GW1-2022-05238_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD
This form can bc'uscd f1ii-iingto oi.mullip3q.WzIls,
1..W&16.ntraftor tutdrmation:
I.A.AVATCH ZONES
Chris Ruffer FROM TO I OPSCREPTION
Wolf col!grtdorxqloo W fL
4223 A
NC,WellContraclarCcftific�3tionNitlrlaijr 15.OUTER CAStNG(for IIl"C'"*"0 L"" L m FROM TO DMIETEV.- 1-ITIMICW" A—TAL
SAEDACCO Inc fL I IL I In. I I
M.INNER CASING.OR MING i eothermulctwkcd-lwo).
FRONT. .70 _RLIMETER TIUMNESS MAITML
?.'Weil coristruetl6n PCrnlith. 0 A. .38 ft. 6 sch 40 PVC
I-1a#1fg)i;arn61r'WVftP-ii 7WhrfiX. fri-dcn rjr.')'
58 ft. 48 ft, 6 n!- sch 40 PVC
3.Wcirljs'e(ch.CCIC*o use): -- -
MSCREEN
Water SupplyM10h. FROM I TO GrANTETM S1.0TS17Z TM1(WNFN,% I-MATENIM
0-Ag&ulm'ml 64uni6palftbi I io 68 ft, 58 Ft- 6 .02V
dGeollicimal(HeatingfCooiing Supply) MResidential Ni"alcr Supply(single) 48 ft. 38 ft. 6 iii. .020 SS
C31ndustriaMnuttrcial Masidential Watei Suppb-(shircd) I&GROUT -
FROAT 70, NTATERML E,%lPLACTNMNT-AtffH0D&AMOUNT
DHP,ption 0 ft.* 32.5 (L Portland Tremei
Non-NVA(er Supply.Well: - -
Mvionitoring. D.011ccovVy ft,
Injecl Ion Weil;
13 A q i i itic r'9 c q h a:rg i WO&IIAW,11cr Rcluctliation t9.SAND1G ILVEL PACK
TH(M., TO M LU'R(A
milui(Ci�iomgc 114 Recovery3 1 �ilinii` Rama':
73 ft, 35 ft, Sand 3
F-lAqiuferT:cst lj5tbrtnwntcr 6h'
inige '
20tDRILLJNG'L0G 614ach addifid-nalAms'if nec"58TY)
bGcotllMial(Closedipop) otracer
YMN
ElGeodienual(I'leathkVCooling Return) 13011ter(explain under 02 t Retuatks)
4..'Date Well(s)Cbplple led: 2-23-2022 WIAl 1D#EW-3 6
See GO a note$L MAY
(L (L
Chemours
facilby lDN(sTappi6ble) R. ft.
ft..1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, fL
White Oak, NC, 28399 Plty sikid Aildi s5.City.jaidii t21.,REMARKS
Cumberland 73-68 is a Gin SS sump
Parcel lJoilifte4iflon Nci,(P1.14)
�w 1aujtudc and1ongitmok in dqgmslminutalk'cdn'ds ar decimal dcgreci:
22:Certirtration-,
N' Chris-Ruffer 2/23/2022
Fied Well Co ntxtaf Dale
G.Ls(aCe)tlte.tivell(s)i MPerinaneat or OTemporary
ivith 111 NOW-02C.0100 or 154 AICAC P.C,0209 Well Coitv�irdmr§Mmar45,�ndh�ia
7.h"thN a reinak in,an&isttpgvcIfi ElYes or MNO ,rccdi-d llrs ht;rm provOM r;iAw-inW mviter.
aavr wrrrhv xrtl cvxrumrcvlc a Lrforvwiim twd expbhi dic ohmire of-Me
rry "i;'921 MMkV=CfiM Of-(An 6C&XI.CIftliftfUiML 23.Site'e ditigramwor additional well demits-
age to proi'd did6aal well site detail' or � I
You *,6--back of this P i e ad s' %vel
8.Nmunbcrof*c11scon9ructM: coustmbfion'del,ai,Is.
For)iNhIple 0r NA'1-jAZ11Wr SAPPI..V IMIS 0JVLY 11101 MeMME CORStrUMM,3VA CVO
,r.A�nutar�t Spurr: SUBMITTALINSTUMONS
9.Tkal well depth below 1-.md Sgrfaee. 73 24+ Fnr All Wells. -Subinit if iis form%64hin 36 dayso co f mptcliou of 1v'cll
FormsefiPI'l lllejfsJjlj Cjj'jfruaS jftjW'%,re)j; canstructioh to thti folloni ng:.
10.Static water level below top of casinW. A) DMsion of Water-Remourcei,Information Processing Unit,
If.Vm.ier level is above tds I fAg,use"+ 160'Alail'Scirvice Center,M416-,Ji,.NC 27699-1617
1 1i.Boreholcd1zmctcr-.l0 in (in.) In addition to sending Ilia fami to ilia add rm in
2466&,6,als6'sitbhtit a Copy of this fOntl Within 30'days of compl&ioii of well
12.Weil construction method: Sonic Colistructiall to the fonoMag,
6C.augm'iD[nry.cWC'L cli=p I usk etc.)
Division s Re of Water ources.Underground to"coon Control Vrogrmn,
1, 1 'c . PC.
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.RA-leiglij XC276994636
13,i Yleld(gpin) Method of test: 24c,For Witcr Supply Injodfon Wells:
Also subtiiit one'copy of this fonii within,30 days ofcompletion of
wail-camminictio'n*►to the cbunl�r health department of the counh,WI='
13b�41sinketiontyper, Amnunt:
conmctcd,
Fe mi G%%'-I Revised August-201.1