GW1--04537_Well Construction - GW1_20230713

WELL CONSTRUCTION RECORD For use ONLY:
This forfncan be used for single or multiple wells•
1.Weil.ContTactorInformation:
14iWATLR ZONES
Scott Hunt, Jr FROM• TO DINCIUPtION .
Well CoMndnrNana! ' ft. ft.
4561-A ft. rt..
NC Well CanlracrorCertifeeation Number 'IS.OUTER CASING CIoriunti matt itllsl ORLiNER lire fitabkl':
' FROM TO DIAMETER ' TWCKNFsS, MATERIAL
SAEDACCO Inc f4 ft. in
Company Nam 16.INNER CASING ORTUBIlYGA;eaihermal clased400p)
FROM TO DLt4MQETER THICKNESS MATERIAL
2.Well Ciondtr'uction Per'init#: • 0 ' -R. 25 ' ft; 2 ha ' SCH-40 PVC '
List all ajytlicablc tscllpenirits(En.County.Sane,:Variance.lifectf[ry a;)
R. ft. ha
3.Well Use(check well use) I7:5Cut:EN _
•
Water Supply Well: • — ' - - _-- - FROM TO DIAMETER SLOT sin THICKNESS MAtl RtAr,
ClAgtieillttuai .ClMunicipal/Public -25 R. 35 ft. 2 ill* .010 SCH-40 PVC
. ®G rm eotheal(Heating,rCooling Supply) ®Residential Water Supply(single) fa ft. ill,'
DlndusiriaUConwtcrcial • (]Residential Water Stippl (slEtttcd) `cam • T. Pro . ainTErlGL EMP[ACE4tEVT 1IIHTHOD.5 AMOUNT
Diminution . . 0 ft. 19 ft, Portland Injection
Non-Water Supply Well: •
CaMt nitodng ry•°Recove ft. ft
Injection Well: . ft.• ft.
. °AquiferRccharge •CIGroundwatcrRcnicdiatian ;19 SANDIGI{AVEL•PACKprappIle.,bti ..
FROM TO • MATEIIIAI. ` EMPI.AMII tMI:tupn
(°Aquifer Storage and Recovery (°Salinity Barrier` 22 R. '3 6 ft. Sand #2
❑Aquifer Test DStornmater[)ruing. •
R, It.
Ol✓xgiCrimenfal hrhn0togy [7Stibsidcncc COtdral rIlL-DRJLLiNG:LOG(tiuneh additimtialshcctsif acccssari•l -
DGeoiliennal(Closed Loop) OTracer FROM r TO DESCRIPTION faubr.hsnrneo,torentckhrx'rrain tan.dal
DGeotltennal(Heating/Cooling Return) . DOther(explain under#21 Retnai s) 0 ft: 5 rt. Fill
5 ft. 35 • ft. Sandy Silt
4.Date Weit(s)Completed: 6-21-23 , Well m#O1/-37_ It. • fL
•
r-h,i a" ;, r r.a
5a,Well Location: rt. f4 - '° -- +'Is.,,,� -i i.r L
Chemours _ • It. • ft,
.It ll. . 1. ` �—
Fact7ii}•rYlwncrTlande Facilitl•ID#(if applicable) R. ft, ��
1248 Bill Hall Rd. , Fayetteville, NC, 28306 R fr iffivrri.:,S:,0iI i'!:.-.ry,,.Nr,3 UR;t'
•
PlgsicalAddrass.City_and Zip Rd�`�i'"�:,
%21:RE6rA1tK$
Cumberland Bentonite Seal from 19-22'
Calmly Parcel Idpitifleiniuu No,(PIN)
Sb,Latitudeand Longitude in degrxeslminutcslsceonds or decimal degrees: 22.Certification:
(dwell field,tote!Along Is st.nitltrd)
N w �«tt- - 6/25/2023
Sigmture ofCerithed Well Cop _ tar Dale
6.Is(are)the.{Tell(9): 81PeninUlCttt or OTelttparary si nht !iris arm,I hereby cent a cheer Me•udl s i way weret compacted itr atrardanee
s b f 1. l'. t
with 15,1 NCAC OW.0100 or 154 NCAC 02C..0200{{441 Corrstrttctiorr Standards vnd this a
7.Is this a repair to an existing well: Dyes or ®No cf>pr of this rrvoni has b nt provided fo die'loll owner,
1f this,lea repair.f 11 oat known well can tnrctI-an information and r.pton'the narare of lift -
repair rattlerP21 remarks sresian ar on the back of this form 23.Site diagram or additional well details:
You-may use the back of this page to•provide additional well site details or well
S.Numberaf wells constructed: 1 construction details. You may also attach additional pages if necessary.
.For multiple kdecrlon'or can-water supply wens ONLY.with the same cunstruriion,you can
submit one form. Si113M1TTAL iNSTUCTIONS
9.Total well depth betow.land surface. 35 • (rli,) 24a. For All Wells:- Submit this farm within 30 days of completion of well
For assis/plr nulls list oil depths Ifdj(li+rent(er„nrrtplc-3@200'and?re!PO; constnetion to the foltatving: '
10.Static water level below top of casing 10 • (f ) Division of Water Resonates,Information Processing Unit,
if n'arer letrel is above casing.use"+" 1617 Mail Service Center,Ra1cig1.NC 27699-1617
II,Borehole diameter:6" (in.) 24b.For infecton Wells ONLY:, in addition to sending the form to the address in
24a above also submit as copy of,this faun within 30 days of completion of well
12.Well construction method: Roto-Sonic construction to the following:
tic:augcr..rotiup,cable direct push efc:l Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh.NC 2 7699-1636
13a Yield(gpm) Method of test 24e.For Water Supply&-Injcetiou Wells:
Also submit one copy of this font within 30 daysofcompletion of
1311.Disinfection typo Amount: well construction to the county health department of the county where
constnteted 1
Form Gar-1 North Carus lira Depmurem m of E irarurrcta and Natural Resources-Dive ion of Wafer RrnouuEsc Revised August 2013