GW1-2022-05213_Well Construction - GW1_20220531

WELL CONSTRUCTION'RECORD
This form Mbc used riniifrgldor multiple wells-
1.W611.6nitraftorhtformation:
u.AVATER ZONES
Chris Ruffer I MCN RIION
ft
4223 A ROM
NC.WCUcontfna6rccrtif=ti6nNumbcr 15..OUTER CASING Mw PrnjljPca4r',d wells)OR LINER(if mji,,,bk)
FROM TO PLATMETER 1 THICKNESS, , tT,
i
SAEDACCO Inc IG, ft. i 01 i I
Coiq;uty.N:mtc MANNER CASING OR TUBING(veotherm dclored4onp)
FRONT To DUMETEW, I THICE-NM MATEML
0 ft. 3.8 ft; 6 IL sch 40 PVC
I-W 41faRVIrable frill p,.ih fix.Caifnhj.,,Vmle,Irarlarce.InyeCUM r1r.)
FRO F.TFR S I LOTSIM TRICKNFSS' I-MATERtAt.
Water Supply W01:'. 11 "70 Df,%%T 28 ft.- 6
OA 0. 1 gTf"It.11ral, 0M0nicjpaVPuMc ia
ElGeo6cmial(licitineCooting Supply) MlIesideDtial'Witer Supply(single) ft.: in.
Mlndustrja Contnicrcjal ©Residential Water Supply(slm md) IS.GROUT
FROM , M MATERUL EMPLACENTMAYMOD&AMOUNT
0 1 t., 12 ft. Portland Tremei
NOTOVakr Supple Well:
13MMitodrig D alloqui-cly
lt1j,PcI lPtl Well: ft, rG
0 ikrpfifcr'Rcqhirg6` Dddiroun'dvkatcr Remcdiation 19.S,1LNDXR,%VEL PACK lir alsipliviibli.-Y
FRONT'' TO IPI 0711KNIT AM"1011 cr w R sto!pgcaiccovety 138alini1v lbiiice I RN
15 ft.. 33 ft. Sand 3
6Atinitcr Tot 13SOM116lut brain,
it.
ill x,perhncn(aI Tc-,-hnQtQgy C014ml
10 CLOG(.911Ach addiliormVilhedi,if wowlryl
EIG0011tennal.(C1.used Loop) EITFacer FRUIV .To DESCRIPT]ION(mbr.Wrdiivti,wrtlnick 1)tnc'anajl wrv.itc
EiGeoffiennal(TleatingCooling Return) E10E1wr(explain under 92 1,11einaiks)
ft... ft.
3-18-2022 EW-2 7
See Gap s notet.t. V
fG ft.
Chemours f4 ft, MAY
Vactlity,6vncri4awc Facility IDJ Oqpj6c.6kj —ft. ft, urth
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C,
White Oak, NC, 28399 Cj1y­'1bdZ'P
Cumberland 28-33 is a bin SS sump
CqqlntT ]?xcej l0iail9tzc;j170n No.(PIN)
51P.I*itude:atid LiingliRdcin dCgMcs/!ninUt6h�icq"nds or devinail i1j, 22.Cerfificatiod:
(lfw-ell fieldi kw.10104 is,mLMC;tni)'
N W '(;hrj.S' ,1 .Ruffer 3-18-2022
sigmwri orCeFtIfird Well Cejitm tdr Ddle
6.1s(a1e)_thewell&. MVernianent or •OTeinporary
11y'n,ping
i�ilh 15A XCAC 02C,.0100 or RTA'JVCA&,02i7.XJ,0r)*ell cojfsfrficdol?srandardi 1714 11wia
7.LAtLs a repairto an exi.5tingwell: E]Yim or Mn Copy ro'iAT"If-i-11,mviter.
.23.Site dingrantor.additional well details:
_pfo%r
YGu may use&e Wei,of this pag!,to- Me additionil well silejetaili,or will
constmetiondefails: You inay, atso:a1lach additio'nal pages if necessary.
cv one Anin. SUBMITTAL INMICITONS
9.Total well depth fieloiy land Sjnface. 33 . :All %I[, within 30 days of corupteti6n of Well
—(ft!) 24a. For s Sii.bfidt flds fdrin
2@1M� construciipn Coo(fid fojtovsini;�.
10.Static water lael betaw top of casino: (ft.) WN-Mon of Water ResaU r�es,Information Processing.Unit,
If i Mw i-le v el Is zk o ve L a jit_q use 147 Mail Sur ice Ccnici,Rilcigh,NC 274046-11
11.8orchole diameter,10 in
(in.) 24b.FoX TnIlSft 3yelb.0NM Ta addition to sending the formto ilia address-in
246a6me.AsP.submit a cop%: of US form Within 30 days of of hellmethod:13.Well tonstruction method: Sonic construction to thelfbilo%ving.,
(i c.auger.rotM.dbjrAi=push etc:)
Division of Water itesources,Underground InRcillon Control ProgrAnt,
FORWATER SUPPLY WELLS ONLY: i636 Mail Se'rVice-lbeater.Raleigh,XCi74609-1636
24c.For Water Supplv&111*ctl4n Wells:
14.Viodworn) Method'oftest, Also submit of Phis fdini-%"tb,iu 30-days ofconioletion of
13b;blsinfec4ion Amount:
well cortstniction-to the county licalth department of the cownWwherc
constructed.
Form,GW4 Nonli Carolina Depaturnem of-Enviromwiaand Muffal Resources—Division oflValeiRe-curcm Revised August"24J1.3