GW1-2021-00675_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD For Load Um ONLY
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1.Well CeotraMr laftnuadec
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Brian Being M ORKvjrmN
Well Commnor Wee FL 0.
4240-B
NC well Com a for Cendkwee Number
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SARDACCO Inc 0 tL 12' ft 1.5• to. NA Steel
Congeal Naas:
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L Well Cealttnctba Pernk a: N103003991 70002483 0. FL 4
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0. 0. 4
3.Well Us(clued(well Star):
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Waser supply Well: Mom To MATtu4L
❑AgKultund ❑MMKVd/pumc 32' 0. 20' 0. 1.5• a lU N71 Stool
OGeodlemW(Hen inyCaolilg Supply) ❑ReadewiY Water Supply(sW*) 0. 0. a
❑btdnoeVCarmlwrcial ❑Raideantl Weer Supply(shMed) JL
mom I TO I MAmlL I-nV1%ACItRN7ME1N0DaAM00RP
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❑Atpula Test ❑stomma rUwtempe tt 0.
❑Geothermal(Closed loop) ❑Tear "Wet To
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❑Gew6emn( Result) 1130du r loplam ada ell Remad,) 0 n. 20- 0.
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Remediation Management service Company Is. 0.
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2650 Shenandoah Ave., Charlotte, NC, 28205 0. 0.
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Mecklenburg 12710204 Temporary injection Point through DPT tooling
Comm, Pend Wahrl alion No.(PIN)
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35.210533 N -80.801867 W Brian Ewing 1/27/2021
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IL Number of web constructed: 1 cowlrucfiae duoib. You may also aaach additional pasta d am asmy.
For wwdnpk atleeram w new-wmrr uVph welt ONLY wA de uorr teaew dxv We ea
e.b~m.f.mr C 7BMITfA 1.INST 1CTIONS
9.TeW well depth below lood nrfeoc 20 (B.) 24a. For AN Walla: Submit this farm wkhm 30 des of compiolum of"it
For wdn,k weer lie w0 depdu gdt)reeem feeweple-I0100 ad 1P Iwrl comaniction to the folbwitg-
I!.State wib level belt lop McWam IRI Dh'Noa of W'attr Rarrres.Werau- protrudes Usk,
I/»uwr(curl u droer�wunr.ww'y 1617 Mae Slane Cab.Rddbl,NC 27699-1617
tl.Bwdwlc dinwtrr:l-5• 010 241s.For Mordent Wdls ONLY: In aMbon a song the form to the addteu in
24o abm e. also submit a copy of this form wkhio 30 doi of completion of well
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FOR WATER SURLY WEt.tS ONLY: 167E Mae Servke Center.Rddgb,NC 27699-I6A
13s,Yidd(gpo) Method of few 24c.For Web Supply R 61atlon Wdb:
Alto submit one copy of the farm within 3()days ofcon*ldion of
l30.DWsfaWu type:____. __ Annual:_ _ well commuclioo to the cowry health deposmus of the many*hoc
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Form GW-1 NonhCmlma Dtprtoem of Fmoo eem are Novel Romems-DhaWaofWab Rmuaes Rerred ALVO1013