GW1-2022-05250_Well Construction - GW1_20220531

WELL CONSTRUCTIONRECORD For irswrml Use
Thf,s fonacanbc uscd,Fift single or multipk wells,
1.Well CtintraetorInforma"tiom'
14.WATER ZONES
Chris Ruffer FROM To m8cmPV1()N
4223 A ft.
NC Well Contbeior Con if=tfon Num6ey 15.OUTER CASING(ro?'m ith 14a-vd wills)OR LINE Ft i If iill FRO31 I To. DLOVE-TER, I TH!MIM
SAEDACCO Inc ft.,
INNER CASING OR TLrRING(geolk-rimil cksed-lootw)
JERONI To DMIETER _THIC"ESS I hLAlEIUAL
1
2,W01 Comtru4luff Permit0 0 ft ft. 40 ft.. 6 In sch 40 PVC
!$I 4i,aiollrabk vor4eimftllfir.cimmi%,36ile,.11arifirrce.fiftrdm fir.)
3. 05�c( c'clz well E'l 9q),
17.SCREEN.
FROM TO '1DrX'%TFTFR' SLOTSWX '"HCUNt-lig IATRRMT.
dAgTiculti-tital 0municilmm.�l ic 60 ft.: 40 6 k '.026 SS
06cothelmal(licitineCooiing Supply) 011esidmfial W iter Supply-(singk)-
OludustfialfConintcrcial 1311esidmial-Water Suppb-.(sharcil) 18,GROUT
FROM , To MATERIAL I EMPIAMIENTItMOD&AINIOUNY
Eltrrigation 0 ft.' 34 it Portland Trim
N-on7WAter Supply NWII:
lujPetioll
DA,quiticr Rc6.h4gi DdGroulidvs-atcr Ranicciii1ion 19,SAN WIGRAVEL PACK(Ir aliplitibbfi)
F'Rnh1' TO AMM"TMETH511
E6k i(dr Sto "'.aiii kcco,,)&y Elsaliwiv�Ird6i I F-m
- . 719c t 6 1-agiz, 65 ft., 37 =Sand 3
OAcliliki Test am. - I
�t ,ft.,. It.
20.:DRILLING'LOG-611Ach a414111ionji sbccls if DUCLn5flryl
ElGeothennal.(Pused Loop) DTtacet FR0,S liarJ604 vd%InKk t�K.'gn6iiw.,C.kk.)
oGeolltenna I(HeatiaeCoolftig Mum) E100ter(Lxpla in Under.421.Retuaiks) Yt. ft
ft.,
a I te.%Iffs)1�tfthpklcd: 2-2-2022 VVe.11 ID#)EW-5 8 R.
See G& s notelL
ft.
Chemours ft. rL MAY 3 t 2022
Factffity lDff qpjtnt�c)'
I I . 11 fill it. PrDcwvz`n.g Unix
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C,
White Oak, NC, 28399 pinsira),M ,q,P's-Cj'y'and ZIP -21.RENIAR"
Cumberland 65-60 is a 6 in SS sump
Parcel ld silirL�.iflpn No.(PIN)
5b.Latitude and.Longitudc in ftnvestminutestk co nrilccimaldcgrccs:
22,C citT icaticin:
N �� Chris: Buffer 2/3/2022
DW
6.Is(arC)the EPCrUlafieftl or oTemporary gy-y'gll6ly M um,I I kereb-il cerrify rliar,the ire )way corafmeted in-v'eoftLaqce
w1vY FM-jMtCO2C,W00 or 15et KCeIC 02C.0200.1MI Cq;4ti7jMo)i$faa4anls andjljora
7.Is this a reliali to an csi-tting well. mr 'cNio ccoy bas,PCclf provided 0 jilir-,01 mviler,
��fsls a Tep i�r;jjfi ear kumm (vul expWi Me manure qfrlic
,ipafi midi"01 hvrk",fdiisrp,.m 23.Site d=additional well details:You
may cl;of this 09e,to Pidide additional well
8.Number of wells Foitgruqed: 1 constmetioll details. You 1112,v also alfach additi olial pages if i meesiary.
FV kV&ihV1&om-iMiir sJ rAy i dlg ONLY widi r1je.samc oMsmikrimr,wm-eva
SUBMITTAL INSTEMONS
9.-*a1`*vcllAcpth below land Sttrface. 65 (frNiC Fdr All Wells: ,Subfidl lids farm v%7(hin3b days of-ciomptcfi6dof vo'ell
Fbpnuqhoje i�elfs ConstraCtion to 411c rolioviing;
10.Static water level belaw top of casinW. A) Division of W2ter Resou rees,Information Pruieming Unit,
lf)odier level b,rjF ave eusfag;use 161 1 7 Ala,il'-service Center,Raleigh,NC27,69!)-1.W
11.11orebotedianicter.10 in (in.) 24b.ar Fgh.god Mkils ONLY: In addition to sending 1W fanu to ilia addmssin
24daboke.also-sub Ant a copy'of this fonn witilin 30 days of completion of WdIl
12,N%,elfConStruetion method: Sonic consituefluli to the following.
6
Lc.aqcr.rww.cable&mc1 pusti.etc.)
Di kion of Water Res6urcesf,'Underground ltkjcction ContrW.Firoggyaul,
FOR Wit TE R SUPPLY WELLS ONLY. J[636 A fail I.Se'"ice Center.Raleigh,N. 0 2 1 7699-1636
13.' Yield( pn�) AlIctitod-oft6t:g 24c.For Water Supply&injection I Wells:
L Also submit one copy of this form with-in 30 daysofcomoletion of
1311.DWnrMti1juhP#.!:1 Amount: wcIf cansiniction to the county kcalth department of the couinh,w1wre
conMictcd.
Fenn,6%1-t Resources-Divk Ion of`Nklalcr Resoutes Revised Aogust 12013.