GW1-2021-00663_Well Construction - GW1_20210203

WELL CONSTRt1 *10NRECORD For lrromlUWOI
The form can tv ,,d for nnek or rmrhipk ue[fs
1.µ'ell COntra(Yor Information:
IL WATER ZONES
Brian Boring ! now to DE54'alrllrN
Well Cartncrrr Nano fl. It,
4240-B ft. fh
NC wFll Commctnr Ccnifnman Nnntar 15.OUTER CASING ffor AmYLoN weEr OR LBYER E ieahk
noN TO PIANETFR TNtt'ANEHS NAT[PiNI
SAEDACCO Inc 0 tt. 12' IL 1 1.5" I.. I NA Steel
('arrprun Non: 16.INNER CASING OR TURING unisolormadc sae L
mom TO DIAMETER THICKNESS MATrmU.
2,Well Construction Permit%: NI0300399; 70002483 fi, fl, k
LurtflulT,/inil.la arallrrmerb r.e(�,mih saran•.t'eriuwr.IryerOo{nir ..__..__
tt. R i
3.Well Use(eland,well Par): IT
Weer Supply Well: no, To 1 mxwrTEn w.or snE nf(1Nni$ I MATERIAL
LIAgrlcuRllral f 11af1mlcipal,Public 12' tt. 20' FL1.5" ra NA NA -. Steel
(lCeothennal INeatinit•Coolmi;Supple-f I lResidenial Water Supph Isingle) fr• h. is
I:I fndustrial+Conimercial I IResidcmtwl Water Supph tsMred1 I&GROUT
mom TO I MATFKW 1 EMPtdCTMENT METIIW a AMOCNT
01migation N. h
Non-WaterSuppn Well: n. h
❑Aquifer Rcctrugc OGmundn;Ner Rcnedi:"ion 19.SANDrrGRAVEL PACK
❑Agnifcr Smragcand Rmmcn ❑Saltnin Rama now To N4Mm41. EMHAITMENT"""On
❑Aquifer Test ❑Sbmmalcr Drainage —
❑ENpcnmcnlalTechnololp ❑Slbsidrnc Ciantral
21k DRILLING LOG a"aei additional dwb M
O(ieodvmul lClosed Loop) oTracer now I 1n IDLN'RIIt10NrWrr,ie4ww.wa'rsh 6r.M[.1
OGoothemml lNealm rC'ouline Return) ®Odor l explain under#21 Retnarksi 0 ft. 20' h
ft. ft.
4.Dale WeBlel CD"Ipkted: 1/13/21 µdl IDa A14
i ft. IL
Sic.µ'JAI 4rclttion: it Jr.
Remediation Management Service Company tl. N.
Fa tin,Cioncr Nam Facto 110 ipspplwablcr
2650 Shenandoah Ave., Charlotte, NC, 28205 ft. tt.
PMscal Addict,C'ih.arrd Zip 21.REMARKS --
Mecklenburg 12710204 Temporary injection point through DPT tooling
t'aa o Paers Idcrrd'Ic*,o.No !PIS I
Sb.lAtiludc and IunXitude in tk•Erecslmilmtcshecoods or decimal degrees: 22 Certification:
Idwdt feM.ram Iallolrg n sWTccml
35.210533 N -80.801887 µ' Brian Ewing 1/27/2021
Stgrwum of Ccrnficd Well Contractor Datc
6.Is larci the wetbsl: -IPermanmt or E!Temporan n r102.1 ,s rh r n..,,,. I b I. rh rrrd' r all, m nrrlor" >rr - e r ,d ,.
[ G nii L H.xoh l,tN(A(' 1.(' OHx,... i5A NCI('n( OhM>Nr7f(r n,fl'a n.m> / r.h unA rlu,rn
7.h[lass a repair to an existing ell: :11'" or KNA ,.r„•'f rill,rr.„,fbu,1'r...........ker..rb .rra.........
I/shin ,erlurn.671�.a Qa�.xnr,rrl..m,rnn n.n reh.1,oerear neJ nrdani rlv,uuwr e(do-
-N-f rrlr.021.rmr,rl,rrobm,rr,.rn mr•h,,l i.,i aril,arr,n. 23.She diagram or additional well details:
You neat use the buck of this page to pmcrde;djaimcrl well site detals or sell.
S.Number of wells constructed: 1 construction tjetaiL You no.,also attach additional pages if rines&m
F,,,,r,uhrMr Wier rear.n a,ur xmr,,oils,rr rh,rALY ram Ov.ran r loremurno, ...u,m,
,ueumrw f,�m,. SUBMITTAL INSTUCTIONS
9.Total"ell depth below laodsurface: 20 IO.1 24a. For All Well s: Submit this fnmi walnn it daps of completion of well
f—..ah,plr l0 hwr n.ul,w 11#i*f construction to the following
ID.Static water Mel below hp of rating: IO.1 Dh isiun of Water Resources,Information Processing I.
n xar,lr.d n.0"n. anr.,x.o,. . 1617 Man Scrilke Ceatcr,Raleigh.N('2 76 99-16 17
11.Borehole diameter. •5" lio.l 24b.For IRjsttion Welk ONLY: In addition to scatting the fool to de address in
24aabose. alw submit a cop} of this fool within 3o dos of completion of well
12.Well construction method: DRIVEN constnrclion to Ile following
n c. satet.os.m.,;ab1c.dims Push m i
Dhislon of Water Resources.Underground Injection Control Program.
FOR WATER SUPPLY µ"FLLS ONLY: 1636 Snail Smice Center.Raleigh.NC 27699-1636
Ina.Yield 24e.For Wafer Supd)&injection Wells:
Utloml _ Method of tract:_ Also submit or* copy of [his form within in dalsofcornpletwoof
13b.Disinfection ape: Amount: well construction to the courin hcabh department of the corm whets
constructed
Fenn GW-I `wrnfi Camluu[Ayannem ofEmlmmrcm and Nawal Resource. Ls,swoof%Acf Rcoucn Ro I"Argust-4-11