GW1-2022-05249_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD For lucnial UscONLY:
nfs farm cart bc:used for sin„lc ci multiok wtils-
1.W0,6kitraetor hifortuation:
la.'WATER ZONES
Chris Ruffer FROM. TO "FICRIPnox
ft. rt.
4223 A
NC,,WcllCommclorCcnifwationNitiuber 15.OUTER CASENG,ffoP mullkawd wells)OR LIN`FR
FROST I To I DTAMETER- 1 THICKIMSS: 11AMIlAt,
SAEDACCO Inc fL. (L An.
16ANNFR CASING OR" 1111 the -At Close 40(la
FROM To I DUMETER THICKNESS I MATERUL
2.*611 6uurtietfon Pittlit h: 0 R. 40 ft 6 h4 sch 40 PVC
ft
use);
17:5CREEN
Water Si0pply Wi�.Jh. FROM I To 11TANTETFit I SLOTSWX T"FCKNFS1-- I-MATFUtAT.
OAMculml riMutijkipa-liPublic, (i0 ft, 40 ft. 6 '.026
SS
®Residential Water Supply(single)OGcothcnnal fficidngtooilug Supply)
13 lodusaialfContnfcrcjnll ®Residential%%lcr'SupPb*(shared) I&GROUT
FRONT I TO mATmE&L I EArPLACrSfUNT'VMOD&ANTOUNT
0 ft. 34 (L Portland Trim
Non-Water Supply Well:
Inject loll we.it.: ft., ft;
19.SAN b,1GFt.AVELTAC fit applicable)
'vROar IM
65 (L 37 ft, Sand 3
gc.
ft. ft.
1:1 rimcnial 7rcchuotogy b8uh5idcncctai*ml
'U."DRILLINGLOG(flit ich
ElCrevittenual(!2l,qstd Loop) OTrojeer F11031: LTO DUKRIMOX(mbr.
ElCkothennal(ffeatineCoolfnp Retuin) E10ther(es: laic wider 921 Rewatks)
4.`D.tteNVei1(s)Cdtnpieted: 2-3-2022 W�,jj 11)#EW-6 2 F;C="
See 0f1p a note$4
r
Wcl[,Locathjn. (L (L
Chemours 1L
Rql ity)Uw N r Nmw faqlhy iw`(jr,appltabld).
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, In, ft. M kvft,�,, .g Ursa
White Oak, NC, 28399 Phs-i-raid�ild6s�dtp.and Zip 21.RENVLRIO;
Cumberland 65-60 is a 6 in SS sump
5b.IltihrdcantlLOngrntude.in.d;grccs/mhtut6 couds'ni dechnal ftgri:6:
I kO 221 Cektifi6floll:
—N W I Chris- Ruffer 2/3/2022
Ft— =,tffJcd1VdlCo,,o=,'(di Mile
6.Is(are)the well�(s)- -xiPermativat or oTewporary.
fty--"Oblk (hafJje ireflis)vvax(K-ere)
idth 15A XCACO2c,0100 or 15A KC,1C0--C.-0J0P
7.ls.thbi a repair to wo,itxhttng�Nv'Clk E]Ycs Or kNO 10j&;ir.11 mviier,
#1fS'h.a qqxT;ifVl tvr AluciftV well and explahl the"narare pfrAc
23.Site d ani or additional well details:
reMir udir 921 rmi2rkv"rAan ear un the bast:af this farML 41#1"
You may use.ihe back of this 0&to Pto%4de additional well site details orti6ll.
R.Nutuberof*ells constructed: 1 constmefiondeta'its: You 111avalS6,ittachaddifional pages if jvxes'sary-'
Foe)#'M hipfe lreftrx�-o i ty' vta t'-u4 i re r snp#y-i vr Us ONLY w1rh the mm e o6fistruirica i,yea con �[JBMETtAL
9joid well depth bet ow
o*land surface 65 (ff.) -34a. For All Wills! StAintit Ns fumy within 3.6 daysof-contpictiod of well
A'r maNple W,044v 4irleerda ffd4fferoit(e, 2@AVy con'stnicii0li to 111c folto"ing
10.Statte water levell IMOW top of casilgr. Division nf Water Remourcei,infitrmatibnPrdccssin-.-Unit;
11,11we't lev.ei 1,jMove WAing 1617 Mail Smice Center,RA- cigh,,XC,2T69-1617
,Boreboledilain ctr-10 in
(in.) 24b.For fiijafag Lif!dIq ONLY: In addition to sending the fomilo the addiess in
24a;abb�le,also submit a copy of this faint willtin JO days of completion of trdl
W IL Well construction method: Sonic consto3dioli 16 the fbllo%i,hlg:
(LP.,mer. direct iluSk etc.)
Division of Water Resources,Underground rnjecdon Contr6l Program,
FOR WATER SUPPLY WELLS ONLY- 1636 Mail Service Cmler,Raleigh,NC 2*9-1636
24c.Fdr Water Supply&-Injection WON:
3;14 Y1 cl d(gpnl) Method of test Also subifift one"copy of this f6mi within _3 30'days of completion of
113b.Disinfect I ion Jyper Amount: .,%,%-cli cominictitn to the county licalth dcpqrtnient of ilic c01lFt4�1LVhCrC,
constnictZI
Fbnu,G%W-1 NDHh Carolina Eltp rttortnt.nf Envimnirrcnfl and Uarural Remwees—DiviiiDnol'U'alerilmotrom Revised August 2013