GW1-2022-05214_Well Construction - GW1_20220531

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WELL CONSTRUCTION RECORD. Far[12crn-it tTsc ONLi':
M form can Irc bsedAii,singlc or multiplc wells,
1.tr'4'c1l:Cot)traetorIt[forn)atiotl:
Chris Ruffer FRONT: T[) n1SUs[t�u)x
WollCoramtctorNanic f1. ft.
4223 A ft, f4
NC.WcllConnaclorCcnifi atianNunlicr 15.OUTER CASING(Mr multi-eased wcns)OR LINF.Rfit 41i cable)'
FRONT. To _ TI METER THICKNESS ALMRLIAL
SAEDACCO Inc ft., tG i in.
CauTmtj-Nanw. I6.INNER CASING OR TUBING-(geotherinal ckiwil-tort)
FRONT .TO DIAMETER.. THICKNESS NLATERLIL
2,Well 6"str•64ion oernilt W. 0 R. 40 It. 6 n4 sch 40 PVC
1ltidrll rrgificrabtk x'rtlli rmitt(i-c."Counhi,.SFnr,;MOrtarrcr,lrftCdC4 rtr..) ft. ff in
3.41?c1LLisc(chaC1,r>ctl pse) T7 S(,REEN
WaterSullltly%Vol, FROM I TO I'nrANfETER I SLOTSI7.F 'FR1(-hNFSN 1,NIATERIAt.
l�r�gtictttttttai CJlrfunicip�llFRtblic 4o R. 5o p. 6 in• 02o ss
t76eo(hemtal(HcatinglCooliilg 51>l7ply) ©Residential Water Supply(sinule) ft. R. its.
11IndustiiaUConun(ercial OResidcntial Water Sgpph'(shared) t8:GROUT
FRONT TO NIATERIAL ,EN[PLiCENIMNT NTMOD&AMOUNT
Qlrn Ttion 0 It.: 34 fL Portland �Tremei
Non-~'seater Supply WeIL
Ohlonitorin ®itccovery
Injection Weil: ft. CC
O tiifer'Rechirge. � 5r3G�unl itS lter Reutediation 19,SANDIGRAI'tEL I'A(=tC fir a 111ie.440
F'KI N I .TO . "N1AT'F;Hf.41, ttNIP1.A(`Fs�11F:\T NIFTnOU
QAganfcr Storage and Itccaycij' QSnlinity Bariici 37 41. 55 ft. Sand 3
Q,4gniferTcst QSlomlr Itctlirl ilagc
61 xperimcn6l7'echn toc' QSabsid.rtcc CoTO rpl
10.DRILLING'LOG(aflueh ad+litionirl sheets if rwcexssrr')
❑GeothLinul(CIPSedLoan) OTracer FRONT I.To sift,d0
❑Ge*odtemtal(FleatiieCooling Retun)) QOdter(espluin under 921 Retuatl;s) ft• fu
ft., ft.
#.11atCR'cll(s)Coninlcteds 3-17-2022 Wc1ljDgEW-28
See Gap s notes(
4
Sa.'11cll1 ].ocatEdu: iL fL
Chemours it. ft. MAY 3 12�92
Factlilp�(rcricrNantc Fi-; ity IDrt Ctfappliaibky ft. ft.
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, ft,I ff.
White Oak, NC, 28399 P1tvsioalAildrekCits..and2ip '21.REMARKS.
Cumberland 50-55 is a 6in SS sump
Puree[IiknliftC;illPuNo,_(PIN)
iti,I._�tihrtic ariil I.Ctn ittrdc in.ilrgrresrminutrslscciinds r .decimal ftrecs; 22.Ccrtifieatind:"
(ifs llttd ain l;tt7otlssrrfliutiCnll {
N ��' Chris„ Ruff 3-17-2022
SiAQRlt let e f Ccrti tied Wdi Ce nuactei Mile
6.IS(urC)the�rcll(}: P rDianent or i7letnitorary kr.vgninb Jhir fbnrr;,l lrerrby rertifs that the,rrll(s)r:as f vrrrJ consinrered''Waceordmice
ivieh'15A NCAC•02C•,i7 M or 11t NCAC 0.0,4204 Nell Cpiritrricdon Sraradarda and tlurra
i.L4thir•a repirtu an exiFting well: OYa^r or MNo c�rir.bfdris ireriW 'breir proivr�rPtryifv+rnrll rnvnrr,
,j,?'ft'rtc u-ir tcd�rir fad7rwr,�`ra?itN rvtttcw„�ttamdart htfrareratrtlevr,rai/neyrdrzlii the riaraee ofrttc
rrvair a,rMk;. 21 n-mil-tsaaricma orcia Me.hica.of'rhu,farur. 23.Site rlingraucor additional wetl delaits:
You[nay.use tlie,bock-of this paw,to ptodide"additional~cell site.detiilg`or cell
R.Number of',tells constructed: 1 constmetimt details. I'ou uta�alsa atlaclrad�iGoual pages if tr ccssary.
iwj iwd re ti*erkwtc*r r satpcJ,r iM1..€t7,t;LF irtrh rti,'.0 me carrrstruettuu,}n,cxrn
.craitvrttmnr,ji:rrn. .. - SUBMITTAL ifiTSTbbldllS".
9joial i e['1 epth bel*land surface. 55 (ft,) 24a: Fur all Wells: Submit dds form«ithin 36"days of'comptcdon of wcil
For4nudafptcivr=lt$7ratrrflae sl#tfdf,crtaittra',r,,ut�Ir.I�Ct7tI`cirardF'dt19)' eon5tmCtiori`tolhc'faECr�clina;
10.Static water level below tup of casing; Dh•Lsidu of Water Risaurces;Infnrn Atiiln Processing Unit,
If itwer hive/it vha)�a nittrap,,we"}" 1617"h1aiI.Ser ice Cenier,Ralcigh,NC 276904617
11.13nrehnlc diameter:l0 in (in.) 24b.Fol.lnl(Y !!!I Wellc ONLY: In addition to•sending the foml to dte'address in
24a above:also snb0lit a copy of this fortu within 3(i days'of completion of w0l
12..Sfic1f mustruction method: Sonic cro1L tnietim)to lho lollotti iltg:
(i.c.ai4er.ioiar}.cnble dircriposhctc.)
Division of Water Resources,Ukdergroutid Ittjeefiou Control Program,
FOR WATER SGPPLY WELLS ONLY: 1636 hlilil Seffice Center,Raleigh,NC 276994636
13a,Yield(gpm) llctbnd of test• 24c.For Water Supply&inicettun Wells,
Also subii)it otfe''copy of this fonft within 30'day's ofcontpletion of
13b.DisinfiY'tinn tylre Amount:_ well construction to the county health dcpartmcm of the coitttwwhcru
constnictcd.
ForluGRr-1 NonhCamlina Resources—Uieiii0aefWaterRewI f tras Rct•isedAugust2iFt3