GW1-2021-00693_Well Construction - GW1_20210203

N ELL CONSTRUCTION RECORD F,,0m,alI ceONIS
Thn f m,can h,. d f sinpk nr rndnpk omit.
1.hell Contractor Information:
IL N'ATER TANGS
Brian Rwing FROM 10 D"Airlifts
A III( Innalnr N,.iI ft. to.
4240-B ft. ff.
N( All]l I cmfwahoo Nnmhcf 15.OUTER CASING foe arkkawd wells,
eb OR IYLR Scahle
rRON TO P141IFTFR TMLII-1 MATTRIAI
SABDACCO Inc 0 It. 11' ft. 1 1.5• I.. I NA Steel
I... ,,,.n,r,. Ill INNER CASING OR n BING_gLaK Acl*r4+!a-p) __.____-. _
UL MFTFR TIIIC►SINS Moon At
2.Well('aDMtVctlo n Permit a: wi0300399; 70002483 FROM rt TO. h. ..
1111 ,yy/u u6L•nYli;o-:mi:+�,,.t�•wm. f:rz:�lamer fryeroaL n, . _. ___
if. n.
3.14 ell Use(chcrL well ow): 17.SCREEN -
1A Ater Supply N'ell: moM TO DUMAtFa MOT,vF ful"N'S, M% VIAI.
t.;AaumuOural IJhhu)kip:d;Ttbhc 11 ft. 19' & 1.5• w NAIi NA Steel
I IGcothemlal(IleaungCoolinc Supph I I Ille",nlmi Rater Supph I,indci ft. ft I`
1111dustrlakConrowicial I(Residential Walcr Supph nsharcdl It GROGT
1 FROM TO MATFRLAI. x.urLA(TMFNTMFT1HODAAMOL'N7
❑Irrigation n. ft.
Ron-Water Supph Well: h. n.
❑hlonitonng ❑Rccoccrs _
Injection Welly ft. n.
fl Aquifer Recharge FJCmundwater Remahanon 19.SANDlGRAVEL PAI' t!MKItk---- - -- - --
moM To ATFinan. rwn.A(nfrNT MrTmsn
r:,Agunfcr Slnrngc old R¢men n!,ahnin Ramcr
❑.•Aquifer Tcst ❑Slomawaler Drainage
❑Eq)cnmcmal Tcchrnbg) ❑Sobstdcrice Conml
Ia DRILLIRG LOG launch addiewd steals it secomer,
11Geothemml4Closed Loopl ❑Tracer mom TO 0n. HFTION,t.►..s.raww.o'a"win er.ea-,
OGcothennal abnR'C(mline Rctuno ®OIIaT(r%piam under a21 Rcinmaksl 0 n. 19' n.
ff. n.
4.Date Wrnt,I Completed: 1i15i21 Well IDAA25
n. n.
SL Nell LAwatirm:
Remediation Management Service Company ti. f6 �1
F.arb6 p.W,Mary F.A. ID:„fafglicahlcl )
ff. ff.
2650 Shenandoah Ave_ Charlotte, NC, 28205 �- fa h -
Plnswal oldies,On, and Zp 21 R[MARRS
Mecklenburg 12710204 1Temporary injection point through DPT tooling
C„wn P,ncl ldin,fcllN.4n I PIN I
Sh.Latitude and Innritude in(letlecs/mimltes/seeoods or decimal degrees: 22.Certification:
ul odl faW m.l:rblmp u.,dllCmm�
35.210533 N _80.80I887 ., �� Brian Ewing 1,27,2D21
Sigmmrc OCcm6cd Wcll Cmneicw lute
6.B lard the wellw: _Permanrnt or E'Temperan n
R, :hn f,•,m I n „h, , only rh,n J,r ndh,:,. r ..•. rmrre:r ,nl.mu
NC a( PC nhY.., Ill \I I( ."( ""I'It". !_.u.n.• n.m Snu.Lud,.eel Jre.,
7.V this a repair to an existing well: --!In
n r SNo .•rn,t rw.,.:.,nYb,:,l+,.nm,t r..s, .n11.,..,,,
J"b............. M1li a,r:,. .n.a4.•,,,.,u,n. .nipnrr�.c.0 i„J. ,n rlv n,.non.,I roe
23.Site diagram ar additional well detail,:
Yon nw, use the back of IN,pace to pro,nfic adlh0on l well site details or cell
M.Number of welly constructed: 1 iU1nItIKYlUr1 details. )'on marl also attach additional pages it ncces,:In
{ .,m,hnar ,n�an„a .ern upr ,r'J•I)A/l nrtn nv vwr tartW.aMw _.,,..,,, c(Bw1rA1 INST ',cnoNe
9.Total well depth below land surface. 19 (D.) 24a. For All N'cll,: S A nal (his loon Mllhui III dJts of completion of well
1. m 1,4,..,7,u,r,.11 J, ,h, 1.`Fur u.u1`w i.u:, construction to the rollotNgG
10.Static water Intl below rap of ca,ing: (O.) Dit'l,i)11 of%Ater Resau Fees,Information Pr ienaing I nit.
1,..�:r.1c.rl:.,d„•,r.,:.:ne ,., . 1617 NIAR Service('enter,Raleigh.NC 27699-1617
11.Borehole diameter.1.5 (in) 24b.For Inkyllon Well ON I.I': In addition to sending the form to the addn`Ss fit
24aabote. also submit a cop) of the, form whhm IO dais of Completion of hell
11.Well ,nMrnetion method; DRIVEN :unnrnKlnun to Ill(ulluxunR
o c ,nor.rNan,cahl,d,rccn push m i
Dhislon of Water ReMgrre,.I.o&rpuund Injection Confetti Program.
FOR WATER St PPLI 11-FILLS ONLI': 1636 Mail Smicr Center.Raleigh.NC 27699-1636
I Ja.1"icld(Elmo Method of test: 24c.Forll'atct Supph A,Injection Wells:
Also sobnnl one CopN of this form %whin 10 da,sofcomplettonof
I3b.Disinfection hpe: Amount. well construction to the Counn health department of the c0nm whom
Comtmcicd
Form(,%-1 N,mLl,mluu 0.p,nnwm of ion mnurrm nd Nmunl µcsowcc+ Un nsw nl N,ra R(3aut6 µc.,sad A(gaR 2411,