GW1-2022-05154_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD Far tar�rru,l u�prim%:
Then-form can b'oscd f1W ifnglc or rnultipk.n•ells
L Weil-Contractor Irtformation:
14.%V%TER`ZONE.S
Chris Ruffer FROM. `TU DFSfRtprtOY
WOIt3prArrrtvrN;im: ft, tt.
4223 A 0. ft.
NCvell Contractor Cell ifrcitioo Nwrli& •15.OUTER CASIFNG f6rc mollltsvcd ictlsF OR LiNER{iT.a i ficabkl
'FROM .w DIAMETER FLRclii1TESS� NT,4TEATAL•
SAEDACCO Inc It.• iL
fnarj.'utY.Nanw Iti.INNER CASING OR T USING entt6erinul etused4w r.
FROM .TD DtANURTER I THIC"ESS I \tATERUL
2.Will Construction 067iit is o ft., 16 ft, 6 _ sch 4o PVC
Idstfrlrapplirahle"dipramltr.fix.Caunha.;S.ndr •lrnrintxr,7f�ecOe+b rtr.:J
ft., fL in,
3.Well.13se(chect wcll tisc7; 17.S('RI:eN.
Water Supply Well: FRONT I-To or:wre:Tr R st.0-TS17: TmCKNF_S5 1•MATRRTAT.
DA,,jrfcultural C1Mun,idipaVFitbAc i6 ft, 26 ff. 6 .020 SS
®Geothermal(Heating/Cooling Supply) OResidential'Mii(er Supply(single) ft.
❑htdustriaUConmtercial 1311esidential I'Vater Supply(shared) 18.GROUT
TO. hrATERL►L' E►rP1 ACTStE\TaiEfr101! AirOLTNT
Elr .-ipn 0 fE. 13 IL Portland Tremei
11Ton�'VatcrSuppIf'4YelE: �. ru
I=37donitodng ®Recover)'
Injection Well:, rL rL.
0Agtiiter'Rechirgo 06ouridt ater Reittediation 19.SANutf:1LLVEL PAC fir a t rheamL)
FRONT To - Ntn•ri;Rrar. RNTPTa+trr;�trsr NTr:ruUn
C1A4nfcrStornge aiTd RCC'ovcl" C)Salinity 13liHef 13 R. 3i If, sand 3
QAt)itifci7'cst- QS(omn}:ItccDrtiii,7jc fe. tt.
QIMNp,crimcnhtl TcelinotQpr 13$65id:ncc Control
-=0.'DRILL1N G10G(attach add itir nal sfreels if rwcescanrl
ElGeothemutt(Closed Loop) ❑Tracer .FRONT T4 DFSCRiPTtO�tcnlar.r.,tntti.,r.a<ta'�rcr< x' �i ,�,:se.l
❑Gc'olla anal(FIeatins?Cooling.Retutn) ❑Oilwu(explain under#21 Rereads) tL iL.
4-21-2022 EW-24 '1
iJt+tcNi'ctl(s)Complctc {Ve111(I)g See cap s notesL ?
;a 1VellLitcathun fl. rL MAY 3 1
Chemours ft. If.
F,,cffity,6vrr,ri4ame Faclilh•ID;r fif;�pplic.•rblc) ft. fL jtT i�ilri€rt�f1 > v.�� RR
viFt. ;
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, R iL
White Oak, NC, 28399 P1tYsralciidtzss Cltg._andZip 21.ItlM1IARICS'
Cumberland 26-31 is a 6in SS sump
Colony Parser]r oOrtciliuu No,fPIN)
.56."fitudc aiid Lonte 'fie in dcgmcs1mfi&utci;/kc'finds of dccim:�l dcjrtccs: 22.Ccriitiwtiotio-
(ifilett t5cld e>tr laylatis;sullk:icrd)
1, WI _Chris_, R_uffer� 4-20-2022
Signium'afCe if:cdWeliCanlractdi Date
6.Is(are,)the ivell(�): ;�Fennanent or. IITemporary- e_ "
• Hr-argnin�.ti.0 Jamr;,l Irercb}•certiJ}•rlraf ihr irrJ!{s•J v(ar{k ere)cuntarurfedur accarrJancr
with l3it iYCAC•02C,f3JA7 or 1 sA NCaIC O:,rC;91PC}lt+'tl CoiratnecNoat Staradarcrr!nrrl tla!ifn
.Is 2hbi a r5pair o an_eAsting`vell: Ct}im .iir ENO crliso}tJits rrcorrf ldas b�rn'ararirkr(ra ifte If dt mrirrr.
��ns�a rrsur7r fill e�it,kTra+M1w tt�rll�cvr„u7nmicata�rJ'arrurrrl�Nr ar�ui!ea;{t?afarlFu.ar��ra�.tajrfia
a e m rrtzrrler3�31 irrniatdsa icon zrtcu Brie b iL a}tldsJarnr. 23.Site:dblgrantor.additioual well details:
You niay 11044e back of this ixi&.tdproxiide additional well site.details.or will
8.Numberof itells constructed: 1 construction deiails: You ma}'also:attach additional pages if nrcesseg•.
Fire areitlla�e ir`pctir,4ui_e*r rr��i-uuu r.x>iRrJ,s tri�rls i?,4'L}'midi rli,�.srrmr construltiar,}taaa cYttr
.catavrdtaan:)orn. SUBMITTALiNST T(IONS.
9.Total well depth below land surface. 31 (n,) 24a. For All.%Villst "Subtitit Ilds Taunt within 36 days of rompleli0ti-of liell
For JrraMplei''ais stvP4r&ffd''*vrt'art con5tntcti0rito the foltonifig;
Ill.Static water level b'elow top of casiitt t- (ft) Dii•iSEoa of Water Resou rcm Infttrmntion Praiiessing Unit,
if waiet level lr allore raskg;am"+" 1617 AIAH Service Center,R tleirh,YC 276994617
11.Borehole diameter,l0 in (in.) tab.Fnr tnfeefind Wella ONLY: In addition to sending the form to the address in
24a above,also sibrait a copy of this form within 30 days'of completion,of wall
12.Weli'mustruction method,- Sonic construe lot I rill,iollowijlg:
6x.z *ar.A itup;:cabic`direr[gush ctc.)
Dtr islou of K'ater Resourccl,Underground fnjccilon Control Vrogram,
FOR WATERSU'PPLY WELLS ONLY: 1636 Mall Service Center.Raleigh.WC 276934636
13a,Yield(; 24c.For Water Stipply&inicction Wells:
p mpftct: Also subrilit aue 6py of this foil; within 30 1 days of completion of
1311%Disinfrtik un type: Amount: well cattstiucrion to the county hcWth department of fhd-t utrrrh'.wltctp
co'Ktnictcd.
Forth GAG-1 Noah Carolhm ticpannttnt of Emirormmm and�Iarural Rewutas-Divi;lon of R'utcr Re_eptrces Revised August 2tt13