GW1-2022-05173_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD Far ImnuvlCisc.DNLY:
This form can be wwd ftir.sfvgle oa rntdtipk.wclls"
1'.�'t�4Cantrtctor7tr[owtltatiou:
1.1:%VATER ZONES
Chris Ruffer FROST. TO InF�CRltrlp?t
Wa9"lCorAradorNaRlC,
4223 A
NC,WdlContractorCertifrcati6nNin&er 15.OUTER CASING Gor;raah casdiwflslORLiNER(lru Flcahk)
FROM! I TO I DLOVETER THICKNESS ]IIATIRiAL
SAEDACCO Inc fG, rt. irr.
C{in puty.Nwao .16.:INNER CASING OR 7'4THING'`w1hermal closed-too r
FRONT .TO 1 DLIHETER_ TIIICkwESS I hlATERL\L
2.Wcil COnstrp tion Ownit k: 0 R. 59 Ic 1 `iu. Sch 40 PVC
l-at ar11aMlirahle well pehrdfw f(,r.Caunh,,Stirte.4rarlarwe,Irykfiani rx..J'
3.'Will.ji$a(chec .H'ell tosC]: 17.5(ALEN
�iraterSnpplt'SVell:, FRONT TO DIArttt{TErt 5t.OT3[7}: THICKNESS MATERTAt,;
OAgriculttttal ❑IrftinicipaUl'ttblic 59 ft: 69 f►, 1 in, .016 Sch 46 PVC
®Geothermal(HeatingtCooling Supply). CiResidential XVtiter Supply(single) fi. ft. itt
MhidustriaUCanmierc'rai MResidCD6al Rate[S[lpph (SlL1fCd) FROM GROUT TO' MATERLIL E\IPLACDILNT'AMMOD S AMOUNT
[7hii'lition 0 ft. 53 it. Portland Tremei
Nort--Water Supply.Weil:
❑h(onitoring ®itccci"crp ft. (t.
Injection Wells ft, ft
l3Aq)ufcrRcOarge 6tlGiountln►ter ReDrediatioii 19 s,\NDd MIAT,L PACK(if a t illcabtt)'
'FRONT Tn_ MAXPRIAL RUPTAk-FA ENT\IETnOn _..
QA401(c,r Siorage and RrcoyClp d$0nity Dimcr 56 ft. 69 ft. Sand 2
1]4t)tiifcr7cst ❑Storitmatcr[rtnnac,
EIV-N timcnfall Twianology ❑Stthsilimcc C dr4ml
2n;DRILLING LOG(attach additional sheets if necessary
❑Geodtenual(Clysed Loop) ❑Tracer FRONT I To MCRIPilON(ptb.h;irdoevi vd%1s Kk tr KTvAjftw dt.)
❑Cr otltenual(Heating'CoolluL Return) ❑0dier(explain under 921 Retimiks) rt• r4
rt. ra
4.t1a(e.«'ell(s)Cautpletctl: 4-7-2022 Wel11Dr$OW-46 r . •�
See GO, s notelL
. !� urn
s, tirr�n I ttcatinn �.,*—ey
rt, rL
Chemours ft.. ft, —
F ilit)aYMncrNarac Factliry1DRffappljwaXe)
ft, ft. 'aiY4�:v+�11�7 •C`v:�!';.�'tJRp
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C,
White Oak, NC, 28399 P]itisfeu4,ifdiascCity..andZip 21.RrD1.\Rti4
Cumberland
Cdtt�ty Parcel laoditic;dion No.(PIN)
h.In�titirtic and,Longthuic in t1egmcs71ni 1utcslSCeands or dccintid dcgreest 22.Certification:
(lf�s,�tt t'r€tdr tvn.l:ri�7otgr i�yrrlticic.ul) � .
N N C:hiris.-Ruffnn 4-7-2022
Signiori of CcFtIfied Well Ccittractdr Dile
6.Is(iil'i,)the well(S): xPerwaneut or 0Tempor2q. 111•.signing thlt jryrm:1 hereby evifife rbaf the w4l(y)tFas Rice ek C[,7 uTcied ru'aeegr&wre
whir 15A NCAC 02C.0100 or 15A NGtC oc..,U2op Re it Couatrs:cflon Standaufr al d th4i a
7.ls;thixarcitairtoani`sitttfngw'ell: L7Yes .or ENo.. Vyofthlf'r,e'on ha beenn,i,ri*4t:ikei0lmwrar,
pailr
11'airr�i3ra;�,4 .11liavtfica*itsvie�etlaticrtu'ararcvlcrrajr\Fiarxurrdrat�mrlr:t'taP+rtnrlx aNatnre nftltc
.rr alid; 2,r�%a�k-saiviiiia n�u'q the balk c 1'rlrrs.'nrur. -23.Site difi ruttt.'or additional Tw Al details:
"You niay use tlxe,bacl of this paw,to,pro\'ide addiiional tyell site details or xsell
R.Number of trells constructed: 1 C©I15(11k.Ii01t derails. YOL1.ItIaC d154 attach addiBOnal p.1gCS if tr:CCSSsrtry.
lour trrulydrdd rtjerakNtc*r tar,,n-lour r srt�l.J,rn�i'lts O�\'LI'rrlrli rbe srrrria cv»rstrurtlar,yt:vr.cvira
,cmlrviiE anvch:rrr. S C]IINiiTTA L INSTITMONS
9.Total well depth UetoivvI-tnd surface: 69 !!Im For All NVells: ;Siibuti[ d9s faint v ithin 36 days.of eomptclion of Fell
For construction to tied foliouina:
10."Static water level helow top of cmiifW. (ft.) Division of)Niter R6out ei,Information PrY&Mim;Unit,
lfwwlerlev.el is ebar�c,s�iafri, rtxr"+" 2617 plait Scrsicc Cel ticr,.Ralcigir,,NC 2 7699 4 617
I I,Borehole diameter:6 in (in,) 2Ib.Fox Tiff nri RcIlg ONLY: in addition to sending tits;four)to Ilse address in
245 above-.also submit a copy of this form within 30 di}�s"of completion of►yell
12.:W011 eousirtiction method: Sonic ronstmc►ioli to tied following:
t:e t4er.roiary.utb)c dried goshrtc:)
'Division of Niter t2es6rc6,Uuder0ouud Injection Control Prominl;
FOR WATER SUPPLY WELLS ONLY: 1636"Mitil Service Center,Raleigh,NC 27699-1636
t3a,Yield(gpnt) 24c.For Water Supply&Injection Wens:
il3ethod�of test:
Also submit one copy of this fain}.within 30 days ofcompletion.of
13b.Uisinfcction type: Ainuunt: ryctl comsinictihn to the county dcalth department oe the,col ah•:whctc
cortsiructcd.
I'ornt,CntV-L NonhCarolinaDcpaan=ofEnviromi-4m.aadNntaa•d Resources—Div;lonof\NatoRemu - RevisedArrant_N)13