GW1-2022-05162_Well Construction - GW1_20220531

WELL CONSTRUC CON RECORD For Ictontal ilsc 01It':
This formcan ba used.kiifagleai multip3q wells
1.Well.Cautraetorlufartuation:
Chris Ruffer FROM To Dr•-GRrt=rtaN
wol6rxmclarMama, ft• N.
4223 A
ft. fr, I
NC Well Cantmctor Ccnif ditl6o Nunticr iS:OUTER CASING(for niti lti-vaW-40 rscflc}OR-LiNFR I Ii'e alcabk)
F'ROAI TO Ot�Li6E.TEit TDICtMNE$S AI,4TERTAL
SAEDACCO Inc fit ft ''in.
Cfirirli tnj'Name W.-INNER CASING OR T17BING'1_uco thermal d a Ld-hw't
FROM TO DUMETEit- TUICANM I AIATMUL,
2,well C6nstr'ut:tirinPermit#: 0 ft. 50 ft. 1 "im Sch 40 Pvc
Lis(dril crgiticnbJe xell'pr."units(r:r..Cnunh,.:,Strrlr;Ynriarrr,l�'�ti(�rtr..J
rt. ft.
3,Wc1l;l3sc(chcclt.►xe11 rise:: t7:SCRI:KM
�VatcrSupply Well; FRosr. I TO DrA,rt,,rrR sl.artirn: TR(CKNFS$ I MATRRM.
f�Agrieul[nrai t ilviunicipaUPliblic so A, 60 ft. 1' ii .610 Sch 46 + PVC
Maothemral f cadog/Cooliog Supply) dResidential Watcr Supply(sin`.fe) ft. ft. irk l
❑Tndustrialfconlntercial EiResidcntial Ai'0ter-Supply(slmr d) FRO ROUT .TO AfAT6RW: E,[PLICEAIEVTh16i110D l'A\rOLtNT
❑Irrigation 0 It. 44 ft. Portland Tremei
Non-Water Supply Well:
phtonitoring. Mccoti-cry
h1jecliOn Well: ft. rc
f7ARuifcrRcchirge SdC;roulidtjntcrRentOiation t4.5:►ND;Gw+►'eLr►C1iGraitticatfts)
'KROM 7C) ,t1• MAI. KSIPIACr UFAT MU110n
❑Atinifcr Stomsc aiid Rwovet} IZISalinity 13liricr 47 ft. 60 ft. sand 2
❑A+liu(ci Test MSOMIN'Tatct�Inlgc ft,
ff.
G7J pert ntaI Tcchnotpg%! ❑SRhsidcRCc Control
'2o,'DRILLINC10C(nlrach ad4fitiooal.sheds if accessary:
❑Owthemial(Closetitoop) ❑Tracer FROM 'To (IF,SCRIPTION(cobr.hnnfricr.weirnivktir:ft iii.ic,&J
❑CTeotltenual(Heatirt`ra,,'Cooling Return) 00ther(explainin0er#21 Retuad s) h. fL pp
4.Da(c_Weil(s)4Whrpletcd: 4-13-2022 :,WellID#OW-24 See Gap s noted
Sa 4l'c111a►catit►n: it. ft. —
Chemours ft. It. lnfcl m iai ionUri:Facilitya in'urlJarfc FacilityTDM(itapplicable) ft. ft. "` 'c
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, ft. ft
White Oak, NC, 28399 Plns+eul,f[dicssCi[}^.AttdZip -21.REMARKS-
Cumberland
Coot ly 1?2n cl Np,,(PIV1)
h.I ittiiitdc aril 1 cirrgttiulc in.d4gncilminptcslscconds or d+xirnul d• recsc 22•Ceitific[tiori:
(Iftiiel!f>�td Ptel Lii7t�t�ia?cahi%`i:rdl /��••��-y c {�
l� ��' L hrlS RUffer, 4-13-2022
Stomtiue'afCcrtifiedWell Caritmadi Bate pp��
6.15(are)file wcll(s): MPertnanent fir oTernporar•s 13•sJ•nrn^i8ir nam.1 herrL•ccrti c fhrzr i1u aril Y rry lM1'CIY CUnYrrv[rCd I l•(IL'CE3�veuiCC
y# a f J 1. f J ( .l
wirlr I5A NCi1C 02C.0100 or J3A Nt tG 0„C.0Z0P 11�11 CotratrticNo!r Standards and tWi d
.7.16,*N a r+cpaii to an Existing wcll: o tles .or ®No. rvlirnjrNi4ecor(Jhrssbfsni'pnwitlod ro'n$!W11 mviier,
1jaf,iS
I u,r r�,�rdr,Jilt ravr fihu�w tall cernusiircvtc�va Jit�cirrnrrrcor aarl ttltioJit rl>t�rhtrur.of rJic
t�E r 6idiioil,rawr2nCr:rrrre;air+rrran ou 23.Site diagram or additional well—
details—You may US6 the.back of this page to provide additional A ell site details;or cell
8.Numberof►t"ells constructed: 1 construction details. Youitlay also'attachadtlitional pages if it;'cmory^.
tar nrafrinle 1,tP jr4gn cv'nn i-utarer sa.Ky wdls.ONLY w1rh rin^.same construrtlar,}%Nf,CILM
.rrPxvtzemnr j4,,,.r; SUBMITTAL•1NSTLTC.TiONS.
9.Toial well depth below land surface: 60 (f t i 24a. tsar At .«'ells: Sirhliit this fbith[Within 36 days 6f completion of well
Farrir�ilninJciic.11t7P3raaPJuprhs{td{e-rant(ext9uPe aazh'tlndFlltl�' consEnlctiort[trtltcfp[[oesing,.
10:Static water level h lust'top of casings (lt,) Iliti•406 of Water Resou rti-ts,InAwir utinn Pi cetsing Unit,
Ifwalerleyef&above LusfuZ am"+" 167'NIaff.Sers•ice Center,kalcigly,NC27699-1617
It.Borehole diamctcr.6 in (in.) tab.Fnr It.ftfion Welly ONLY: .in addition to sending the foml to the address in
2466o►'e, also submit a copy of this.forui ►sitliin 30 ditys of completiton of well
12..Well consiructiou method: Sonic cotrstruetlait try ilte ftrbfisving:'
r:ralar}^.'cable diiec t push.etc.)
'Division of Water Resou recst Underground Injection Cuntral ProgrAin,
FOR NVATER SGPPLY WELLS ONLY: 2636 Mail Service Center.Raleigh.NC 276994636
13a,l icld m ii7ethod of test Ne..For Water Supply&lnjcction Wells-
Also Also subtAt mie copy of[Eris frirtu within 30 days of completion of
13tt.bitinfcYtina hpe:• Arnaunt well construction tP the cotmty 4ca8th iir'rtment efi ilic counh.rr,•hcre
constructed,
North CaroRna D.7arfn=i.of Envirowmnt and Natural Resouias—Divvbrt of Water,Re5p rtcs Revised August`MlI3