GW1-2022-05139_Well Construction - GW1_20220531

WELL CONS'IRUCIION.RECO D For lvtcnw USODNLY:
This torn ran be used frrl..single or mullipk wells-
1:WcICCbntnc�tor Liforntation:
ti.WATER ZONIlS
Chris Ruffer FRONT 7O OFSCRIPTR]NN
We1ICorxrnctoTMuni ft. ft.
4223 A
ft. ft.
NC Wcll ContrscfarCcdifecatiritNwib'er 15.OUTER CASING tror-mutts-6vtd'ncl10 OR Li1�ERiifa`F aticabkY
FRONT TO DLUMETER, Tt1TGtiiYE:C'S A ATEflTAL
SAEDACCO Inc ft..,I ft. iri.
(�Oiquaiiy M INNER CMING OR 7 tMING''t'eatLermul cHised tt�,i t
FRONT TO DLAMUER. TttWKNF.SS AfAURTAL
2,Well Construction pee-tit n: 0 R, 45 ft; 1 lit. Sch 40 Pvc
r iAtrftapri(irabfe x c!1 flritajts!i_e.County.Shoc.1rariance,Ir1e drab etr.:J
3.WdLUsc(chccl:vcll use): t7:si Rt?eN
Water SnpplyWelk, FRONT I TO I nrANITF.H 1 SLOTI,47% 7111"'NF-SS I MATERIAL
DAgriculiural ClitiinnicipallF'tlbl'ie 45 ft: 55 (t. i in __0 10 Sch 40 Pvc
06cothennal(Heatint3lCooling Supply) OResidential Water Syppiy(single)
®hidustrial/Conuucecia! ®R7aidcntialN1VattrSllppi}'(S1k1tC{j) FRO.hl 70. MATERIAL- I rAtP ,iCESIMAFETHOD&,AMOU4T
171tii ation 0 ft.' 39 (L Portland �Tremei
Non«ratcr Supply Wolf:: ft.. (t,
gititanitoring ®13cca{erf
Irijeclion we[[: ft. (L
MquifcrRcchiargc Mr;ionndvs-atO Reowdiation 19.SAND.'GRA1'EL PAC i tl(a i r11e11)l0-
'FRfrhr Tn NIL rERt4L F:N7YL4C.FN/F_3T NIF:7nI]lr
17Ai(tuifcr-Siora9b and Ztceaycg' Malinity B!Mcr 4z R. 55 ft. sand z
❑fttlfer Test ❑Stamm to i]rutiagc
O xpritncntal Tom.mIgg,4. drsi OStdcnce['Prowl
20;DRILLING LOG 61meh addilional sheets if"cessory)
❑Geottemul(ClactLoop) OTracer .FROST I TO Dh5CR(P1flO�fmk�nh:en{iicts,faei;'nrekf ii,vactal
❑Geothermal(RfeatingiCoolitte Return) ❑Other(explain ander921 Remad s) tt, fl.
4-28-2022 OW-45 ta" �'` "—'
d,Dute"F{'eli(s)Couipis foil. ri o11IDf� See Gao s notes,
5a:lYcll Location,
fL ft; 2022
Chemours ft. FL lnfixkma�icn Pmc*qqn";n, Lira
Foct0y'Onn r Nmtic Foct7flti IDrc li+-EapplicziWe}
J,rlM l
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, ft,, ft,
White Oak, NC, 28399 P1ry3i A, Addi'es5 city-.and Zip 21.REMARKS
Cumberland
COrrutl' l?arCCl lr}aititiC.111vn Na.,(P1N)
5h.1htitudo:iris!1Civilituil in,dGgicc5lminuteslgccontlsrrriccinial.degrees: 22.CcrtiticItions-
(Jf�we1!f�til,rbrii);rt,'ldFi�3s">guljitti;rrl) .. (-�(� [] {�
11 �j' _Cf..(1 i' A 11�C 4-28-2022
Sigmfiircofcertttico WellCautrtctdi Dais
fr.h(are)the{i'�II�N}: MNtutauent or L Tempot-ar}' Bp.r,'gnrng llas.farm;.,I trereby cer{ffy That the ivef(fs"J mw(F,rre)cgnd iryelyd ill aveordLaCC
Iikh'15A Nc lC 02C.oto0 or.15A NOW 02C.USPP 11 e ll Goirahgrcdcvr Standards and llvn a
7.Is thibs a relmir to an EdNjjng wcW EIYcs .or ZINo cyvajrlih-fecon144rsbir n pMrld.•d faiFr.riY-1101;rrt:
ff l�lS Ii,a,�}�rlr:fill txal N7iinW well cexusrnriloa br,(orrnalkn tug/exp?aht the nature of rFir
repar ru frr im irraarCs 1,r iiiin ar c;v the t4:ci c f this•Torn 23.Site d iagrani'or additional well details:
You may usp: ., back of this eagle to pio4'ide additional t{'eil site iietailior{cell
S.NnRtberof wells constructed: 1 cousttuctioui delajts: S'ou shrug also:auac[r addiliouaf pages if n:cessary_
For mahivIe fttje llavteN atxr,»inter rr PxV'r4=ii&L7NLY w1rA rlie.srtma corrstruitfon,} tnrtr
xa+l n6rmur, rra. - SUBMITTALil1T UC7701'iTS
0.7*i.;A e'll ieptL belowland,surfucei 60 (fLl 24a. For All.Willm ,Snbndt this.funn K7thin ate.days:of'Complctioli of will
Forrrraddpl n•ells'!rx ie"'Y4700.te^-�7@2o 'vi,72,Plds?17' constmctionto(he fortowing;"
10.Static water level below top of casings ((t,l Divisio'n of Water Retiourves,information Processing Unit,
1f hater level&71jove ctiiif4 ta-ae "}" 1617 Mail,Sen'iee Center,Raleigh,INC27G99-1G17
1I.,Borehole diameter:§ in (in.) tab.For Tu falion W ells ONLY: In addition to sending the form to Ilia addtzss in
24a aboi,e, also subtujt a copy of this toms within'A da�;s`of completion,of kv211
12,Well construction method: Sonic c'oaStrucliah to' follotkirts:
{i.e.auger.iDiary,cable dix--t gush etc.)
Division of Water Resources,Underground Injection Control l rogran►,
FOR WATER SUPPLY WELLS ONLY: 1636Alai]Service Center,Raleigh.XC 27699-1636
13a 1 icld(><pnt) Method of test 24c.For Water Supply&Injection Welts:
Also sulitnit ors cops' of this fortis within 30 days Of.Cotn0letionof
13h.Disinfection,type:, Arununt• well construction to the caiinty!health department of the coini*whera
constricted,
Falnl G{['-1 North Carolina Mpartnunt of Ern�itoruncin avid Norursl Resources—DIkkion of Rater,Resutrom- Revised August>it 13