GW1-2021-01250_Well Construction - GW1_20210209

N�ELI. CONS1 RUC I ION RKORD rf,-CIINII
P, .I -1 11, I I r .lurk ,JI ,.,A,
1 {Nall C unlrac r I lfomwi ul
Dylan Fierst lNIIM In _ I oF.T Nlyllb\
'Sc111'm-:r:,,:1n\.unc fl. fl. --.-
4507-A
\C 'l ,C I-xim I m n,o, >Inrl,ir IS.OITFR C.ASINC(fir amilitasedwrlla OR 116FR lit anPlwAhk,
FROM TO I nl NfFTFN I TI j(kNFei I \n TTRM
SAEDACCO Inc 0 ft. 6' if, 1• m. SCH-40 PVC
f-.,,,ar:,m NI 111 IE.INNFR('ASISG OR TF$I:N(:IjoR4rmu1 ek,.eJJugn
,- FRONI it) IIL 1IFTfR Tlfl('h\FSi I \(\TI_RnL
R all(I nbuthnn Prl mlt 70002809 WM0301091
1t II
3.Rdl Car lchcal:melt ux•e r--- • ---- — --- —_..
17.S(RFLN -
R'atcrSuppf, Mill: FROM nl 1 RIaMI:TfX flan irr nut'Ia(\s \lan'Xnl.
f1. 16' ft. 1• rn 010 SCE-40 PVC
I I:\>9,.uhwal LlhtuniciµlGPublr 6 � i
IIiCOlhCI0G11fHicrtiny.COplirt:Supphl I12[21QLmIvI\5'OIcr S(IpplT l6in_!{CI —
IlindusVialrConultcralul IIRc<idnl[fal P'.Ror Supph l<hucdl ila.C,ROLT
FR(M_1,) . )I\TFRIV _TF)IPLKTM6TMp110IIA.\1101\T
❑fmsabno it. ft. —
Non%%Ater cupplF R'cll: —
It. fl.
Z%lnnilorfn, ❑Hccm:n
InpaUuo Rill: if R.
1-1 Aqiiltcr Rccharl;c IlfimwRlxmcr P.CnlCdidtinn 112 S.iNO bILNEL P4(klit applkalrkl
rail\I !1 10 1 )1\ti'RI\I. r:]IPL\f l'\p'.\T x1 T1111D
❑Aqui(cr Sn:mgC and Rsman I'1Nnlind}Pamer 4' D. 16' (1. FILTER SAND 20/30
❑Agni(er Tczr ❑SSOnnx:ncr Drrilm_,c — _
❑Fkmn'lli Fcchneloc, ❑SUbsid-Ice Comml 0. i h,
2R,DR IL11NC LOG fanael nl,wi.mal lF.\Y,if srttxnn 1
GOt❑ fkmwl lL'lused Ltmpl UTrkcr FROM I nl I nFSc'Xlrnu\,wa.,R.,nrna.,..ar:.a
❑G.•alhcimal ilicaGne:Cuclile_ Rctun;t 000w,(c\ Utt under 021 Renmrksl 0 D. i 16' n.
-
4.Date 1Vdllsl Culnplctcd: 1/14/2021 \%ill IDa TN-5 --
ft. ft.
5a."ell lamatloll.
Cutter Family Properties, LLC
Fatly,Ch,rrr NRn'w rv-rli l; ID'nRnplk:,Alc±
fl. 11.
Dow Chemical - 6101 Orr Rd., Charlotte, NC, 28213 -
'h,..ical tJJrsc(II,.IN,d Zil.
i 21.RI a1.1RRN I
Mecklenburg 09706202 Temporary 1• PVC well
1'annn Rnvd LlnoLcaliun No WIN,
5h.Latinlde and Lnugitude fit degrer if inutmwemlds m decimal daxrt•cs: +2.(-ertifieaNan:
f d ocl!P.dJ wm LrAlnn_r Ise.dll_a�nl'�.
.__..� R' L��^^"� � 1/15/2021
i;:IW( (C;+In;J t4'c7l lomrnwr [r�;;
6.161Arr)file nclllsl: ❑Permanent ur ,:,.,.
k.
[rl A ( Wi If At'.I, ,114, f a 11-4 r 0,1.,
?.L thl\a rcpail tr of cn.hntl%ell -11ci or 8Nit U
k Jt
......
23.Site diaenm nr additional nail details:
F-,11 uem use Ilk husk of Ails vai.,10 film Id:aJlditioual,cell site d l:uls or neil
R.Numheruf ,Mclfs olm.tmcled: l C1911O0c0un dI!;.,I, YOU nlal :dx)aUAlurddi(Icual ri-"-•as It rcec)scm.
t,.• �,,.r .. ,,,,r.lm .. ..,.,, ,,..,• ....... ......rTCI f ,,.,,.,, srM<r„nurrz<uon ...,...,.
•.,.r .,, ,._ SUIt1113TAh INS'1'U('I IONS
9.Total x lit dcflth helun land alr(ace; 16 _ __ff61 24a. FLr All 11'rlls: Submit thu Ibnn xidall Ill d:n of eonlpl&loll Of Mcll
;:,. r, ., ,i.l,.. .,: Couelmction In due follmin,
I11.Slaha xAill le,el belux lup of casing: ift.) [)IN Wits ul'\iater R i,roes.InfornlAdon F mcessin;!1 nit.
n,,.e,:1..,, , �,„ ,.,...... . .. . 1617 NLtH Nenfee(inICT,Raleigh,S('27699-1617
11.Borehole diameter,2,25• lia) Mi. E.4r a l]Inn 4'•11.ONLY. .0 addition I,semilm;fl,c form to(fw Rddicss III
21;l ab"c. also suhmil a cup, of IN, form mlhiU to dos of a,mplclwn of will
12,"ell"In\t mi'l11 tntMlmd: DRIVEN LOlisl I11Cllorl m Ilk fCRO„In_L•.
(fian.i'Ible JIRCI pnl',fV,
Uir isiun of 1{'aRr Raaourc'cs,Undrr-nmad Injcclfun Cnnrml Pmgralm,
FOR M':%TER SUPPLY 11TL Le ONLI'; 1636 Mail Seniac Canter.RAleigli.NC 27699-I63r,
13a.1'idd IKPn11 \Icthnd of tem: 24r.Fur\\'Ater SuDpb X InJtetiun 1Pellc
-._. Aloe s[illnRl ow <opr of [ills funs xill,111 io (furs Of eomplali.,na(
13b.Disfulectinn Opct Amnon- ,Tell rns Ooomi lu the sour," Ikailh dell:mmeul Of[tic Connn nfc¢
:onslmctcd
F„nit(:11.1 \ralhC�wlue,4T;mn:cnt,d 6n us,m:n1.,Iid l e.,IC14c;oV'Cs lio"Id-1ugirt-oV