GW1-2022-05251_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD Far h1cpW Vsc..OK V:
M form can bc USPA F&single Of altillipIc*C115,
.11.Will.,Ontractor Information:
U.WATER ZONIS
Chris Ruffer FROM IM) OF-SCRIPTION
V610i t.qrArjqor'NaM'k ft. R. I i ­
4223 A R. I A. I I
NC,,Wc]I Co ntih cto r Cc n i fwaa i o o Nianiici 15.OUTER CASING(for molli vand Ast[14 TOR LINFR(Warl Tioblei T..
FRO'm I To. I PIAMETER CK SS M ar,,7,,
SAEDACCO Inc fL, ft. I in. I
C41apally Nollie, 16.INNER CASING OR I IBING,(-.zeotbLirinaickiFLd4t)tii)�
-FROM M DL4tiIFTE1;t. THICKNESS, MATERIAL
well Construction OCIM'lit M. 0 -ft. 30 ft. 6 in soh 40 Pvc
fist oil liftrUcil err.) Ft. ft
m.
3.Wdl.0 5 C cheel,wqll 1iCg 0.
*N
Water Supply VVIAh. Fliom TO MAILIFETFIC MOTS17T. 7MCKNF,1,S I MATRUIAL
3�O ft.: 50 ff. 6 S.02b S
MOC1116ral riNfunicipayhiblic I I ,
06cothannai(Heitjngtooiing Supply) Mesidential Wiafer Suppjy(sirigle) ft. I
Mlbdustrial/Carnmercial Mesidential-AVatcr Supp4,(shared) ig.-G ROUT FRONY %70 MATE L%L- i E4tPL*,MMT3n7MOD.4XM01iNT
0 Ft.' 23 (C Portland Trelnei
Non-Hater Supply,Well: ft fi.
MAqu#cr Recharge" Mjroimdri-ater R,ernediition 19.SANO.'GFOLVEL PACK tit applical)k.)
FROST 7t3 A C.FA I KST h I FT I 10 1)
'13Aq-01kr Storag'c"anJ ke6voy El5ilin!fy Birficr
27 ft, 55 N. Sand 3
0AqM ier D­ihioagc,
bj'Vcrimcntal Technotogy 086sidcriccConlTal,
10.DRILLING LOG 611mh additional sbeds if Pecesmryl
ElGeodienstal(121used Loop) Trj
lidwiltennat(Reating 14
,,r-ooliug Return) E10dier(explain under 921 Remaiks) J4 (
%H(4)j[;qtnplcIe : 3-25-2022
d Well 11D#EW-10
See s note$L
54:Altil Location: ft, fL
Chemours ft, ft. 3 1 2M
"2U,,n Pr"�c.LaS.,ipn Ur�i
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, ft, DVVQ!-30G
White Oak, NC, 28399 Ph4kifli�ddrc's&Cjty_thd'z"T zILREMARMS
Cumberland 50-55 is a 6in SS sump
Ktudc in -lids ro-'d exiroal
is samckill)
_N Chris, Ruffe' r 3-25-2022
WellCOntlacady Me
6.,Is(are)thewell(o): EPertnaneut or Iffernporary. gy Irereby cerf;fy djw-ME ireflfs)twx fµ,eir)conqnfeied in,iteevithwre
7.Ix thL%a re6aii in an cAstin�vcli: ElYew. or IKINo coy,bf ffiic ievanf hail
T
23.Site diagram or additional well detaits-
you roili use the back a this paw,t6provide additional Avell site.dkiiiii,of A;Vill
8.Number-of*611s co,usirticted: 1 coflsftucdon'deialrs:-Youinay als6:auach additionalI .pages,if I necessary.
Fbr;6hq19e.lo�vvl}i-.tv luki-ionwr jWAv wlqfs.ONLY.wirfi,rhe some
UR SNIMAL INSTUCITONS
9.Tot a-I well,depth.helow laml surface: 55 24a. For All Urells: Slibihil dl�is farn-i uithin 10 days of-compiciiori'of well
Far*, 4m*�edswsr r,'6eeP16Vd*rof1 to Otc;
10.Static livater lael.helow top of casing;. Division of Water Reisou trey,Information Processing Unit,
lf)twter Ind it abors cask-,,tax 160 NC-27699-1617
11.Borehole dizinctch.10 in 24b.For thhfig1l WON ONLY: In addition to sending the form to the address in
24dabo1,v.also submit a colic, of this fanu within 30 da};s of completion of cull
12.'Wel-I'constmetion method: sonic constnittion 16 the f0floMlig.
(i.e.ng'cr,nxaM cable,'_dory rush etc.)
"Division of Water Resdurc6.Underground Injection Control Pro(,
FOR NVATER SUPPLY NVELLS'0NLY.-' 4636 Mail S,Tvice benter.Raleigh,NC-2*9-1636
13a.Yield(g'trl) For Water Supply&Injc.Ct(4l1 Wells.
_p Alcthadbf test-
Also submit one copy of titis f6fin. within 30 days ofcompletion of
13h,D.1sinfertilm type, Arnount, wFli,comsimcdon.to the county I I icalih department of ihc colmhr.whcrc
con.-itmacd.
Fann-MV-1 Nonli Carolina De-womm of Enviroulixu aW Virtiral Resources—Diviflon ofWalciRmiou es Revised Aqgust 3