GW1-2022-05130_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD Fn trAcirm tsSox%:
This form coot be used rai 4agle or rnalliole.wcOs-
f.RVcI1.ClintractorLafarnratiou:
I4;WATER ZONES
Chris Ruffer FROM: O OFSCIRIPTR)\
W01 Con;ra.PrNa"..
4223 A
NC'.Wcll Contractor Conificntiors t fiji i6 i 15.OUTER CASING(Mr muitll-cavil ncI10 OR LiNFR(it a ficabkl
FRONT .1.To DL1tirETER THICKNESS TIATERTAL
SAEDACCO Inc ft' I. R' Ill'
CbxrsPvu}Nana M.INNER CASING OR'TUSING('a)thcrrllat ckr5cd-lon t.
FRONT TO I DMAMTER. Ti[1CKNE5S I AIATMkL
2,Well Construttion Permit n: 0 R. 6 fa 6 •ll. sch 40 PVC
Lirl kil-nppilua6r¢w,ctl permit;;tier.Caunh:..Sttrm;.lrnriancr.113'eCdC4 rrr.:J'
3.Welt T3sc(chccl:MTell use): 17.SCREEN
«'ntcr Supply Well: FROM I TO I DIANIF:TER S1.OTSIM I T171CKNFsS' I SIATRRI,II.
OAgricult0ral L'MunicipaMtblic 16 ft, 6 ft. 6 iri• .026 ss
DGeothemnal(HeidngfCooling Supply) ®Residential Witcr5upply(siDgle) fa f� in•
❑lndushial/Commercial ❑Residential Wow Supply(sbared) 18.GROUT
pp -FRONT TO NIATEIRAL I ENIPLACEINTUNTAIMODSAMIOUNT
01di"ation 0 ft. 3 IG Portland pour
Nan\Safer SupjriF W®IF. r(i
Glhlanitoring WRocnl'ery ._
Injection Wclt: ft. n:
QAgWfcrAccftargc raCmuAdwatcr Rcincdiation t9.SANb1Grt%VEL PACTi tlr a u rl;catstca
'FROM]" 7Ia NIA'rF ltGIL [{N1Fl}ICXAMN'T Nn:TnOU
o8quifcr Storrage and ecoccty ❑Salinity Hama 21 R.. 4 (t. sand 3
❑AgirifcrTest ❑Stomm xtcr ljruiia^c It._ ft.
Al:>�climcntai Tti:i:ltnotl,Sp CJSRhsidcltcc CQ1:txo1 "
20:DRILLING'I G(alueb additional sheets if necessan'l
❑Geothennal(Glused Loop) ❑Trdctr FRONT -70 USCRIP7'I0N roobr.trarduc+i.ardkmtkl.sc,"grahl slorc.dt.1
❑GM(hennal(Heatirtgg030UII2 Mum) ❑O&,r(explain under 921 Retuad;s) f4 ft.
ft. rL
4.Da pided: 2-2 2-2 0 2 2 WdljD#EW-39 See GAP a notes{t
S;f,!8r411 Locathm:
ft. fL a ns w a
Chemours ft. ft. MAY 3 1 Q
Facilit}',Qlvr<rNnnrc Facilityll) (iCapplieo 1c) D, ft.
1248 Bill Sall Rd White Oak, NC 28399 Cumberland C, ft ft, xxar .r .*
White Oak, NC, 28399 P1(titkid'Addizs5.Cj'y-,rndZip '21.REAIARK$
Cumberland 21-16 is a 6in SS sump
Ct1911r .VarcC]t0�nlirC;:dlpn No,,(111.14)
Ccr
:fib.IailiiiticantiI•in de in¢cgaxeslmiitutcslsccomiscirdlximalittgtice:
22: titiratigil:-
(ifti�11r0drl>rrllciU71vr�l++Icrlit:%o1) []
N W lChris. Ruff er 2/22/2022
si�,iuttic�'a('Gcrtilicd 1ve1i C'anrractdr rtalc
6.Is(are),thewell(s): MPerntaneut or ❑ entporary Ur 3ignbly ihas firnv 1 hereby certify tb4.r Me irefJ(s•)was(k-erX)c•qnwbnered ue,aerordunce
u'irh 15A NCAC 02C.0100 or i.SA AVAC 67,02700 Welf r orri"cdon Stamlards and il4t a
7.IN'this a qp airtn an esi.-4ng vcII: ❑S'er- or MNO crPYofrJiis iecnrd lrrisbccn provided iq*..errll mrirar,
PCrhfs la a J�1r'r; if t vraxt ilw trrfl.cexu7nrcilcrn'brjan,'u]link and explain Me-irarara-ojrlre
ax ui�rimirrdr2P.n rCs v ie n aruv xLe hart�ftlrixjorur. 23.Site d141 rani`Orudditional w0l detat
You[uaymse ilii:!rack of Phis N&to provide addi6onat well site.jetails:ar Iriell
S.Kwuber of it ells wtirotrstret�ted 1 construction delails:Ycu.uiay also:atlach additional pages if necessary.
ForairrilaJ�frtrt}�rk�ur�jrra�r-}rYtrirsrgvn[s'rrrl7sL7,�Zi'rrldrrJir.srrxtecolrstrucrlwr,�'nn,e[m S BRiPI"1"A .[NST T .`i'IONS
sa(nrdt was fr'ri a:
9.Tofu wetl lepili belaw land surface 21 (ft.) 24& Fur All Wells. Subfitit, (his fti"mi within 36 days of completion of Kull
FOe-ftf�rlrtrieieells'listv-III tfuaIffo'l'i: Z riaittemmoft-3 OO'and-2@;A!ry C.7nstmctit?rito:thcfoftonina;:
10.Statit ovater level below top of ctasht(,. (ft.) Divisitn.of Witter Rviources,Informatibn Prueersfn;iTniI,
1f1racerlrr.ri!.460v cvrsfraR'case" 1617MiAlServiecCenter}RAkigh,NC-27699=1617
It,Borehole diamctek;10 in (iD) 2ab.Fnr Tnfatinn MAIv,ONLV: In addition to sending the form:to[he address,in
24a'above.also subthira.eopy of this forin within 36 days of'couipletion of wdil
12,Weircoustniction method: Sonic caustnictiou[o tM1f 6Uoddne_
tic.auger.rawaq'.c5blc:.dim=1 Fasli ct�.)
I)(t'istuu of\Vattr Rr'sou roes,TUndet KI crud Gtjectioa Canttvil Pragratit,
FOR WATER SU'PPLI'WELTS ONLY: 1636 hind Service Center,Raleigh;ETC 27699-1636
13.%field(gpni) ,lIcthoil of test 2'fc.For Water Supply&injection Wells:
Also stibaiit dniP.copV of this funii within 30 days:of conloletion of
lair.Disinflxklnn,typ,: _ . __._-. _ Amount: Well coresimctfon'to the county health department of the connivn•licre
cons 1cted.
Form GAr-I Abnh Carolina M-pannueau of Fntirottnlcru and;7anrral Resources—Aivislon ofRratci RI_-autm Rewi%ed August_*If I