GW1-2022-05182_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD FpiImznatltlscONLl':
This form can be used rah eingie or Mailipk malls"
1.Well.CbntractorLttarniation:
'ta.Sti�llirR"LONE.S
Chris Ruffer FRONT TO, DF SCRtPT10�
%'dt tnu arlfante; R. ft.
ft. fG
4223 A
NC Well CarOnctorCcnifk!Ai6nNrurl ei 15:OUTER CASING ffnr mnlil-ciwil wins)OR LIVER (If-a`licahk)
,FRONT. I .MI Dmair it. I TIIIG6,"�T s F71T,a1E.n1AL
SAEDACCO Inc fL,I f4 I a.
Chitni,nty.Nanw 16.IN.�'ER CASING OR 117BING'('eothcrm-it cla+xd4w
FRONT TO 1 DIM,\t£TER_ I THI hNESS• ATATERML
2:Will Constrtictjon l'cimtit : 0 R. 70 ft:. 1 tl4 Sch 40 PVC
140 of/amlir."abler.el1pelmits fix.Cbaah'S411e.lrariarre.fry-arbrme1r.:I
ft.. ft. in.
3.#ll.lise(checl..tir co use): t7.SCREEN' _
WaterSUppli Well:. FROM t TO I DTA\IETF.R I Sr.OT1,%I7F. I Tn1"-N-mS' NrATRRTAT.
❑Agricultural 0lviti61cipaUT'tiUlic. 70 ft, 80 ft. 1 in .010 Sch 46 PVC
Meothemtai(HeatingtCoaling Supply) bResidential Water Supply(single) ft
fG in
Mindustrial/Conmtercial ORcsidentfal Water Supply(shared) 1 18.GROAT
FRONT 1 TO, 3TATERGIL- I Lln'LSCE\ITNT516fnOD&AMOUNT
El lriBoation 0 fL 63 fL Portland Tremei
Non-Water SupplyWgfl:
❑hlonitoring Mccol-cTy
Injection Well: ft.- ft:
❑AWiiferltccfiarge AdGnsuTrdrsala Re11ted4ai0n t9.5AND1(;R,$VEL PACAfif a r Yrcal)k-)
FRONT"" TO }iTA'rF,Hr�G [�]PLACtati.VT\1t7tR)Ir
17Agni(crStort�eaud Rodovety CISulinhN•13ariici 67 fi., 8o ft, sand 2
❑Aquifer Tcst Mtorinivalci l?run0gc
Mxperimcntil'Ihhnotoa, 17Subsidcucc CoMint
10'DRILLiNG LOG faltucd addiliaaal sbr•9.s if rtecessanl
OGeotitcnnal(Giused Lagp) ❑Tracer' .FRONT.= TO D15GIKtPi]AN(mbr.tiatric�. ta'n�cret .: a 4su xsr►
❑Geodienual(ffeatitwu"Coolftw Return) ❑Otter(esplain tinder 921 Retuad s) ft. (r•
4.D6teWcil(s)Coniplled: 4-6-2022 SyelllDOPW-19
See Gap s note4L A' �; !1�_,
Ra.NR'M Lahcatian: fL f4 MAY 3 1
Chemours (4 fc
Factittyx h,—Jx-aw Facility iM(i 4ppiknbli)' ft. R. �I]<DiXr; 2:}aa�I r. s Ili
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C,
White Oak, NC, 28399 Pltysical: ftdr'ss Ci ..imdZip 21.RE,MARKS
Cumberland
Cncrrrt}' 1�t>:47ld.rtliLSa�.ryfiau Np,,(Er1N)
:51).i lfitDdc aiid l.jngitjtilc in ilcgarc rtninutcslsccTinds or dccitiial degrees" 22:Certificrtiori:.
(ifai It f Ici,aril l l0ti is 1,rrf(iC1;16 {�
11N ��' Chris-Auffer 4-6-2022
Sigeutur of Ccit[bad Wrll Co nuactar Date
6.Is,(are)thL.\Vell(3)r zPertnanekit Or tffelTil}Orilri', Pf signi;t•.lhir anmj PrerrL roll y Mar the Yrefl a war were curaur!eye4 ur:aveordance
Y h b � 3 f (1 (, „)
idift f5ANCACO2C.i7100ori5ANCtCO:IC.D:DPIVell 'orritrrecriorrStandarttsandilmia
7.Lv this a re jiair fu an cci.itinr N'c11: ❑Ycc ire ®Nq colic ofArls rfcrird kris b,�nmr;rkd ra i�'irnfi mr,r�r.
(f tzSPs�a mlurlr�iP r�vrAtrr+uw a'rn't�armrcviott trr/i�rnurr+orr trrar!etilfatrr r7te�aranrrt o1`rFrc
,epic 6ixPar421 ii-t�a 23.Slfe diagr'atn or additional Well detlil3:
You may ttse,tl e,Uack 6f dds page.to jrroiade adi idotial,Fell silo details or arell
S.Number of Welk constructed: 1 constmetion details: You.inag aLso:atfaclt addiUoiral pages if n;Vessary.
Fear gin0 fd'e 1r0'ekr4o c*i.ra+rrml,t Wr saW#yr RIS ONLY wirli rye urme c rtrsr MIon,}r,`trekin
ser&y+aruwr7t rr7. SC 3NIVE fA :fNST T .TIONC
9.Toial well depth bolo*land surfueZ 80 (ft:) .24a. Put All Wells- "Srihridt this farm a7thin 30 day5,of'completion of Felt
For PwIfi le 1I.l416r aibiep4s If resit Pcsarra�ilr-3@ 00'c m/20.100'y Ccsris9n1Ctid i-to tlic f'olloviiog;:
Id.Static water level below top of ca.4inw._ (ft.) Divhion of Water Resoure",information 1Pitieessing Unit,
IJYr rir+r 1ry J bs�sl+ouc cwstar,as "�" 167 SlaiF St'mice(,-enter,Ralro,NC 2 769 9-1 6 17
tt.Borehole diameter-6 in (in) tab.FDr inft'atinn WON ONLY.' in addition to sending the fomi to Ilia addw in
24a abbti,e..also sulp»it a copy of this fomT within 30 days of completion of well
12.Well cous#tuction method: Sonic construction ib thefollowiill;::
(Le.su.-Cr.rufyhp;'cablc dixsipuslick)
Division of Water Resources,Underground tupcilon Control It rograin,
FOR WATER SUPPLY NVELLS ONLY:' 1636 At-ail Service Center.Raleigh,NC 27699-1636
13 h Yield m ,1lctirod'of test 24c.For Water Stipply&injmtirin�'Yctts:
Also subtirjt on copy of this fohn within 30 days of completion of
13h.Disinflecitan•type-_ Aniunnt Nvcll constrrution to Ilia corinty health department of the counwxyl cru
constmacd.
Fdrnr GR'-1 Nonh Carolina txpammemofEtwitonnxm and Natural Resources-Divvlon ofWaicr Rewtitz Rcs•tscd August 2013