GW1-2022-05143_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD
M form c=bc'uwd Cap,single a:-migtjpk wells,
1'.�'Vell 6ink.etorldormation:
I.I.AMA'M R ZONES
Chris Ruffer
Well colaki6rNam¢, ft. ft.
4223 A fL
NC,,WcllCoritmcloiCcrt!fLcatir aNiinlici 15."OUTER CA-I;tNG'(f-)r intjJ1k4s6d%cD0 0 Map 116able)
�%1111"2 UL11111-1 M,FROM I TO R- -I T 31.1tTEIRTAL,
SAEDACCO Inc :!!t.1, lt. I ia. 1 1
Can utj:Nant4 16.INNER CASING OR TUBING'(wilbenn.9 c6j-.wd4qy0.
FROM TO THWKNESS I 31ATEMALL
2.*' It bDMVt11ict!0H iv,'C'Mlit s 0 ft. 49 ft, 6 ltL sch 40 PVC
(ix.Counj%,SUrv,Iforlauce.Ify"r-CA e1c.) ft,
SCREEN
R.Iater Sitlilstv Well:. FRONT 'J 'DrX,%1KTFR 5T.0T%17Xj-T111(-kNfsN I'MATPRIAL.
49 ft.- 0 26
DAgdcli f tu ral 0.Muni6pavbM I i 9 ft., SS
'410 w fL,
Meothctmai(Hca(inglCooiing Supply) OResidentialWi(cr Supply(siDL I I
01tidustrialfContulcicial MtsidcutialWater Supply.(shan:4) M_GROUT
FROM MATERML 1,EMPLAMMOT]NIEMOD&AMOUNT
0 ft. 43 (t. Portland Tremie
Non-Water Supply,Well:
bj ec!Ion Weil: ft. ft.
MAtitiffer 9cqbllrgv` Rcircdiation 19.SAN WGRAVEL PACIC t1raji jil 1w1&,)'
MAIM VA 1.FRO 10 I PJ,%Cf:AK_NT SIEFF1011
74 ft, 46 ft, ISand 3
Mtpufer,T6t ClSgorrrncatcrilrunage
ff.
Afl.,DRILLILNG,LOG(miAch additional.sheets if acce%kilry)
ElCrevdiennal(121ustd Loop) ElTracer FROM• TO
11 .GLothennal(T-Teating�Caoliug R2=i)� 13011wr(explain under 92 1•Remit") It.
iL
4',ba�te Well, V I=Q
P)f-duilfleled:' 2-17-2022 di1D#EW-42 See qj4pi s note$L
MAY 2
ft. ft.
Chemours ft. ft. Irdomna4ion Unh
Flcilitpk3wocr i4anw_- Facffiiy IDR(jtappii_�cF11 ) ft. it, _D
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C,
White Oak, NC, 28399 Cit' nd
21;REMAN KS
Cumberland 74-69 is a bin SS sump
No,fP11N)
trest5ninutcs?scContlsnrticcimal it_ roes
22.Certification:
or A, It 2�t'4;kA id lao 0 tig"is I art
W Buffer' 2/17/2022
Si.-n3tur,6aFCr3firJcd Well Catitmodi. Dale
6.IS(are)the oPermancitt or oTemporary
Lry,signr*ng ikfyfarm;-I hereby cerfify rl w4w wrftfs)roy cowinicled in aceanhmce
iPith'[5AVCAC'02C-.0Ta9 or 11t NC It Ok.0209 Well §randa4s nerd rh�ia
7.IN'thN wiviiak to an Exi,,tingivell: ElVem, or MNo .r1i.mviler,
ar-&q Am hraijL.qfMixfbrm. 23.Site diagrani'or additional well details:
You toay,uieA,�.-back of this Page to provide additional well site, euils or hell
8.N,timber,of Wells&nktruclW: constmetiondeli ks' irou p accessary ages if
AL .TIONS
0.Total wel(,dcpih helow-knd stirfac 74 24a. For All Urills. Wi S�bfidt Otis fdriii 'thin It) days off-completion of well
Foe m9b,"'r4e 6n5thicii0ji W ok follosing:
10.Static water level below top of casing: DIVIN'in"d of Watttr Resau reisjn&rm'a'tibn'Pitieemiing Unit,
ffuwlee I evelhvbqv w.i,fa�g am;1+1' 161,
Thlait'SaTice Cl dicr,lbileigh,W-276694617
It.Borehole diarlictet.10-in 246.Fn hwiecfifid MIN ONLY-. In addition to sending the form to the address in
244�kore..also submit a.copy o.f this forth ividiiii 30 daLl-s'of completion of%vd1l
M well Construction method:-Sonic Lonslitictiolk to tu t0floMfIL':
Div Won Of Water Resources,Underground Injection Control Vivgranil,
V99NVitTER SUPPLY WELLS ONLY-` 1636 Abil Scrviee a-tiler,Raleigh.NC 276094636
13.i*Yield(g'm� -24c.For Water Stipply&injection Wells:p �Mdhod of tit:
sub6it.one copy of this form within 30 days of completion of
13b.Disinfectiotl'typt:, well.consthiction'to the county ficIalth department of the ccnmWLvhcrc
congntacd.
Fonti.GAI-t NonbCatolluE)cpanniciii.LifEtwirojumutaitd Nattoul RL&oLirces-Divisionof\N'LltcrResoutm Revised August-V13