GW1-2022-05165_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD Fa�tt�cmalLTsct3rTi}:
This form can be uwd.fai3fngic or.maltipk melts'
1,tiVell:Contrlctai^Lrfor111atian:
I.I.%YATlR'LONFS
Chris Ruffer Fttpil. TO 11F_SCRIPTION
Wcil ComradvTNalme.
4223 A
NG•Well C6rr mdcjrCcniCrcatirinNumber 15.OUTER GASI`1GYrhrinu111 ca"sad nef1s1 OR LiINTFR iif a `7Pcahk)
FRO31 TO OLVITEFER THICts,'MS: h111TERTAL•
SAEDACCO Inc tt.,I ft in.
Cnnsp:rnpNVIlio. 16.INNER'CASINGOR'IVHING •ecit6crmActukd4oc
.FRONT TO DUMET6R Ttuciums§ I AtATERmL
2,ti}'c11 CDnstlalction i'crntit 0 R. 49 tt: 1 h4 Sch 40 PVC
Litt ullapp7icabfe xrdl pfirm(rs(d_r..Carrnhr,,Snrm,lfariarrce,1r,*-dCn car..)
.rt.. r4 in.
3.w0l'use, ACC): t7:- -----
Water Supply lVeM. FROM I TO nr.%%trrrR I SLOTSIM I THICKNF-1,5 I MATBRIAr..
CIt1�Ti:llIt11Ca1- 17hfl1nielpaUf`a►blic:. 49 R: 59 tt. 1 ill• :010 Sch 40 PVC
ClGeothennal(ileating/Cooiing Supply) Mesidential Water Supply(single) ft. ft., iit;
Oludustiial/Conmicicial 131ltsidcntial Water Supply(shard) is.-GROUT
FRONT 1.70, MATERIAL- I LNtPLAC NMNT3IEnIODSANIOTiNT
DEm ration 0 ft. 43 rL Portland Tremei
Non-NV ter Supply,Well
MhAunilodng ®Recn�rty rt
Injection Well:
MquifcrRccfiarge M roundwatcrRciitcdiation 19.SAND,GtOLVEL PACK lifatriicri:del
FROM, TO :1tA rrumT, -TUF?fIt)11
'Agaiifcr storage aixl kit 6 cly 0s ilinity Ban9cr 46 It. 59 tL sand z
❑rlgirifcrTcst 11516m13.%ltci Drun.•tgc
❑I~xpctimcnial Tmhno1Qgy i7 ubsidcncc 614rpl
20•DRILLiNG L.OGtaltach adJitionHt sheets it rrccescanl
'Geotlremsnl(Closed Loop) 'Tracer FROST. TO DescttreTlo�rmMr.I;,ntdc, wla r+,ck d ,:- m wa aa1
❑Geothenual(ReathWCooling Returnl OOriter(explain under.+21-Rewart s) n. U,
4.Datc.Wel3(s)Cduipl4tedl: 4-12-2022 ;%yellIP#OW-46 ?e 6.•s
See Goo s notes(. 4_.,i..,r
3a 1VL11Ia►catinue tt. rt.
MAY 3
Chemours (G rt
ficility,61mrNan,c Facility iM'G[agplicablc} info
iSit®
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1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, tt, ft.
White Oak, NC, 28399 Phi'hzidAddici 'at•.,Ind 2ip 21.REALARI{5•
Cumberland
Covua� Parcel Irlmljrwllipu NO,.(FIN)
$b.I>ittihrdcariliin ttntle,tai�I aaresdminutrslsccnndsrrdecimalijegrccst 22,Ccrtifli6tiati:-
tifnrt!d'�Id,t>i�1:tN7o[r�_i,c,t(]ic:icdl {�
N W Chris. Rl ffeC' 4-12-2022
SignituieafCcrtilxd LYet[Cgntrrctdr Dale
6.Is(are)the xPernianent or .oTetnporar�. /lv.ofgnbrg rJris.firrra:,l Irereby terrify rd,ar-rbe weff(s)vvs{yrcre)consrnrered irr aefordm,ce
with ISA NCACO2C.+OILY)oi•.1 fA NCtC 02C•0200 Hilt Cviritrsicnwr Standards and A.Tr a
7.Is this aniiairtoadciistingwell: t]Ycs or EN0 f81,yPif11lS.fMt„YlbfS'lhf,rI,IYri'1llatdrgihillwimvir�r.
if at§tSlt a rel�rdr,fidt cavt kRoirw tS�etdeextrtaare{ton d,rfnrrru;r:i„r rrru!c-rgPab[r7u_-rw tnro of tltr
-pair 6rrlar*21 remizrkvi i 16iu at an Me 1, aphis faro,. 23.Site diagrant'or additional well details:
You may.use.tt'e ilack'of this page' to provid#additional tee ll site:414;i s.or W;ill
S.Numherof wells cottstracted: 1 constnlction details; You.ntay also atlach additional pages if necessmy.
For tmidrdAre l2terAoi cr owil pater:aN pl wails ONLY w1rh the same vonsrrucriwr,yo.-Ixon
sai wet uvc d(.riA S EIi3RiITTA L MSTETCTIONS
9.Total well depthiclots latul surfac.. 59 (ft,) .24m Ftic At W`il(s. ,Suhriiit this Earn tt•ithin 36 days of'complMiou of t ell
For Mawple 144is'ditr iaPlit nhs tfdo,re�q(exam pie-3@?Ppnan d 2 1t-W7 cOnStnrCtion to`thC k1tovlina,:
10.Static waterle+telheiow top of casi6W. (i1) Division of Water Rtiources,InftFrnratit n Prd"eessin t Unit,
df arsater level 1,An' t4lBini g-am +" 1617 A1ait Service Center,.ILticirh,.r1C 27G9J-t627
It.Borehole diatnctei:6 in (ice) 24h.For Inig all--M 1ic ONLY: In addition to sending the fomi:to the address in
24a aEaore..also submit a:copy of this fanu n itllin 30 days of completion of well
12.111cli coustniction method• Sonic constmctiau in;tlto Mow-uie:
tic.angcr._roinq:cahlc litre t paste etc:) 'Division of WaterResourees,Underground InjMlon Ctin".1 Pro;ran►,
FOR WATERSU'PPLY WELLS ONLY: i636 Alail Service Center,Raleigh;NC-27699-1636
13a ti'ield(gitim) Method of test• 24a Ftir Watcr Su pp ly&_IniCqton Wells:
Also submit one copy of titis forin'Lsithiti 30:ftsgf.cortipletionof
13h:IlilinfL-ctiun,fvpu. _ Atnnunt: «wcli consthw idn'W the county ltcafth department of Ehe coirrtty-where
conmumcd.
Form(al�r,l ICunhCarolini Departmem of Erwiroumetawd;dartoW Resnurees-DevvionofRPalcrftesoutu RcvLxd August_013