GW1-2022-05245_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD Far I ricrnal tTs,ONLY:
.,nb forfficm bc.used rii single or multilik wells,
1.Welf6utraeiar hiformation:
14.WAlt,R ZONFS
Chris Ruffer FRO'N1 .70. OF-ICRI"ION
ft. 171.
4223 A r
NC.Wcll Commclor CerfifwWoo Nllrbcr 15.OUTER CA-SFNG(for in u h kaQed viefIrs OR'Ll cable)
FRONT TO. PLA METER, THIMI!UTAMTERM..
SAEDACCO Inc h, ft.
nl
C4111putyNalue 16.INNER CASING OR 11111ING'` nobermal ckisA400p)',
FRONT TO DIMMEnW I "IMNESS NLtiTEAt1L
21 w1j1 Constili4wilOeiin-it i. 0 R. 54 It 6 "�L F sch 40 PVC
f.W all apy�lrable'wr 4 primi tz(Le.
3. (ch,c,ckwcIl use),-. 'CN
VAC RE
Water SuppLy Well- FRONT, To. DTAArKTrE1 SLOT,%1ZX I IIHCKNF_�iS VNIATERTAL
0.Agridu.Ituml ic, 74 0, 54 ft. 6 im,
A26- SS
136wifiennal(Headrkg1CooiiDg Supply) ®Residential Water Supply(single,I.
1311ndustirial/Copinfucibi ORtsidutial Water Supply(shared) IS.-GROUT
FRONT TO. NIATERLU, EMPLACEMENT NMMOD&MIOUNT
ElHoption 0 it.' 48 It. Portland Tremie
Non-Water SIT pDly Well:
[Alouitoring DORCCOIXTY 0.
ft
lrljec!iop Well: ft. ft.
13Aqi#.(crRcchirge EdGroundssn#cr Rdiowdiltion 19.SAND,GR,'LVFL PACK(it applicAle)
.: I 'VR0hf' 110 1 A(:"IFNT NIVM010
ge ecovety hi"' Ep
f.:l�qilitjcrs"lora' and R- n8alini El Cr '111.: 1 ft. Sand :F_�':
79 5 3
IlArlid(d�Test QsOrrnwaicrfirninagc
IjE.V�cfirncntil Tcqhnologn, bSubsidcncd 6nlrol
IQ.-DRILLIN,G LOG faiuch additional sheelf If ftTownryl
EI Gkothqnnal(closed Loop) 0-Tracer FRONT .TO DESCRIPTION-(mbr.Ijardticvi.willnKk 'gWjj QWe.dM
DGeothen"(Heaiiqt,)Cao[fng Return) 110flter(explain wider 421 Rettlads) rt. ft.
ft., fL
2-10-2022 '%V.ejl][D#EW-49
See G
k"t— V I
R..no s noteifL
t.
Chemours ft, I'll MAY 3 1 2022
EacililgrOtttxrNnrre Fdqffly IDX ffaffikabIV) tt. ft.
o Urih
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C,
White Oak, NC, 28399 PI(Vikid Aoqieis.cjtyjlnd Zi' '2 1.REMARK:
Cumberland 79-74 is a 6 in SS sump
Coofily Parcel hiinilirccalik)n No,(PIN)
Ac and 0-occimul Alftrees: 22:Certiricatioif.-
_N W _Chris RUffer 2/10/2022
.-. o rceraind well cc Himcmil Ddle
6.Is(are)t17cme11(5)- XlPernianekti or IlTemporary.
ft,p-yigijr'fig j1rhfiaqr41 Ireroy ecifify f�jqf dir vjvs emairyeied ior;deeordfin
idth 15A AVCAC 02C.010I0 or.1.5AVCAC-a2C..0200}Yell Cmrstuicric.;5(driflards olldfWid
16-06 aLrell3jifo an C'.KjNtjngwCll-
Mcg. ar AaNio• copyof ixi
?VAzTM,fj11AW1rhV'(;1tW 1LT1Jeo,?jY;nfcdan htlor6wm:cvj andewpbM r1je,ohneire of the
aralt the hark-of6isforM 23.Site diagnat or additional well details:
You nii),iiip:,.th,e back of this p6g&to Provide additional well site,detajls,or well
R.Nintiber-of wells constructed: 1 consItuctioO delft& You finny AIS6,afiacll a"fiouiil pages if necessary.
For wiiizipre iq�vz�,wr or' orvi-miier the mme
=!�Udr SUBMITTAL fTQSTLTCTIUCVS
9.Total well depth befowl I;md surraCe: 79 24a. For All Wells Subfirit this funn within al!)Aays of-completion of well
For)MORple 4:01`06ir 47"thArts irdwe'reol; con.5tructiolii to Ille to'llowl ng I;
10.Staflewater level below top of easing: ivisidit of Water lltemu regg,tnformation Processing Unit,
11-ver level b,aboi-e caj*�am"+ 160 MAil Service Center,RA- cigh,NC 27699-1 617
11.13archote diameter.10 in (in.) 24b.Fnr[njW !jnWelLqqNLLV- In addition to sending Me-form to-the address.in
24ak o've. also submit a copy of this f0ful within�36 da);s of completion of wd1l
12,Well'coustructiou method: Sonic Lonstiuction 10 t1w follovyiug:
(% e diiect Dusk etc.)
Diyisio.0 ofWater'Reidurcks.Underground tojecilion con"I V.rogiujil'
FOR WATE R S UPIP LIF NVEL L5 ONM 1634 NIA Service Center,Raleigh,NC176994636
13x Vlcld(gpTu) 51ctliall of test: 14c.For Water Supply&-.Ipjm10 I n Wells:
Also subnift one'copy of.this fonii within 30 days of comoletion of
'13b.l)1N'inrCrfi1jn#pC. Amount: well constriction to the county h0lth department of iftc counmwficrc
to nu Gk%'-I N',Dlah Carolina Department of Envirojuivianad Narmal Resources-DINk ion ol"Walcr-Resoutes fteviscd Aqgust2'N)I1_