GW1-2022-05181_Well Construction - GW1_20220531

WELL CONSTRUC'I•ION.RECORU Far lnfcrualLrSc,ONti%:
Thy farm can be and fair single a%rnultiple,wells
1:iJ5'cll:Gittti�tctorltrtotntatiou;
14.I ATER'BONES
Chris Ruffer FRONT 'fit I DF'Cttt"101
V411,COMaLt6r NRU11
4223 A
MC.iTJcll CatittacforLc[tiCreatiiraPttrt[Itci t5.0UTF.R CrLGfVG'if{tr niiliti cased eets OR uL1NER tit ' lcaAkl
RER: TFROM ro s aATr,AL
SASDACCO Inc ft.. ft i4.
Company Nowe Tti.1NNER CASING OR 7'LiBING'f-�eoidermal ctefcd400 i.
FRONT TO DL%,%IETER.. THWKNESS MATERL1L
2.Well Construction iierhlit w: 0 R.I
20 ft. 1 'hL Sch 40 PVC
lrri uticppilicuhle rcell pri>rNM.(&r.,Cnunh•�Stirte;-lrnrir.{xr„lnf8^7eq,rtr..)
ft.
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WaferSuppt y Well FROM r0 DrANUETER 5TOTS17% ritit MSS i nt,aTER(AT.
OAgricultural Cllvfunicipalfl'uhlic 20 ft, 30 ft. 1 ia. '.'0 10 Sch 46 PVC
®Geothemnal fHeatinglCOoling R4)ply) DResidential Water Supply(single) ft, it. irl
131ndustllal/CoRlntcrcial OResidential Water Snpph•(sInn:d) I M GROUP"
171105i Tt). MATERiAL, V Ed[PLACE.\MNVIMTHOD&ARrOUNT
[71rn' ttion 0 it.' 14 (L Portland Tremei
Nort-W;-iter Supply WOR:'
pJvtOnitoring MRcco,.vy
MJeellott Well: ft. r4
❑AniiifcrRccharge ®Grotln"N ltcr Ren[cdlation 19.SANWGRAVl L PACK(if applicable)'
-- • •"� 'FRllii Tn TtATr;Rt.4t, ti�tVI.AC}+1tF:\T\i}:rnC1D
AAtatdfcrStortgeaiiclltccnysiy QSalinih 13arritjr 17 R. 30 R:. Sand 2
DArliiif'cr,T st- A5#omm tct fii loin
❑k,Npzri ncnW TRhnotllgy. l3Sab5idcncc Control
-10.DRILLING LOG(attach additional slkcts if IeceeScarSi
OCeotheruml(Clpsed Loop)' OTracer FRONT I TO D65CrUMM,rcokrr,t arA{iea/,pii;'nick id vrq, f t
EIG othenual(Ileatingproollbg.Retum) ❑Other(explain tinder Q I-Retnatlks) h tL
4-6-2022 OW- /L. fL 9a f4�p^a
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;a:11PcB Ltication: r4 ry
Chemours rt rt
F°acuit}'aburerNmac Fatuity'iDn{ifaupliaiblc) R. ft. {„ib�rtt�•1 -1lrctl�
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1248 Bill Hall Rd White Oak, NC 28399 Cumberland C,
White Oak, NC, 28399 Plgsseidalildigss.Cit},alda 1I.REMARKS'
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Cumberland
C\9ugv 1�RYI lt}IitifccalipuNa._(PIN}
b.I [ti#irlil ,gitulk in d gmeslminutcslsccnn+Is tirciccimDl it rec� 22.OcrtificaHon:
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N ��' _C,hrl5 R.U{�_f 1_er 4-6-2022
Situcc df Gcrtlfied iYcll tractii I7dtc
6.LS tatE)t1tG{rell(): -MPerinaneut .or. oTemporarp !1}arguing thin farm;:!herrbp rerfif}'rLLJ f�1Y 7rC��{.YJ V,7lY(y'cICJ CfnylrLCl[!i IR.ttG'L'OYtL�J[C
ivith ISM NCAC 02C A100 or 1S,f NC lC i73C,0200 Melf Cpnatrrt cNon Slara lards mid rlxrlo
i.IS ttti�t lr rxp lir fn Wi tti4tipgit'clli l=1Ya_r- or ENO 'V 77y0frhis rrcrirrf h17s&Ill Prnrirlid iaildr. t-ll mviter,
,f'Wtlsra,rrp[ P•Cheat'Roit5vi��IRtexusrt{rrlc�ralr�amut:a{r and rt}ilc�3ar=tiie.mrareofdie
le'�+rzrrwkka•921 rema'&.ti.iii—An n 6 nv rile bidt uf"imrfjorm 23,Site diagranior additional will&talC3:
You may 6 e.&_,6ack of this page.ttr,ptovide addivanal well site aetails:ur well
8.huutberof n ells eatlstruct ed: 1 coustmulon detaks: You iaay,also attach additional page's if necessary.
1 varairalrinrr irvevhNi tx vo;N kwri r. pfy ive?1s.0iVLY»drA rIn•same roltstruetlon.vcw cYm
crku„atGwc t,,,n, SUBNHTTA1,iNMICTIONS.
9.T061Well tlepth hctaiviand surface: 30 (ft� 24a. Fnc All Welk "Subfidt (Iris furni utitbin 30 days:of cotnptetiod of bell
FnrairaiPaltrtawcilx'licr��tJ"ems'#(ef irraDtrxatr� l .7+�;i10'nnrl3m?d �' eanstntclioutoi(hefoltoning-.
10.Static Water lerelbelow Wp of cusiup, Dir'i�iuu of Water Revourec�i,Infiirmatiun Pr eesMn;Unit,
If iturer level b,above casigg;uu"4- 1Gi7DIitil Sert•iec Ccnteir,R'ileo,NC27Gs9-1617
It.13otchole diameter:6 in (in) 24b.Fnr in lyX i�gn Wi.Ay ONLY-. Tia addition to sending the fomi to the address in
246 a€ne.also submit a.copy of tkis:futx[n Within 0 days of col lipletioit of wi I.I
1 .'Well coustniction method: sonic eonsamction to the ftillotidtlL:
(i:r. r.'iuinty:cn1?le:iiir gcisti Division 6i N�rater Resou roes.Underground Inj.eiioin Cuirtrol Progrvuh,
FOR NVATER SG'1'PLVANTLLS ONLY- 1636 Mail Service Center,Raleigh,Ne 276940
13a Yield(>{tm) 'Method'of test: 24c.For� ater Supply&Injeaton bells:
Also submit one copy of this fonh within 30 days ofcoutpletionof
13b.bilsinfttitinn u _ _-- - Amount:. Av 111 cu s lcnon to the county'dcaIIth departmcmu of tltc comaty.where
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FarruGSA-L ttmhCaralinaCApsrtrlita[oCEnirann,cntand 4a[uraJResources—Diiisloaoftit'a1crE2txattCrs Revised August