GW1-2022-05212_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD
This form cm bc"Car-single ar natiple wclls-
1.1 Well OPti-auor Ittforniation:
I J.AMATE R ZON V%
Chris Ruffer FROM TO 0"CHIPIr70N
4223 A ft. ft.
NC,.Wcll Coantm6a Ccfljfiaitiaari Nwdkr 15.OUTER CASING iNr ratilikived'u0b)OR LINER(if a I ILlk,fTtoNT I TO. OMME,.Mft, I THIMNUS IvIn-THAL
SAEDACCO Inc fL, (L
iu
Colt*-,Uly N untL 16ANNER Cr1SiNGOR 'BING 0-eeiberinal ckv.-td-I-xv)
TO DIAMETER. THICKNESS, MATEML
t,Wellf 605ttlietion '0 It. is Ft. 6 bt sch 40 PVC
173CREEN
water S"1111ty Welft. -F11051, 1 70 1 13TANIFTER I SLOTSIZE I 7111CKNTS5- I MATERIAL
bMunidpalftbft 1:5 ft. 25 ft. -6 W. .020+ SS
fG JFL
OCIP-otheriml Oeatingtooiiflg-Supply) DResidmial Witor Supply(sftle) I -
Mlndijs(rialfcoflinlcFOR1 Mzsi(kntial-Water Supply(shared) is.-GROUT
FROM I TO. AULTERML- EXPLACEMM 3W1110D.&AMOUNT
0 It. 9 ft. Portland Tremei
Non-W;,iferSupplylyill- --
1djeeI!o!1 well:; ft, ft
Q ql ikr'Raq, irgi M rJroundV'V'-11cF R.enickition 19.SANo(GPtVkL PACK fir alijilivabli..)
'FRONT-- 10 MAIVRIM,
1-
- 2 R.- 30 If, Sand 3
I I A clu"'i fic r�Tesi r, 'MWI t C t 6hin"I�p
2G.-DRILLILNG,LOG(ntiAch additional ifiMs if aecesmy3r)
DGeothenial,( 0 137fracer I 'A%**L1j e siz.dc.)
qqSed LID P)
El Qv d te n n al-(He a d t ke tC a oli n gR e lu rn)• 130dLer(explain ujider#2 1-Remail's) fl pq F-
4.Date NVCH(i)Conjpleted. 3-22-2022 %VjjlJD#.EW-20
See Gho s notesL
fL I I I L MAY 3 1 2g22
Chemours PrCiCzazing Unitficnity IM"(ifappli--nbli) TVVZT-r�
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, ft, fL
White Oak, NC, 28399 PJD3kid,4d&ck cjl�.jwd zip 2 1.REMARKS
Cumberland 25-30 is a 6in SS sump
01"My 110=3Id.nlifeClllnnIJp,fFIN)
$6.1-*ftWe'an d L. nl 4*6/0i"Utol..-, H.(4 9"d,eJnla,l 41qglvics:
�lt " . , -- 2L Certification:
(It vvpl
W Chdt.-. Ruffer, 3-22-2022
sig!uwri c re taffied lVell Ga it='tdr Dwe
or 09feniltoraq.
7.is th1s,a ftlinif.it);tnixisting Nveli: ElVes', or MNo ccVy ofeff,rerpJ ky&.,,a fiTrided vnihawll mviler;
01;&S:la-a?TAd?,fl1(Mr kw tw 1vi'rt bV0fynrT.1VR awl raptahl th C.m:vin?of(1Ie,
fYpir Ztd&;93t 0a ill"010 23.Site diagranuor additional w-II iietaiti:
You My tige-th-.back of this Ob.6 t rovicie additional well site_&Wl' or ii•ell
S.N,Htnlicrofhelli&tts'Irtteted: 1 cons(metioudelails: You.iilavaLso:,Ittacti-a"ti,oDai pages ifaccessary.
SURNMIAL UCT1614S
9.74ial ivill depth belo*-Iand Mirrat 30 q*1ion of$Ml
e. -24a. Fur All Wills. Subfidt this f6pirwithin.30:dayso -con f
,�fl&M. .'s ifdwrejit fexwpfer J.@209'aml MMY
Division of ' i
10.Static water level below tapofeasiiiW.. s,Infiiwinntidn Processing Unit,
Ifiewee,(evens ahovv caiing ase I617AWI'Servic'e Center,P-deigh,KC276994417
11.Borehole dlainctei-10 in -,(i1L) 24b.FnrFn[U%1gijWcIIs-9TfLYi In addition to sending the form do the aildrmin
24dabqve.ailszo siihniil-a cotn,of-11fis fbitu wfthin 30 da)'s of completion,of sv2ll
MMMI constntetion•method: Sonic cot>strtictian 16 titsfoflo%i'itij_
(I.d.pgr.40ia .cnbls diieci PuSIL art:)
"Division of Water Resources,Underground tnkfion Control Prografil,
FOR WATER SUPPLY MTLtg ONLY: iw"Mali'S m* ice Center.Raleipliq WC 27699-1636
i4c.For Water Supply&InjectUin Wells'
13.0 Vield(gym) IMcdiad of text:
subunit one copy of this Mini %siub.in 30.&5�i of completion of
13h.Disinfection ty-pe, Amount. Nvell,consiniction-w the ccttnt�t licaith d6partmcnt of(lid coiiWxvhcrc
constructed.
Vann.G\W-1 Nonh Cmlhia L\,paitmejit ofEmironnxiit mid Mnwd Rewurces-Division of\%1n1qR�0txtM Revised August Ml I