GW1-2022-05252_Well Construction - GW1_20220531

1
WELL CONSTRUCTION RECORD .
RIF factual LtskijO.NtY:'
This foie catt biusedforFingle at multitik wtiltt• .
1
1.WaLCalltriltOrIfiterelatlott:
141.WATER'ZON
Chris Huffer FROM: TO ORSCRIPTION
Weir CorittutlarNatno,. ft. It.
4. ft;
4223 A
NC Weil Cceitradoi-CertificetioitNutth& .I&OUTER CASING(foi*PI tilii-ekeA istilst OR LINER ate) ficablth I
.FROM. 1 TO - DIAMETER, THICKNESS: ' 3MTERTAL.
SAEDACCO Inc ft. ft. in.
Cetiv;eik Name .16:1NNERfASING OR TUBING(gLetlicrinal cgtemd-loop)
FROM TO. , DIAMETER. , THICKNESS ....; MATERIAL
2,Well OnstrOetion Perinit 0: o •-ft.. 43 ft. 1 .1.- Sch 40 PVC
lisridtapyitiriiblir kriepeinrit*fiza Cairntx',Sudo,Variance,Infect*air) — .
. ft„ ft. in.
3,Welly0,(thtelt.iNti1u:s0,: , 17.SCREEN
Water Simply Well:
FROM .1 TO DTAMETER. MOT WI: TH WKS ENS. •MATERIAL
• .
- .. 43 It. 53 'II. 1 • -illl. ;016 Sch 40 PVC
bAgricuitural EliThinieipal/Poldie
CICeothennal(Heating/Cooling Supply) C3ResidentialWater Supply(single)
Oludustrial/Coruntercial GROUT .
ORes•idential Water Supply(shared) mom .,70,
MATEEcIA71.7-1.EMPUCEMENT.METHOD&,ASIOLINT
El friiftatiall . . 0 'II.' 37 ft. Port land I Tr emei
Non-Water Supply Weil:
„ . . ..- . ft.
DMonitoring rittilecovery
Injection Well;•-,
pAnnifer Recharge VidOuirdstater Reittadiation •19:SANDiCALA,VEL PACK(if alifiliimbl•i), c.. , . • , .
• . —. ,...,. . . . ,. . .. ., ,., 'Ilit'pm* -Fa ' Alta:WA T, ENWIACCAIIENT Mfilliall
AAtiniferStaragantid ReCoverY EISalinitvanier R .
... ..., 40 It. 53 II. Sand 2
ElAtvii(diTcit OStOrmtratet Oetillt1gc
•ft.• ii.
r4E,Nperionenbil Tp.7101Qt9.gy litttIsittcruc 0;1141-91 _..
'25 DRILLING LOG(ntUcli additional sheets'if Recessarst'
Eldepthe .oral(0001 Loop)' OTracer FROM. .10 DESCRIPTION(cabr.ban:Mini,sotru'ock It rowAren Ate.Ora
OCiotitennal(ReatingiCoolineRetun), 00ther(explain under A121 Rematks) -14 ft.
—t 4. .;•','•.
.4., rt. -4;thifii.wajw caniiikte41; 4-12-2022 .itiigio#ow-22
- See cap s note&
5uL Wttl.LtieStioni .ft. 4. MAY 3 1 2022
Chemours rt. ft.
Information Prccaritzinfl Link
Iliciliiyottwtur Nanto. FacflitylDV(iltappii44c) 0, ft. •--- Vii/Q/301:3
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, it.. it.
White Oak, NC, 28399 Plivik.ill Aiii4Fsi....c:11-3'.04.-ki) . -,21.RI:IMAM-2.i
Cumberland
Gamily ramellthRoitication No,(PIN)
$b.I;ittitirde'airil tantliutie in degvevsicaintroSISCCOndS or deeiniral'degVecir 21.certineatiod:
(it welt D,Attiotte jtitio4is:.‘itfiltiled)
,... ,
•N W thri's ff' ' Ru- er
, .,,.• ...., _., .
4-12-2022
Sigteterief Ccitilicd Well CentrAcit Dare
6.Is(are)the-well(s): 3oPernianent or .1]Teniporary.
fry Aglibiy.Mir fanrr,,,,i Irereby,cerfzip'001 Wig ir4I(s)was 0;w:el agqingled 40ft/stare
ititlf15.4 NCACrOiC.0100 or ISA Npie 02C,0200 Well Constthetion Standards and that a
7.4:WA wirOafr to an C.;Visting we* pYii-- .jir No e6-0.Of this'rethiyi liar Nen prifniric4,fiiilie it:1711 mviker;
ifibisli a irPitte-Pl,,iwo inzolim war cdttarklikyrlylOrynt7#41arld t'Apk1111 the nature of Oe
repair tiliJar 1121 zruita-ks'sreiiiiii or at the:bilikalthis form. 23.Site diagram:or additional well details:,
You may.n.Se the back of this page,to proude additional well site details or Well
8:Nntuberof WON conitructed: 1 .constinctimt dein& )(botany alsontiach additional pages lf neeessiny.
For inntifpfe tOt:eriomoi oT-Ittire'r SlihAVIVSEISONLY with 4'1 je same eteterrilion.jolt can
A34mit WY'form.. SURNIITTA I,INSTUCTIONS.
9.'TOtalwaoepth betawland sitrfacei 53 (64 24a. Per Ali Wells: Submit This fool Within 30 days of.compkliOtt of Well
Poi^fflitlipleir.elislisi alteilths if Oiyait ..,TiTiTPIer 3.@2C1fr dat1201POI . .constinictign tO tit .fogolviiiw. '
10.Static water level helms'top of easing: (ft.) DiviSiatinf Water.Resources,Information Proeessing Unit,
if water levet is above,cusiov;use"-4-" 1617MatI Scvviee'Ciatcr,;Raleigh,NC 27699-1617
. .
!I.-Borehole diameter':6 in IIII.) 24b.For lialectlart-WeIhipNLY: In addition to sending the fonn to The address.in
24a ainiVe.alsO Omit a copy of this form within 30 days of-cOmpletien of Well
12.Well construction Method: sonic construction to thofolloWing:•
(Lc. figcr..rotaiy,c.r!l*ALTect push.sc:)
'Dision of Water Resources,larderground
ivInjection Control Pogrant,
FOR WATER SUPPLE WELLS.ONLY::' ' 1636 Mail Service tenter.Raleigh:NC:276094636
24c.For Water Supply&Iola:dim Wets:
123.-Yield(grit) Method oflcst:
Also-submit.one copy of this form Within 30 days of completion of
13h,Disinfection typer __ Amount: . „.. Avon ccinstnictilin'-to the eon*health'department ofwir the counts re
. constracted,
Fenn GW,I. North Catalina Depiummiu of Etwitteutramtd Nana ReLatlICCS-Milton of Water,Rce:,atrtes Revised Augul2Oli