GW1-2022-05198_Well Construction - GW1_20220531

WELL CONSTRUCTIONRECORD Far[ldarrullCtsc,OI Lb':
This forth cast be usedftififilgider multiolc wdis,
Chris Ruffer 'M Oh'"Culiq ION
Wal(cumtcl or Nam,0
4223 A
M.Well C6n6aclor Ccrfifid ltion Nwh6a
FRONT To PLUNTE-TEV. T-11H MNFR RT.ATERJAL
SAEDACCO Inc fL. (L
OJI'valy Nam MANNER CASING OR I BING'O"Ifierinad c6sed4000)
FRONT .TO DWEE17ER I THICKNM MATERML
2.WrIl Construction Pcomilt 4: 0 It. 38 (L 6 ue sch 40 PVC
aff wf-mljr,bf,
-S 17C
Water S"pilly FRONT I TO DIANt MH �il.OITMM Tll(M'NFS4 MATERTAI,
38, 'it 48 ft. 020 SS
DAgTicultuTal
DGeothcrtnal(tiLating(cooling Supply) 011esidential Water Supply isi",e) ri. _(L
OfticlustirialfCornmerciii ORiesidcritiai AMoter Supph-,(shared) FRO -
FRONT 70 NTATERLU. j-,FNIPLACLNY"T'NFMIGD&"TOUNT
EIIEAP,a16011 0 it. 32 (L Portland Tremei
Non-Water Supply W, 9: it.. , rt
difunhotiplg mccON-cly
hijecif,Oil Weil:,
dAquilcrlieOargi iffloilollridvl:Acr Realcall,ation M SAN DIGNALVEL PAC (it appIlealke)
'TO -PHtAll RAMACIAMSTIN317"1011
'PROhl'' ,
Eisilinily l3aida
35 ft,- 53 A, sand 3
Q Aplicr T.c'st ill na-'c
2(l.'DR11.LJNLG'L0G'hl1jch additional Aecls if atvcwrY)
Meotllennal.(C-]used Loop) otweLr FRONT I.To DESCRIMONtowl-r.hir6t%4,wil46jck typc.:! ,O s4p-dc.1
R2iuin) E10ther(explain under 92 lRetuads)
3-24-2022
c11 1D#EW-15 See qftp s notesL
ft. (L MAY 3 1 ZLjZZ
Chemours ft. ft.
Phailylbl—r7,Jamc Faci1by IM ffaypItabde)
ft" ft.
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, ft ft.
White Oak, NC, 28399 Plk)siciil ik4&css.Cily!'andti,
Cumberland 48-53 is a Gin SS sump
5h.1 atitude On A I.Ongtitudc in 41qgri-cs or decimal dc1tregi. 22.Certiflicatim.
(Irwall,rQ140jta,1;10okjiS s1tMC-lead)
M8 P ffeN W rCwr, 3-24-2022
ig of Cettifcd welicallicicteir Daic
6.16(are)the 21PLtmanent or oTetoporary " I : -' a
k,I igl#!f g thin fgrm,�I Irr reb i cc dify dial Me i rel4s)P. of
as(4-err)cqavuyefed , eroA filpre
iri*M XCA C 02C.010 or.ISA NCAC Okh26I IMI&rit6do,r Slaudards wid IMi a
7.Is'this a rel'mii in an dvftnj ocilf UYek vir ®No "'V'Y df aw�-M.C-47 rd 167S,&TO I P M IVIM T041y!i k I frivi i or.
h,a'Frjo il i,�j 1j,�4 r kv t;`i i w- i�!e­11-coos'a i i(ci?1 a,I#rfo rewli'vi i read a;.plabi rfic opipirr ofrlie
23.Site diagrani'or-additional well details:
re,Udir Mil&1V I MfflorkhsVCXkM or Uq Am b9A Qff11iXjoF11L
You ni*,uieAa_W ig hack of this pa to provldeaddidorlal well site, iiiii
8.NumberoMelb e6astmewd: constiudido deiai,fk'You.itifiv-also'litinelt additiolal'
t - Vdgds if necessary.
For 4iltA.11 nM1'-ltVwr SJ(M r1VW1S,0jsomaLY i6rh die soma oo4ltsltruMo)r,XPacao
df m4n MY-Apri.q. St_illif 11"fA L INSATC-116N9
9.Toial ivcll depth beloW,land surface: 53 ffj!) 24a. For All Wills Sobfidt this Torm v6ithin 36 days of Completion-of liell
IV'C'110fs't (exfflxpfr-3@200'(vid M), co6stillciiQ6 to,the rQKcaving-.,
Diviisig"n of Water iksoltrcci,Infinrination Processing Unit,
10.Statir water level Below topofeasin;r.
1617 Mail Set-vice Center,Ralcigh,XC 27699-1617
11.Borehole diameter.10 in 010 24b.EhrLikjMgqq3yelLqqNLV: in addition to,sending the fortat to The address in
a copy of this faun within 36 da8;s'of colliliieflall of wAl
12.'Weil Comtructiou Method: Sonic Colls(tuctioli to th,�followille:
0'e.aug*ur.ruiaiy,ca.b! dikd r I ask c,tc.).
'Division of Water ttci6urc&,�lldergrduikd luje�iiorl Control Vrogrant,
FOR NVATER SUPPLY WELLS ONLY: 1636 Mull Servi&te6ter.'R-alci�ih,',NC'.27699-1636
13a.Yield(gpni) 1lctttoil of test: 24c.F60 Water Supply&injectl4n.Wells-
ALso subritit opes'cdpy of this fdrin withirf 30 days of completion of
Disifificktion'type Arnounh wcIl-construction to the County licAll department or, the coinh'.whcrc
-
constructed.
Nonh Carlin Depaumcilt ofEuvirounx-M aW Narwal Resources-D.ivhion ofWater'Rmatircm Revised August-10 13