GW1-2021-00702_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD F«Ier efusGN<e
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1.Well Contractor lefermadoo:
ILWAT=zown
Brien Ewing n*m 10 ps'Mtu'"ON
Won Cut wior Name fl. FL
4240-B fl. n.
NC Well CawtadOF Ccwificown Naeber
FROM 10 W NRr! MATMAL
0 1 n 1.5a
SAHDACCO Inc NEA Steal
Cwavmt Wow
FROM 1110WITS I TNWKNRffi I MATKR k
L Wall Ceneirtctioe Pernik d: NI0300399 J 70002483 n. IL hL .
fie e!!opplirNdr urU prrnie,(ie.Caw..Seer.V...."h*wsk{rA.J
sm
IL n. lo.
IWen Use Iclier►well.sek
WaterWaterW Supply e*: ►R
10
FROM I TO I wtAMRYEN I Star$= � MATrmAI,
DAB1%vkBral OlNunicipaliptimic 12- It201 IL I.S. 4 NA NA Steel
OGeothnnad IHealing,Coding Sipph Supply(sit,&) n. 'L is
'1 OResideOtial Wafers
❑htdmuiaU mciIL
Comtal OReaideTRial Water Supph IshMedl PlanesTO ]Wmmffaw
AIAFERML GY RMHFUUMT METEOR a AMOLWT
❑hTi n.New-Wmr Supply well:
is.likkedow Well: n.
0AgmfaRechwV octoumwwerRemedialion
V M
❑Afpufes Sloiege and RirOyen' ❑$allipy'Renterfl. n.
❑Agnikr Tess ❑Slonsiwater Ordmge ft is.
OEapethrKotel TwhnoiM' OSubsidenee Carotol _
OGeothemW(Closed Loop) ouwmdAombffbmmmwA
ElTracer norm TE poM11FTIoR CAW,bedoes,wEn<a rw.
OGtathemW(Heau Reason, MOIheTI undctf21Remodsl 0 R. 201 n.
n. n.
4.Date WeBblGmpkld: 1/13/21 Well►Dal B4
n. R.
So.Wen location: IL IL _
Remediation Managaafent Service Company n. n.
Feeding-Uweor Nail F:iln TDa fifspphcbkt R
2650 Shenandoah Ave., Charlotte, NC, 28205 yL
Pys w AAiesa City-and 2p sC
Mecklenburg 12710204 Temporary injection point through DPT tooling ._
Cot. Parts IAeatlleaon No (PRO
Sb.Lodmde and Leustode in degmnlmkmtWsccwwds or darbo d dn"vec 2L Cerdliratlw:
Iif wen ficK t hb1og is sdflcea1
35.210533 N -80.801887 Brun Ewing 1/27/2021
;1 1 5igiesoacmnedwacrosce, Dam
6.1s(aseltiewenlsk ❑Pena n or ETerpwary
Bt.laranr iAu lmn.! eha JAr aria.&!war Iwrrtl,wnw'trd m nr orJmi,r
.A!fA NCAC 02C 010 ur I TA NCAC n2C 1?.W WW1 Cnmrrw Mm Sawkird..,oral dW u
7.Ill this a repair to an lod well: OVta or ICNe �^vMrAi,srrnN Aes brre Prrridrdmar uNl oewrr.
NMI-,eo rrJuor.fiSrw ka,w,wrN,naa+ie ri.w af.m ,adryd+a Ar maFe Mrhr
rrpvr anal&&I?I rnwurkr union or err rAr bale Mm:,fern. 23.Site diagram or st"dral well detail&:
You tar use the back of the page to pmc'tde adelinonel well site details Or well
S.No saber of wells wostracted: 1 conat lion details. Yoe may'also atia:h addiuonM pages d necessan.
For mdeldr,ejn'Mw m nil-uwr wwMr arfle ONLY ueh raw Ear rreslarf(oa.,rw r,w
..bear mu fr w. SUBMIITTAL INSTLCTRINc
f.ToW won depth blow and mrfwee 30 IfLI 24a. Far An WetM Subtal Ihu tam within 10 days of completion of evil
For.,0WJr.rpr list al!MpA,i/Jilyrrrn trranDir iP:M'oaf yQ 100) construetlon to the following-
19.Stedc water Ind below top of eadog 111.1 Dkidea of Wow Ressorees,lEhrmdMw Processing Usk.
O.rou,Aryrl u aAon,eaer.esr-. 1617 Mall Senior Cate.RateW NC 276WI617
11.Borehole diameter l•5' Ile,) 246.F*r lniv.4ieo Wello ONLY: In addiuon to sending ft form m ibe oddre in
24a abm'e. also subsoil a copy of this form within 10 days of compiction of well
I L Well eor.waw melhd: DRIVEN constriction m the follbwing-
0.e.saw.Mille%.Cable.does task act.t
Dimities ofwater Resources.Us& lipowod Injection Cenral Piogam,
FOR WATER SUPPLY W®AS ONLY: 16M Mall Senior Censer.Raleifyi.NC 27699.1636
t3a Vidal(Spot) Method of best: 24c.For Wow Supply i hslood"Wen&:
Also Stibnto one Copy' of this fans within 10 days ofcompletion of
13b.Didefedoo type: _ Annual: well cons auction to the coma%' health depaitmem of the coma%where
Fens GW-I Nonb Cmhr Depmtin-eF of Em(nimeM and AlteW Rea,aces-Dn wile of Wan Mmam M red Auip Xl?