GW1-2022-05407_Well Construction - GW1_20220311

WELL CONSTRUCTION RECORD For Ranw]Use ONLY:
This fixm can be used ft sink or maltipic swill
%([Field.ID #])
1.Well Contractor.hiformation:
14eWATE.;ZONES,
Chris Ruffer FROM -M 0MCKIMON
W01 CorArwc-T Namc
4223 A ft.
NC WeA Coiftaor Cerlitication Number A&OUTER CASING OoFittill 1—§A*4964)K UNIM fifff-i llcabkc
V"ROM TO PUSIETER TRIMMSS I MATERIAL
SAEDACCO Inc (L 1L
FROM TO DEMIETER, THICKNUM, MATERIAL
2.Well con5trilcann Pcowlit 4: 0 It. 8 ft. 6 kL sch 40 PVC
Varlafrre.
ft. ft. K
3.Well use(ch"Watil uscy
Water Supply Well: FA0111 'to or-AMFITER Sr.Arsryx MUMMS MAMIAL
OAgricultuml OMunicipal.Ttiblic i3 ft. 8 rt. 6 in. .026 SS
Moothennal I'llealingCooling Supply) ®Residential Water Supply(single) ft. ft
MesidentialWater Supply-(shared) A-,GROUT.
FROM TO IPTATERML EMPTACKNOT MMOD&AMOUNT
ofitipation 0 ft. 2 1L Portland Tremie
Non-WaterSuppl)Well:
QMonifori
Injectlon Well:
0 Aqui(cr Rc0airgi: Moroun.dn-atcr Rculc4intion I AN L PAC S 7st i'l
MAquillcr Sloragc and Recovery Malinily Farrier70"Oh
18 rt.. 5 A. Sand 3
0 Aqitfcr TW MSIommratcr Ormnagc
mvcrimcah,I Twhnotop 13S4sJid=c Cor 4rot
EiGeodienual(Closed Loop) 13Tractt
PROW, TO
ElGeodicaml(Read qgCo2Liqg Return) 000hu 4Mbin under#21 Retoar&s) ft. 1L
4.Date Well(s)Completed: 2-15-2022 WejljD#EW-4 4 FL See Gftp (L
s note*L
5a.Well lacathin: rL 1L MAR 11202?
Chemours fL (L
FactlRyADwocr Name Facilily U)#(kappiimblo) fL
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, rt tL
White Oak, KC, 28399 Plivskal Addmss.City.and Zip
Cumberland 18-13 is a 6 in SS sump
County PartCl I&IiIJAMIJon No,(PIN)
M.Latitude and Longttade in k7mvshninutco/accoinds or decimal dcg,rees;
(Irmoll fictd.mid"10mg is sl&r 2L Cartifikation:
Chris Ruffer 2/15/2022
igiati ri ofCcrtillod Well Contractof Da*L
6.Is(tire)the well(s)- oPennanent or oTemporaty bN 3igninx Ahbfum,I hereby rer4y rhar*e vvil(s i�w m o y Jt4rrr) winte-jed ftr,a%TarJanre
irirfi 154 MAC 02C.0100 or 15A KCAC 03C.0200 Well CanitmaAhn StawfarAs and rhar tT
7.Is this a rripair to au exis.Ung well: Mes or NNo copy qffl* t4yrilowner,
IftbisIs o repair.fill 4mr Aw;Kyj well t~ k-thee)inforyw"t dvid expbht r1je oknmre of(fir
repTir crueler IM rrmarL-xxra&m arrApi the back afrAisfuror. 23.Site diagram or additional well details:
You play use die back"of this page to ptoxide additional%a site details or well
8.Numberorweib constructed: 1 conomcdon details. You may also attach additional pages if necessary.
For*akiple jt%lee4on ty not-warer&Vply wells OjVLV MrA the acme constrswtim,A"em
AwNxit ear fames. SUBMMAL INSTITCHONS
9.Total wt4l depth bekw land surracr. 18 24a, For All Welix Submit this fool Within 10 days of conviction of"vil
For otalfiple wells lisp tell deprW itdt,f'li-rejw fe.r4wipfe-3@200'and 2@ IM) Construction to the folkMing-.
10.Static water level below Mp of casiur. Division of Water Resou itei,laftirmationt Psocessing Unit,
4howh's,level is leer,am"+ 16 0 Mail Servi lee Center,Raleigh,KC 276"4617
1
It.Somboic diameter.10 in 24b.For Injago B:r.lLq ONLY: In addition to sending the farm to the address;in
24a abox-e. also submit a coO of this f0fin Within 30 days of completion of well
12.Well construction indbod: Sonic Construction to tile followil
(i.e.xaper.rotary,cable:diyw push ctc.)
DMAon of Water Resources.Underground Injection.Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 NIA Setvkc Center.RAC1910C 27699-1636
For Water SvRpl�i&Ip
13a.Yield(rpm) Method at test-
24c jc6iou Wells-
Also subjAit one copy of"'farm within 30 days of completion of
13h.DhAurmfion typc Amount., ."ell consiructidn to the county y licalth Jcp3Ftmcnt of the courll,,%Vh=
constructod.
Form GW-I North Carolina Dcpaflmemeof Emirojumm aria NawrjJ Resources-Division of Wales ltesatrms Rcvkd ALVM MA