GW1-2022-05411_Well Construction - GW1_20220311

WELL CONSTRUCTION RECORD For inorml Use ONLY: %([Field.)D #])
'fins form can be rr_wd for sivgk w m0ipk voclis
I
• 1.V4'dE Cnntr.4ctor ittfartatattur:
;14i3 r+1 R,Lt)lN'U..� .
Chris Huffer IrRO i Tt) 00('RIF111 s
WellCorMractoTNanx
4223 A
NC'%'dlCommaorCcrtifocotionNambu A&OUTERVASlNG ormulti sseI ells OR-U,NER(.da0lea"
FROit TO Dtn11tFTER TttiCiCNESS IhlATEPIAL
SAEDACCO Inc rL ft in.
Cnngr 1ny t rarrlC ib:Q11TIEFt l^ASTNG'QR1'TUB' ibc�tsl daled4iM
FROM TO DIAMETER TRiCt:NESS MATERIAL
2.Well Construction Permit,a*: 0 A. 46 tt, 6 ; Eft. sch 40 PVC
fig 41Jtrpy UMblex-dipanxits(Er.Cairnfc.Stair,b'ariarwe,Irferefcrl rtr.I fL fi, in
3.'V AO Ube(ckcckYkcll osc): 9 SC1tL11Nr..
Water Supple'Welk PROM TO DfAMURTM StOTSIZF, THICIINFSS MAT9VAl,
Mgricultuml MinidpalfPublic 66 ft. 46 A. 6 ib. 020 SS
®geothermal(Healing/Cooling Supply) ❑REsidential Watcr Supply(single) fi 2 in.
®industriah'Commcrcial Olkesideutial Water Supply'(sbarod) s cRofrT: ::
FROM TQ MATERLIL EMPLACEMENT MMOD&AMOUNT
❑trri _tion 0 M 40 1L Portland Tremie
Non-Water Supply WM,
❑lvloaitodn; ®ItscoNr fQ
Injection Weli: ___ _ _ _.. rt rL
Clagrrifcr Recharge Md oundwatcr Remcdiation 1t+`SAN11ff "E1.11At 1 X _t", l►k?;
ra�M _ �rnrr4tetal. itrrtn ttt•rrn;t:rxota
PAquifcr Storage aW Rccoi)M QSalinily>Bamcr 71 43 rt» Sand 3
❑Aquifer Tcst ❑Stommatcr"nag: R. tt
pl xperimcntal Technology ❑sabsidcncc corml
2A:-D'R1LUKU1bG'1aRac�itiddif ooaiibeeiiit'ireces€a '3
❑Cr othemial(Closed Loop) []Tracer PRO,Nr TO taobr.bardnwfl.rulkmcli d rtnr err.
❑Geothermal(i{earit tCooliue Reruaq ❑othet(ex ain under#21 Remaft) 1L h.
M rL
4.Date Wel(s)Cn mplelcd: 2-15-2022 Well ID#EW-45 See Gap s note$L
Sat ►1rc11 Locatiirn: (L 1L
Chemours ft. rt,
Facilit;)0wocrNow Facilk-IDN(ifapplicable) ft, it MAK I IUC
1248 Sill Hall Rd White Oak, NC 28399 Cumberland C, ft. 1L
White Oak, NC, 28399 P1lysieal Addrum City.and Zip 2LRE f
Cumberland 71-66 is a 6 in SS sump
Giv ats' Parcel Malificalion No,(PIN)
5b.140tude and l ongitudc in deu0minuteslscc6nds or decimal dcgrccsc 2L Crrtification:
(iflacu field,mee lablong,is W icicid)
W Chris Ruffer 2/15/2022
Signature ofGcntfied Well Contracwr Date
6.Is(are)the well(S) 10Permanent or oTeumporary &'signing thin faro"1 hereby feffily rhar Ike lrellf.rl NT'Y 414rrri twfuinfried hr mvardamw
lvirh 15A NCAC 02C.0100 ar.15A NCAC 02C,(lM Well Cunsmirtimt Standards and tlxrr a
7.Is this a repair to on existing Novell: O Ves or K No rater Of011•f Mf0rd ha brM ptr>*k4f M rhr m-11 r+11M
ljrhfs is a repair,fall tier krfoiwr well e,%%1nrcAv lggmwrkn aad exptahl r1a•narore of fie
reprrirwderb2l reamrkr.rerfien orrm the brxk ujrhls fhrnL 23.Site did ram or additional well details:
You may use die back of this page to proNide additional well site details or well
8.Number of wells uonm tooted: 1 construction details. You may also attach additional pages if necessary.
For xrafd ple 1r{te ikm tx nim-wafer jWply welh Ir,YLV mirh rhr-armer"Psouedon,xnu can
mtyniram form. SUBMITTAL INSTUCTTONS
9.Total well depth below land surface: 71 (ft.) 24a For All Wells: Subndt this form wilhin 3U days of completion of well
For mulflple wefts lift all4eprhr if dt rf�rew le 4v vie-.3@?00'amf 3a IM) corulnrction to the toltosing.
10.Static water level below top of casing: (ft.) Division of Water Resou rce3,Info►rmation Processing Unit.
If"ref level is above tWON't-awe"+" 1617 Alan Sen•iee Center,R:tleil h,INC 2 7699-16 1 7
11.I orebole diameter..10 in ( ) 24b.For 1Diectlon Wells ONLY: In addition to sending the form to the address in
24aabove. also submit a co py^ of this form within 30 days of completion of well
12.Well col mmetiau method.• Sonic construction to the follolvthkg.
(i.e.auger.rotary.cable.diaeci push etcJ
Division of Water Raesourees,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 16361611 Semiir Center,Raleigh,KC 276"4636
13a.Vicki(gpm) Method of test:. 24c.Vor Water Supply Oft 1nloct on Wells:
Also submit ow copy of this!form within 30 days of completion of
13h:Disinkvdun opt, Amonnt ..... wxli constmcdon to the county health department of the county where
constructed. I
Form Glut Noah Carolina Dcpcmnr m of Em•irumnen and NarmW Resowccs-Division of%filer Resou Revised August�!013