GW1-2022-05192_Well Construction - GW1_20220531

i
WELL CONS`IRU.CTION RECORD Far.rlx��,ltr�ot�Y:
Thr3 forth calf bc'uscd.farsfnglo or tnRl6plr wcils
1.W`clLCautractorhrfornration:
14.HATER ZONES
Chris Ruffer FROM ..It) pF'SCRtPT10N
}Yell Cardrlelryr iJatnt:
ft• ft.
4223 A
Newell ContmciorCcntfrcatio�nXunber t5..0UTBR CASId1G tfil�wuitl castd rrctlsF OR WPt1 R iif s i ric`ahk]
FROM I TO D11tirETER THICKNESS AfATEPtAL
SAEDACCO Inc !it- It. ill.
Outspany.taatc 16.INNER CASING OR ckwcd400
FROItt TO DMAIETER THICKNESS I MATERIAL
2,Wcll Construction Pci•n»t n; 0 R. 74 ft. i hG Sch 40 Pvc
1.isr oil aFpilirnhJ¢ti'rll paimlts a.'.Caunnf,Sratr,d+nrir:rrcr,Infetbca ctc.J
fL It.
3.W'e11 Usc(ell eci.'w-ell,d5c7; I- SCR�rN
W'aterSuplilr W`01., FitOAI I TO I otAArRTEn 11 SIATSIrs I T11ICKN1_-4'8' I AIATRR AL
❑Agricult.ural 0.Municipa6' iblic. 74 ft, 84 ft. 1 in, ! .016 Sch 46 PVC
®Geothemial(Reating(Cooling Supply) DResidendal Water Supply(single) ft. fc in.
t3TudustriaUConuilcrcial. DResidential Water Su cleared) 18.GROUT
�'�{` FROM TO ATATERIA1; EAn't.ACEAMTM-MO➢Q'AAIOUNT
❑lm nllon 0 ft. 68 tL Portland Tremei
Non Water Supply,Well.-,, 7t, ft.
glvlonitotkg MRecorcly
lnjecII(ni We11: ft. FL
DAljuifer'Recllargc SdGroun'N lcr Reincdiation 19.SANDIGILIL}trL PACT{rife olkal,le)
'FROM Trr 5 vrr,RIM, r RAIPr.ACMICNTMETHOD
QAgotfcr Stoiagc and Rccol.czy QSalinity IJImricr 71 ft._ 84 R. Sand 2
QAgitiferTcst QStommltcrbh[nagc ft. ft.
Q)xllclimcnhtl Ta hndCag}c QSRhsideRcc i ordrpl 2tI;DRILL1l1GT0G fatt:tch additional shtMs if atrc sarc}
❑Grotitennal(GitrsedLoop) ❑Tracer FROAT TO DESCRIPTIONfty»r.banl,ic„pdd'ntckt iri frc.dtl
❑GLothennal(Heatiq&Cooling Return) ❑artier(explain under#21 Remarks) R, in--
ft. ft1,,, y �k�`
4.Datc.W'.ell(4)f-6pipleted 3-2 9-2 0 2 2 W01ID#oW-11
See Gap s noteS4
S;t;Well lttcatilin fL fL
Chemours ft, FL i FriSu;�Tl ,�Pc_%r.vT t�UDtt
FicilityittwNt-Namp FacTlyiD3(ifappka11(e)
ft. ft.
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, ft, ft
White Oak, NC, 28399 Pltti'sxilCA�dessCatp.andZIP 21 REMARKS
Cumberland
Cctorily l'arrCl_1tF:t4ifiCltianNo,(FIN)
fib,li�titiulc`anil I cingittF(li•in�Icgrreshlrinutcs?sccands rir tccimul it rust 22.Certification:(lfptl!ltvtrt,i w.1:?410 i�is'arc(ti%ticirt)
i+ W L+1 tas,R;uffer• 3-29-2022
Siett =-'ofCatffredWc11Coftnu tdr Dal--
6.LS(are)the\t'Nlt(s).. pt't]tlarteut Or L1TcuulRlrar}' lry si•n1n•i&hr.ana;j hereby rrrti c rhar Me n o4s tsrts. Wrre ca inrrted irraerordmire
b b ,tr { ) {, J
lvial 1Sd AVAC 02C,010t1 or 15At NCA4C 02C.0200 Well Cvirstirrctfmr Srandaids and ilwi a
7.Is this a relish to an,eidvgng 31'cll: ❑S''c_r' 6r ®No e`yirof rl:lr'rrrnirJhashr�n pror turd rn:ILv 1trr11 rn wr
i,A.114 i},a n Mir.Ali air kel�tw lerif cws-tnrrtlna igfpwwtkvl awl ce{rlalu Aril:RGMrc c;(tAa
rcacir renlar dtyl.n5w:ae.Er Svk.•irmr mr cis tfir bci t of this•form. 23.Site dWrarn`or additional well details:
You may use.tlic back of this pad:,to pride additional ivell site,details,or ri'ell
R.Number of rVells eonstcucted: 1 cous(Metiou details. Yott ntag also.attacliadditional pages if I=essary.
FurtrRiwArr1gfvilaurc*tratMi->+uirrrs rJs'irrfdst7r}'L1'lr)rJirJlr.arttrrcrutistructlrtuAyoucam
.ra u:Sranc�,ri�.ria: SUBMITTAL INSTUCITONS
9.Total-sell AcIttli beto*�l:ind sirrfaee; 84 {fy) 24a P❑r All tYclts; 'Sl this btidt forttt within 30 dayg of'coniplction of Tiell
Fbrow'4it#Je iir.Jlt`list,aPlt IaSiltll is€aaitlrc<trn l<:7�2017aa4f.e11ak�3 ConStnlCCipli,t5lQhef9w%ving—,:
lu.Static water level;li iow trip of casing;. ft) 1114466 of Wite"r Rer9urr6%Information Procemin,Unit,
Ifirever level'b abuiwa crlafaV.wse"+" 1617'Alail Senicc Cclitcr,,lLrlciclr}rTt`2T699 1G17
11.13nrailole diametci 6 in (iu) 24b.For fnrcrt gg Welly ONLY: Tut addition to sending the forni 10 the addrm'in
24a alioi'e,also subtuit a copy of this form within 30 days of completidn-of w0l
12.Well construction method: Sonic construction to the ponowing..
(.e.3agrr.roiary.'wblc'dims push etd.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY. 1636 AL it Service Center.RaleighrNC37699.1636
13a,Yield(gpm) ,1lctltnd of test• 2de,For Water Supply dk ID(cctlon Wells:
Also subniit opr.6 ' of this farm within 30'days6fC01110letionof
134.DilinfeYttunb7ru; Amntint: COnstnctcducnon ip'the county heal(&dcpattmrnt gestic counh.nlicrc.
I
FantIOV4 e\odh Catalina Department ofEmlrotutraraWl 'Janus"Res+owecs-Dh's Ion ofWaterRmoutm RevisedAugust'-V13