GW1-2022-05211_Well Construction - GW1_20220531

WELL CONSTRUMON RECORD Fqf laerml i4c OWN,:
This formcan bc."Wd rllesingle iii natilik lcctls
.1.
14.AVATER ZONES ---T—o—psc.Filmox
Chris Ruffer FRONT To
wdt
4223 A ft. ft
NCV611 Cdotmetor Ccrtificition Nwrber 15.OUTER CASING wvt1I,*1 T0R_LINVR;1�jg alkl
FROM To PLOT ",vtj IAL
SAEDACCO Inc
INNER CASING OR TUBING(vixittierinal citigetl4axio)
FRONT TO DIAMETER TUTCKNESS I NTATEIMiL
2,Well con'stiliction Pettlit 0 ft. 15 Ft. 6 lit. sch-coj—pvc—
Ft.. ft, in
17.SCREEN
-VEter SuliptyWell:7 F14ON1 i TO DIXIIETFR'I SLOTSIZV Tnf"-NfZS` I-N-XATFRIAT.
25 ft.: 25 ft. ti in, 020 SS
Wvoilicimal(Ilaidng/Cooling Supply) (311tsidential'Writer Supply-(single) it in;
ClIndustrial/Gininfarci5l OResidential-WaterSuppiy(sbamd) 181-GROUT
FROM 401 MATERIAL. I.rxpi.AcLNIENT MMOD&AMOUNT
0 ft.' 9 (L Portland Tremei
NoTtAl'aterSupplyw,ell:
Injection we.W.,
ft. ft
ElAfluifc.-lte le a rg ii Pdroundis",kr Remediation 19.SAND,'GRAVEL PACK fir applicaWel
'FROA1, To I 51A.FrRL4I,
12 ft. b 3 ft. Sand 3
MA in 13§166rill-atcr l7rtaiyRc
ft. ft.
❑ ;rinicnM I Tc0inQtp_w O'Subsid"mcd C014ro I
10.DRILLING'LOG fallach ad4lifional sheets iftwCowary)
ElCootheronal,(Posed L op) tit racer
P FROM .To OF-KRIP
EIG--otlp-,nnal'(Headii.4,lCooling Mom) 00ther("plain uAder.#21 Remarks)
3-23-2022
wellEDOW-18
See G#0 s note$L
SA.-Well Iocatinn: g,---
JL ft. V
Chemours
fact1hy IDNV(kqpiJ:pbIi)
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, ft,, itInFo-i'i"ra.5-5-5 pr,�_cw Ctr, Unk
White Oak, NC, 28399
21.REMARKS'
Cumberland 25-30 is a 6in SS sump
Colrtlil Nrrcl ljijlificllftll No,(PIN)
h.Lititude and Linftritudc in decimal 416 grm:-
22.Certificatiorn.
Chei.8,-Ruffer 3-23-2022
g-, Wi i w.-6wraWcll Cgnifactdr Ddl
irit#[5A X61C 02C.01069 or.15A ArCAefilk,0209,1yelf Co)jjjjyjc110;1 giamlao,4s mlAtlaaYn
7.Is this a reliatirt"o an cxi.jtingw Nvellf OY,-Is ur NNis cepy.of rAiT reo:i1m.%r1l(Amer.
#'WVS11 of rAe
reMirUrUk;1#21 rr`MiAViWfiVU 0t('=OJL&Wk Qfd1&fiYrnL 23.Site diagram'or additional well dretaits-
is p��c.t(Y,Drovide additional wefl sim,You ni4�use*,bj&-bf dddik or 'well
S.Numberof wells&ttstrueted: 1 oxisttuction details. You utay also:atlacli additioual pages if juxessary.
Forjlrajidj*lqj cfiiut ON'LY w16
SUBMITTALIMUCTIONS
30 24a. For All WdIs Sfibfidt this Imni within 36 days of compiction:of well
10.Static water-level below top of casinw. A) Divisipsi of NV2ter 110ou rteiii,InMr,inaflan Procinising Unit,
1111twveikifel If 4Rbdia;awag,out + 1617 NlAil Seff ice C!cdtcjr,,Rdcigh,.XC 27699-141.7
11.8orcholrdiametef-.3-0 in (in.) 24b.For B!Wlan Wgj149NZLY; In addition To sending(lie fomi to the address,in
246&;Qt'e_also submit a poiy of this form wittfin 10 days of completion of wdil
12.Nildil comMietiou,method: Sonic consim6ficni to the fb116%%ing.
(i.e.m*r.roifaq. iusl>ctcj
Division of Water Relou ft-es,Underground Injection Control Program,
FOR WATER SUPPLY WELD ONLY:` 4636 Alai(Seffice-Center,RaleiglijNC 27699-1636
13&-'Vtcld(gpm) Nlethod'of tat: 24c..For W;iifcr 56pply&I&CtWon welh
Also submit one copy of this form within 30 d'py s.Of completion of
131n DisinfLetion typq Amount;. %vc1l constniction to the county'health departnicrit of the c0iuttV.wh=
c6ristnictcd,
FontiMNI-i 'N',ofihC=hjta Dejunment of Enirifoitmentwid Wattim.]ResoLirces-Division of NAalcrResnu Revised August-