GW1-2022-05215_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD For TricnmllTs ONli:
7`his formc"be'used for singleci,rnultiokuctls
1.W61C0ntt etorIitforntation:
A4.IYATER-ZONES
Chris Ruffer FROM: Ti) pF-S4RttT110Y
Well CorAradorttame R. ft.
iL f�
4223 A
NG.Wdl Connaetor CcnifraltionNiurlier .15.OUTER CASiNG ffo�'nr till kakil ".Si OR LiNER lif a l flcabk)
FROST TO DLIMETBR. TniCTiNESi SI,ATETTTAL
SAEDACCO Inc (L, rL ➢a.
(4m ,ar}li uuC MANNER CASING OR 7V18ING` wlhcrmrl c6ed4-x i
'FROST TO DUMETER. I THWKNESS' ALATEML
2,Well Construction Pci'rnit#: 0 ft. 47 It, 6 'hL sch 40 PVC
1,iO0111,FP Mb10i'r1lpdhWf3fie.G'uuntv.,Slvv,Aradonce,11*6c drtr:p
ft. ft,. in,
3.Wclf.Usc(chcclmell If 17.s(. - -
atersuplrtyWell*.. FROM. t TO .nr:1MF.TFR; stors l! TNtcxvN�g =A1;1TEMIAT,
OAgdcultival liMunicipaMbtic 47 'ft, 57 h, 6 iR• '62 6 6S
DGeothemial(HeatinglCoottig Siipply). DResidential Niriiter-Supply(single) ff. ft. tu•
f3hldustrialfcorninercial ®Residcn@allVari:rSuppFy'(sl tredj FaoaROUT To. *rnTSRtiL ESTrivkceiTENT3rsmon eAhrouNr
I7trii lipn 0 It. 42 fL Portland Tremei
Non lliiter Supply Well:
171v4ani#oring CflTteco�'cr�• ft._ ft.
Injection}Yeti:; ft. rL
f,7Agitifer'I1cchirge ild6roundvik kcr Renicdiation 19.SANDIGItAti`EL rAc1:rr t i,uc�lil�r
PROSE 70 MATFRIdL RN1PtA(7FHENT 57►;TnOtf
CIAglnfcr StoTa�c and ltccoycty i:40iniri 1,Hcr 45 R, 62 ft. Sand 3
174gn tcr7is(- O5tomr�itcr liT-1410
f v—Vcrimenfal TcChnoloti, 17$tth5i&ncc Ci nttal
20:QRILLINC'LAC fattacfi»dditiaoal sMxhs if mccessanl
DGeo ltential(Closed I:oop) Tracer FRONT TO DESGRIPTIU\[rarar.hardiieoi,-Mmickh tc"g 8i siz[ ot.)
❑GLotitemtal'(HeatiikgkCoolfugRetum) t70dierfexplaititiladerg2l.Remailisl rf• (L
R. ft,
4.Datc:FVelt(sjConipldied: 3-21-2022 VjjlJD#EW-21
See Gftp s notest, _
i t �Vtll I neat➢iln' fL rL ;y >m., .t ,.t lV d—
Chemours r4 ft, ^
Factlit}at7rcrcrNnnF Faot7it}'➢DmKappitable) fl,- fL �A�Y
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, "ft ft,
White Oak, NC, 28399 PlisicidMdi,ss.Ci ,:ndZi
} , t} � "21.Rl6LAH1iS
Cumberland 57-62 is a 6in SS sump .
Cpauly 1?art¢t 10oilitreg1ioo No,,(PIN)
�b..X��ttitudc Arid i.Rrig�itttde,iA_dl`�nrccs/minutc3�5cconds nr dccini;ll kiefirees: 2Z Cezt�rativa:-
ltfirell tktd,tvau tat 101iiasullivti nt)
N w C.hrfs_:. Ru_ff_er 3-21-2022
Sieruuu afCcrtiTledjVcl[Cantracuir; Dare
6.Is(:tre)the vvell(9): 'xiPerinaucnt or. 01kniporary
By.sr`g»ing elrrr.furnr;,l'herrby rerrify rhar the n•e11fs)wia.(nrm)cmtrtrurrrd hi:aceordmice
riirh 15A KCAC 02C 101001 or,J SA KCAL oil.209 lVell Cona?Ricdon Starulards and fivi o
7:Is'thh'ar!eIlawtdancv4tint;it'clli Eft .fir ENU. cu cii;rhssircvrrJltnsbreir';rayrlrG�lrrrifv vnitmviur.
6b,"is l a ir,pair fll tmr jC'nt�w ivell tnu/..tpbhi rho narare 01rpe
.,ep.-rr rtrdar 021 r6 d&s:neei&.nr ua the back of dies fnruc 23.Site dial;ram or additional well details:
you may use ibe b5cl:oft his papa,io,pfpc;idt addilionai ivell site details or twell
S.Nutuberof Wells conitmeted: 1 construction details: You inac alsa:atlach addifioiW pages if lec'essary.
Frrr t*r mlrhrhe.saiveranstrui77on,tt.ra eyva
saiavrdraxv fair"., SUBMU ALi-STITC`I'IONS.
9:ToiA i�rfll depth belorr9:tnd surfaces 62 09 2da:_l:or All Wtills. Sirbritit Ibis fonri siitluti 30 days of'complcli6n of Stiell
Fi�rriraid�*le�ectls'lisT,�PJrlaagut�'ffcf�1reaiF�cxnr,�i9i€�':ItSf1p'aRul?�1i4��' canstnrckiolitathe.fo[[ouib�..
10.Static%water level lidaiv top of casing„ (lY-) Di"Siuu.of Water Re.ou Ices,Information Yro'cessint,Unit,
Ilitwter evelh ibotvti rds.tg s our" IG17 Atuil,5Micc Ceeitc"r#"li lcigltl.�1C 27699-1617
11.Borehole diameter:l0 in (in,) tab.For Tnfecilnri Wclis ONLY: in add'Rion to sending the form to Ilia address in
24a abode,also submit a.Copy of dtis.fonn in Awith days"of cotnpletioi u of Troll
12.Welt constniction method: Sonic Lon.stniction to fire fouo%*te:
0.1c.sugar. puskctc.1
Division of Water Rcsourcea,Uttdcrgrouud Iuj etioh Con"I Program,
FOR}VATER SUPPLY WELLS ONLY: T636,A.Iall Serc'ice Center.Raleigh,NC 27699-1636
13.%Yield to ';IMiod af:tcst. 24c.For Water Supply&Inicctiin Wells:
') Also subtuit one cop)' of.this fdilli syid)in 30 da},s of completion of
b.Uisinfeeflan types _ _ __ _ Aninunt: r�r l c onstiruction to the county f caikh dcpartmpst of the ca4W'.whcre
st
FarmCaR{-t North Carol!=Dqk skint of Erviraninernand Naraual Resources—Diva ion oflVatcrftesu rom Revised August2013