GW1-2022-05166_Well Construction - GW1_20220531

WELL CONSTRUCT [ON RECORD FoFl1VrffllIJsc,0N.LY:
This formcan bc'usdd fbi singleor mWliolc-wctis,
1.Well 6nir'actorInforni'ation:
Chris Ruffer MOM X) 0K$CRRFIti0N
U'01 rAnutarltamy it. ft.
4223 A
NC,W61IContinclorCcrtjf=fioiiNum66i -l5.OUTER CAS[NG( OR LINER(if ap'fl bk)
FRO'. I TO pT,%,%TFnTt• THICKNESST-11,1111TENTAL
nc ft..
ft iu
SAEDACCO I
coltv"My Nam _F6.—INNERVASIFNG OR WBING(geolijerinal ckied-limp)
FROM TO DIMMETER I THIC&NESS I AUTERUL
We'll con-muction pqrrnit#: 0 ft.. 11 ft. I Sch 40 PVC
PruaPla}plPicahleurfPpeimitrli_r.. el'.).
ft.. ft. fa
17.SCREEN,
NVater Suppkv 11101., FROM 11,70 1-DUVAMTKEt I SLOTSIZE 7141(-KNF5S I MATERIAL_
21 ft.. N 1 -.0,16 Sh 46 PVd
OAgiicultilral bMuTilcipalftblic it I C
13Gcothermal(Heating/Cooling Supply) OlIesidential Witer Sbpp*ij,(single) ft. I [I.-
in
13fildustrialiCornmicrci5i DRiasidandal U19ter Supply(shared) 18,GROUT'
'FROM ' TO, MATERIAL E,%FPLOCE.NMNT319ni0l)&ANIOUN7
Allyn' 0 ft.. 5 (L Portland Tremei
No"-AN14cr Supply Well:
M11ccoxTy
Injection Well:: ft. It;
MrowiNT14cy Rciuccliation 19.S AND;M%VIFL4IAC fir applkabtv)-
4FRONI 10 NIATML A K"VIPIA MMIENTNUM1013
MAq0Ifcr,St0r39c­and k=y6y EIS,-Illinity Ranier 8 ' ft.- 21 ft, Sand
Mq6 ifdrTcst. []51"vrTTmatci.l?rliiiapc ft. ft.
08,xp;rirpcn(al TwAnology. QSqtb5icicRce C014ml
'1(1.DRILLING LOG 614ach p4ldifiormlOwdiif wcmqn-)
dGeothen"(fAmd Loan) otracer:
FRO' To
LIGeothennal WeatingVoolin2 Return)', EjOther(explaiki under#21 Retoatks) fy it,
r)
4.D4 telVell(s)Cdmp lcl(.!d: 4-11-2022 WellID#OW-36
See Gfto s notelt.
&L Well Location. IL
MAY 3 1 Z022
Chemours ft. ft,
facility kivocri4amc,
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, it.
Et
White Oak, NC, 28399 PloikA, . ddicm City.anj ZY °21.RENIAK
KS
Cumberland
Marvel Iki.nJi6c10ptiNq,(PIN)
Latitu&mtd I.Cn or dafti*al dc'grm: 22:Ccrtificatioii:-
-Chris,Buffer- 4-11-2022
Signawri,afCcitifrd Well CGutwtur. Dale
MPermatwta :or" ORtuparary
By sinin11dijumI frerebireOy rhr.1he well(s wa ��,cntjcorafrueied in accordancegg - f 'with"15M MW02C,0100 o 14"41C04trsiciion Stanrlarilscrudrldira
7.16-thbi a Irpaii to au pd'.V#pjg,Nvell. EIYCN or WNo 'c*py:bf0h recordliai bticn prpvidM ra.iIMVWI mmer.
r1je notare qfrllc
9 23.Site diagrain or additional well details-
MAV hilCk all
You may nie"dii back'bf this addiii6flalwell site detiiii or iiiii
Constluction'de6ills: YOU I tLIV aj­';orajjaClj adfflfional pa&S if JWCe SS afy.
For nuilliple 11va'ALVI'tV Qwwk-ywree w N-wdrs ONLY w1rh rlje.savur you cyin
say mar It rmr p,
SUBNfLM L FNSTIJCITONS
9.Irof4l we'l.lAepth beloiV land MtrfL.je6 21 M.) 24a. Fdr All Wills., Subndt 11"fdrtt%Yrithiin 3Wd:tyg of completionof vyell
Fornizat"ple iVcIhJfsivhrAp6 ljdo.raft(emwn�fa 3@2
10.Static water leVel.beloW top of easiitW� Dlvk6t of Water R&ou rces tnformatibn PracciMn-Unit;
Ifuuteo-Nvel h,vbvt!c Wsipg am 1617 NIAH.Service Center,Raleigh,INC 27699-1617
11.13orchole diameter:6 in
010 24b.Dr bilmlan WON ONLY: In addition to sending the form to Ale address in
24a abo►'e.Aso submit a copy of this fant withid 330,days"of completion of wAl
12.WeNcoustructiou method: Sonic C01181tartion to the
(Le.awc r,odaq,QhIc,din FMIL etc.)
'Division of Water Reieuives,Utldergtound tujecdou control Program',
F0RNVATIERSIJ-PPLY WELL 9ONLVv J636 NIA Service Center,IRAI-eigh,Xtr 27609-1636
13a Yield(gpni) NIcthod'oft6t: -24c.For Water Supply&Injection Wells:
,
ALSO sublilit o'n,-,-cdp), of.this. form,%vitbir, 30 days ofcompleflon of
.ion,type.- Amount: well constinictio^D to the couta hcjlth department of the coimtv:whc-rc
- I I
N-oljibC;aiolbuD,-paiiniciii.ofErAirojL=iitaitd Nahum)Resources-Diviii6nof Water RL--a,Lxcm Revised Augnst-N)13