GW1-2022-05142_Well Construction - GW1_20220531

WELL CONSTRUCTION LION iZECORD For lutcnail Elsa QNLT:
This ford can be uscd.fiir single at multiple wcfls•
]'.bVclt"Cantlactnr I1rYtlrrnation:
I.r:INI'MR'LONI I;
Chris Ruffer FIrO,Nt: 7U UiUHtt't It1N
WC11�>'arriGl{tar h(%1mL' (t. ft,
4223 A ft. fL
NC.Wcll Contractor Ccriificmiant umbel 15.OUTER CASLNG Mir'mutti-riled%sells,0R LINER fit"a,1►leabkl
FRONT I To. I)MMETER. TIIrct;zFss NIATEHrAL
SAEDACCO Inc It., f►. in.
f crarrlrui}hanw. MINNER CASING OR TUBING(•eothCnnaI c1w;vd-IMI)
FRONT TO DUMETER.. TIIIMNESS ATATERL1L
2,wol Construction l'crniit#: 0 ft. 60 ft. 6 ,SL, sch 40 PVC
fill 4rllrrlyilirnhJc rsrll jWniiltr(ix.Count%;5Mvel,1radaure,lryac cta«rr:J ft. ft. "iir
3.'Wclt Use(Check.weltuse): 17.SCREEN
Water Solrplr,Well: FROM [ TO DrAME.TF,R SLOTSIM THICKMN-5 -NIATRR1At,.
�7rlgri€utftirat t 1Nti aicipal tlb(ie so ft, 70 n. 6 iR• .02o ss
®Geotheiriial(ETeatinglCooliug Supply) ®Residential IV-Liter Supply(single) ft. N ft.
❑hidustrialJConiniercial ®Residential WaterSupph,(stlilred) is.GROUT
FRONT - TO ALITEHTAT E1[PLACENTEVT NTL'iIIOD S,1N10DNT
❑Trri'atina 0 ft. 54 fL Portland Tremei
NanWater Supply.Well:
❑tvtanitorin� �R�atirg. rt. fL
InJeeth�u}Nell:; rL fL
04t)ttifer Rccfiarge bdGiolindmalcr lIcnicdiatiou 19.SAND1(:R gVEL i ACK'Gf ai 111calite)
❑, iilidfcr.Siorjg6 and lfc6vcry ❑Salinity 13arrice 'FROM, TQ NUt'rr;Hrnl, EtMP1 X[il1I:VT NrtTFit)r!
57 ft,. 75 fl, Sand 3
❑Agnifer Test ❑sto n atCr Dr,,i'n-1gc ft. ft.
171:ypedmcnlal T�hnotelgy Asttbsidcnc4 col tm,I
41.'IIRILIA NG LOG imach addiftonia'l sheds if trecessaryl
❑Cr�otltcnrral.(Clgsedlioop� ❑Tracer .FRONT To DFSCIuenO\ft*,ivnhtnt�icr,�dr'nrcFN rirpctrl
❑Geotliennal(TTeatijt,)CooliugReturn) ❑Other("phdr►under#21Retnails) ft. fL
(L
#.Aate_FF`cU(s)Gompleted. {Val7D#EW-26 See Grp s noteyt
ta.►4'eII,LIICattlt0: f[. fLMAY _
Chemours ft, fL
Facilit}•,'Cin'ncrNunlc FacildyIDNtifappilcribla)
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C,
White Oak, NC, 28399 PlnaxaBAiidics Cat}..:mdEip 2LRlM1L\RKti
Cumberland 70-75 is a 6in SS sump
coor4y }wive 1&et0rtcltian No,(PIRA)
:5h,I ttitutic aliil I.qn tittle,in,tic�ttics/rninutcsl3cconds nr dccim:d ftprecs: 22.4crtifeatioa:
(lluvltltit gin i:rtlur;dsrrtt;tic:ri)
N « Chris, R_ uffer- 4-25-2022
W SiotuttrrrofCe¢ified ell ccn(Mucir Date
6.TS(arc)the 3iiPl'ttttatte[lt or, L]TLniporary'.. !Jy-gning this'fopri,1 lrer by rcr.'tifi•that Me irefl{s)way(i rref cuniirruerrd in accordRnrc
ivi:h 15A NC1002C,Af(k?or.l fA NCA 02C, 209 M111 Coitatrracrlon Sfarrdar4s and rlairr a
7.Lv i iN a reliaic to an esi4tinj Nvell: E]Yes or ZiNu 'rofir qj Arts recoiV bay b-en Pilor ldrrl meJicr,
tl'n'tls`ds,n re{�rlr,fall t�tr krae,irw url!ceNasrnrrtl<}tl irrjprr'irrlr�ar rmd rcti%J;rFn rJir nrrnrc of true
repairtrmltrgil rravurl.�:tit ci"attxi the bus•$erthis farvr. 23.Site diagram or additional well details:
You'"y-use tllg bacl:'of this page.tcf,Vrol7de additional well site.deta6or xieu
8.Nnti lrt:rof isells to trueti:d: 1 colrsimcdolr deiaits' I'ou.inag;tt ;riilaclrudditicriuri pag<` if tt;ccssary-
For riitilrtlale n(A.-sotrar sr,,pAs ivOfs ONLY wirli dle-mme eotrstrrrirlmr,-yo cw?
,ca viitrr✓a-,iSrrta. SUBNTiTTALtMIXTTONS
9.Tof ileycll:delKlt beta)[land sltrfaCw 75 24a. Pat-All Wells; Snhridt Ads fo'ml within 36 days of completion of si'ell
Fi,ran:rinPJe�tieBP'lrxiarPJ,freul�rtltJ((irrrtrtt.Ymrpfr-:�e.(1I1'atkfcQ�'Jl�d7� con(hictiontothefolloijing;:
Ili.Static water level lrclutt'top of casing: ([t;I Division of Water Resource t,lnformatirin E'trit essin�Qnft,
!f warr'r 1e^qdJ is shore cwaitr#tusk"+" l617'Mail Service Cotter,IL•llcirh,NC 2i699-1617
1L Borehole diameter:10 in (1�) 24b-Eq_rjj0Mt ,ll 9Ni1': Tn addition to sending the fomi to the address in
24aabo�,e. also subruit a copy of this.fortn within 30 days'of completion of well
12.Well Construction method: Sonic collstniction to the fouolt'ilte:
(6: .auger.rodarp,cable direct posh ctc.)
Division of Water Resources,Underground lnjeeaon ContM Program,
FOR WATER SUPPi,Y WELLS ONLY: d636 Mail Service Center;Raleigh;YC 27699-1636
13a >i'ield(gpm)
�lettuod Rf test 24c.For Water Supply&In mtfdn�Nells-
ALSO sublilit one copy.of this for i within 30 days of Completion of
131r ilisinfiYtian typal: Amount well construction to the,calmly ficallh dcpartrncnt oC ihc'cormh•where.
constructed.
Fo rn>G1V-1 North Carolina Depsnruenr of Envimmmitt and;lartwal Resources-Division of IVaicrRmuutM Revised Aug=_V 13