30 days of couspidioo of evil
IL Wes ameMwadlsn n d.L. DRIVEN conuncdoo to the follow".
6e.nopm owmy.cable.d to prk act
Db•Wew of WwTr Reowetvs,UTdwpwnN InJeeWn CowRl rTapRm.
FOR WATER SUPPLY WELLS ONLY: 16M Mal Smiee CeoMr.Ralkigh,NC 276ff-I6M
13a.Y10(gpm) Method of em 24n.For Water Supply!hdaaion Wens:
Also Ti I i one copy of*m form wilhm 30 dnys of cooWldioe of
I.N.DkldrWa Mm Amww: Yndl aware Cbm to the a:outa_y kakh depnemeol of Iha cvmly what:
conmaaMd
Foam GW-1 Noah Coates Dgmamaa of Emamamm W Nrmai Romano-Dnsba of Warr Rrtua6 Rn'ard A1rpw 2011