GW1-2022-05172_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD Fer Tucno iise,010:
Thfs form can be used(bi.single oi multiple wclls-
A J.IVATE R ZON ILS
Chris Ruffer FROM
W01'Comrador Naryle
4223 A (4 ft.
NC Well CoiamdarCertificbtion NturEer 15.OUTER CASING Mw muffl-ciwil v -R M'V""0 FRONT TO �::�111,0�VETEF T U—MMI*T\TATERTAL
SAEDACCO Inc f4
(L I to. I I
16.INNER CASING ORI 18 INC,(f.-eollivrinal duvLd-loa 0
FROM TO DMAILTUR TM0MEn ITATERUL
0 Ift. 4=8rt. 1 Sch 40 PVC
fj-fr 4r11q)�ii1cabk'WV41jVi-0X 0-0.COMO.�Tfirh',-1413611-4[IffeC604 0-7.),
ft. ft.
3.NVclI.16sc(Checli Well
17--SCREEN
Water Sopplv 11101:1, FROM I TO I DFAlMETUt 11 SLOTS17Y, I 710"NF-SS' I NIATERTAT.—-
48' ft, 58 1 1 in, 1 Alb ich 46 PVC,
'DAV"Rural
C36co(hennal(Heating/Cooling Supply): Mesidential Water Supply(single) R. ft. K
13hidustrial/clounnercial MRiasidential Water 5upP4-(sbared) 18"GROUT
FROM TO, ATATEkLtT I ENIPLAMRENTAYMOD&AMOUNT
Elfrii0ation 0 ft. 42 fC Portland Tremei
Non-Wafer Supply Well:
E.3NImitoiing I�Rccovciy
Itijecil'(in Well:, ft. f4
QAquiccr,Rcchuge, Remcd6tio" IS,SAN M'GRAVELfACh fLf 1141CLAT.110-
F R 0
DA41!ifuS6 iid C,covc, 'milin iilitic'r!age I R at
ity
45 ft- 58 ft. ISand J
2
E]Aqi:i i Ile r Test [J$tb inim-at C e btal,�,I--c
-puimentil Tc,h otog, osnb5idcnc�(J014MI
.1 . 1! . .. I I 241.'1}RILLINLG'LOG fiffach adilHioFtalibect(if FWcessys7v)
D&IIIential Loop) Eltracer YRONT' TO �DES�C-WiPTION*(c*br.liaMiievi,A.IV6ickttltc: jo sec.dc.)
ElGeodietnial(Fleating Cool W2 Return) [30dLer(explain under 921 Retnaiks)
tZ i k/
ate qlijpl led: 4-7-2022 Ny JIJD#OW-20 LJ
See Gpp s note4L
5a.IN't4l Lmrafiow MAY 3 1 2022
Chemours Unh
Pact1hy,4N,neriqMtc FacIthy IM"(JCqpWi-N,q)
ft. X,
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C,
White Oak, NC, 28399 Z'P 21.REMARKS
Cumberland
Cal qV Nrco ja-.Illirtcalio.I-No,(P1,14)
5b.Latitiidc alid Longitude in dcgreFslminutes.tsccouds or del dual Mt rM.
22.( Ecation:
Chris-Ruffer 4-7-2022
5fgmftjri,ofCcFt1rJ.-d Well Cao=tdi Date
6.h(:ACC)the well(s)- zFermatketit or oTemporary. fil,xiin;-x ikh.formi,1 hereby crilify ijjqt:I)jv irefi(s)way.(Vrrv)cuqyiTqed irr,aceotdance
wMV 15A MCM,02C.0100 or/.M KCW 02C.02M,Well C'6;41 iedwr gwrWards wid fi6i a
7.h this a'relliair'fu an existlpg Nvell: El Yes' ire END Mif Errs;iyf 6vs Nai providiM iirila�;Svdifnvjieri
Ivell expbbi Me 1117rare of the
m'.&,a qrmiif..c 23.Site diagramor additional well details-
You inay we.ftii back of this oje,6 ptovide.addi'donal.well site:details;or liell
constriction
616. You1ti;kv also4flacitu"tio'nal pages if twcessafy.
For ittaidple cy ONLY b4do
SUBINHITAL INSTLICTIONS
0.Total will Alepill below land sltriaic,' 58 74a. Fai-All Wdis, S�bntil this form%V'ilhin 1.6 dq-ys'jof-conip�tiodof well
For mah.1plewelh hurdi4eppft 'onsthictipn to dic following-,
dou rcis,Inflormatian PidcesMng Unit,
10.Static water level Wow top of casing: My sion of Water R i .'
If I I'd I e r le v d-h-;7 J,0 v e oas f(Ag use"+ 160 Mail SciTice Crnter,lRoleigh,XC' ,27699-1617
It.Borehole di,zincter.6 in (in) tab.Far jiQgEeIJsONLY, rnaddition to sending the fornito the addfm,inMl1U 24a&6e.also stibfuit a copy of tMs faffli Within A dews"of CD111PICtiOlk of WA
12.1NIcil construction method: Sonic Lotisent6tioll to the t0flo,whig"
itc.anger.mazy.cab I c,`diem posk ctc.)
Division of NIVater 110.ou rc&,Vndergt�oukid Injeciloil Control ProgrAin,
FOR WATER S13PIPLY WELLS ONLY-' i636 11tia'il'Serviet,Ceukler.Raleigh,NC.27459L1636
13a.Yield gpn]) .Method of,test: 24e,For Water Supply&Injection Wells:
Also subibit one copy of this f6ini'wilbiti 30 days ofcomoletiott of
134.bisinfixtion typin Airintint: wcll-comtnretitiu to the caunl<r Health department of the cou'nh,Ivilcir
COMiRICtcd,
Noah Cafollim Department of Emimnartit aud Mitural Resources-D.ivkion of Water ResoLrom Revised Aigust-to 13