GW1-2022-05253_Well Construction - GW1_20220531

WELL CONS'I'RUC TION RECORD For lacnrn!use Pl lLY:
This farm can be used hr`single ai miltipla n'cils'
].1aYcI1:Gd�utractar Llforination:
14.AVATER ZONES
Chris Ruffer FROM "TQ DTS4tttr?IaTN
Will Eni9ttavorwamo,,
4223 A ft. fG
NC.Well CordmaorCcnifmaitrn Number IS,OUTER CASING ffni•nAltkaseil`WC
-' OR L11�R(if 36 c3Ak)
FRONT. 70, 1 IIAMETER• TIIGIEYESS tAE 1AL.
SAEDACCO Inc i4 fG ia.
rnrpvt}Cti lard. 16.INNER CASING OR 7'L113ING4 wilierm l ctuced-I-xi
FROM TO DIMMETGR THICKNESS n7ATERLALL
2.Well Consttyction T evvit n: 0 (t. 45 ft, 6 ,� sch 40 PVC
lid aft r.}�ri(friJblo wril primp;fir'.Carnrtv'Siafc"Vnriaraw,Inyoniab rrr:.J'
3.WellUse(check.well use): t7:5CR'EN -
Water Sulllily\FcUt FROM I TO I Dr NTETF,H I SLOTSIM I TIUMNINS -MATRRtA1.
C11t$7lculhita[• ClfifniiicipaUl flUlic 55 rt. 45 It._ 6 iR• 026 ss
1713eotheinnal(HeatineCooling Supply) MasiIdential WY to Supply.(single) It: iL-
13hidustriaUC6ni n(:rcial. OResidcntial«roter Suppl}•(sbamd) Fao ROUT'7D >f rreRIAL I E+[YLACESfENT-stsrtlon a narottNr
Ellriiontion 0 ft: 39 fG Portland Trim
Nou-wakr Supply Well:
l7ntOnit4riDs ®Rcco��t}• ft., ft.
IrtJettiun Wgtl:,
ft. fG
[7Aquifcrltechar9e Mdiounds�:rtcrRcincdiation 'MSAND1GRAVELPAtK
fit allhduht;l
TRO&I TO 1vTA'rF:H1A1. -1 EMP1_r1Ct7t6_NT M"11011
CIAgnlfcrStorageard Rccoyc7y l7Saliniri A�mci
70 (t: 42 ft. Sand 3
t7¢quifcr Icst C1Stiimmatci f?riin ioc ft. R.
Q>Y p;TitttcDlal Ii ltndl9g} QSlthsidettce Cvtdml 20,'DRi1.L1TG LOG(allach additional sheets if rercc.sanl
ElGeatltcttual(Closed Loop) [3Tracer, FROSi TO DESCRIPTION tciUr.bnotriias i„arnrek irFsxaatlrl
❑Gotliennal(Heaul pCuolingReturn) 170ther(,explainuuder#2tRemarks) iy ft,
ft. iL
4:1)ateNYclt(s)Cotnpleled: 2-8-2022 iVaIINEW-51 See GaQ s note L
R ' b a• '""
rM
$d:�1'i11 I pC ttfUn' ft. iG ,9 o r
chemours d
rL hAAY ----
}Lcilit}aCMncr7lan TacTtr IDY(iEapplivnble). ft.
1248 Hill Hall Rd White Oak, NC 28399 Cumberland C, ft. i 0{ gyirv`tl f.^C:x?r»u:� nt'
White Oak, NC, 28399 PI1557airtddresCit}.prrdZija o21:REbL\
Cumberland 70-65 is a 6 in SS sump
CaTrtfl}' (PIN)
;5b.I ftitifdc aril>[ongittitle in dr givestrainutcslfeconds or deciliittl tic�grecsc 22.Ccttifiwtion:-
(if%,nII f'iwtd"ma l:li7ong is;sldijciod)
1, W Chris Buffer- 2f8,2022
Sipeutor afGcitificd Wcl[Cannxtcir Date
6.Is(;h,l.)the\Yl'1I(v'y: mPertuatitnt or oTemporar,)' tly.signdng ilrfs fynr,.l frrreb}•Cerrif}•f/icl Jlee rrelt{yJ tstu"�verc}curtirrnrt(eel in ueCarrfancr
Leith ffit"NCriC t72C,t7T0�oi•dSet NCrtC 7ZC A20tt II`efl Cvirstrzictfoir Stnrrrfards ntrrl Jiant a
7.Ls this al re0aiita an exi4ting well: C)Yar•' .or MNo cam;}a,�rl�is r�evrrilrrratLen nr�rirli�l nr 1'ir 1i111 Moiler,
fJ r",fs is a rv)x,Vr fib axar krr+aw IQ if rvrumrctivtl'lrrfarvurr'on rTrJit e•frfndar r!{e Harare c frlic
ie'iirrrr cmfii '1 nvrJrrkv kciii ez or cw die brut of This form. .23.Site d W};r>!nr"6r additional w'cll details:
You nta} itse-.tl>r la tck of this pale.tdptovida adi i fi9nal well site;deWk or stall
S.]Nutnhcr of vMls cotrstruceed: 1 0onst7uctiolt details: You inae also atlach additional pa es'if necessary_
For uriiPr of tr\t-41111av urq t-uvri r TyiWy t�tif4 OJ\'LY mirli die-same e6irstrucriun,}'c..w,cm
vritawrf rim. SUBMITTAL[NSTUC.TIONS
9:To61well depth betow,larid surface: 70 (ft,) 2aa. For All Wells: Subridt this£nmi azthin 36 days Df completiod of Ttell
For owihipleir dlalimafidefRnifrl{atenxlex¢tmpk-3@2091Aiul2+e't07 eon5tnrction'tothccfoltossin;;
10.Static water IeVel kluw'fop of casing: (1't,) D visidn" of Water Rcvounci,Informaisint I'taeessinl Unit,
,Vwa'r'i,-e4 mLurr twat rase 1617111ail.Serr•ice Ctintce,IZA160l,NC 2 7699-1 6 17
11.Borehole diamcter.10 in (in.) 24b.For Infgg-flog«•'c)Iv ONLY: In addition to Sending the fornt to the addrm in
244 alioi'e.also submit a copy of this_foftu Ieittlin')O days'of completion of well
12:�Vcllcotistruction method: sonic construction to the,folloli'ipe:
li�a.��rr�rainrg•.ent+le'tlircci gash rrc:} ,
Division of Water Resources,Underground(ejection Control I`rogrant,
FOR WATER SUPPLY'WEL19ONLY: 1636 plait Service Center:Raleigh,YC.276994636
13;L Yield( Fm) �7etliadbf test:
24c.For Water Supply&igiccilon We t.
Also subfk qne copy of,this form within 30 days of completion of
13hr Disinfkginn.bjle_.._ Amount: wcll construction,to the county health departntctrt of the conritg.u'hcre•
constructcd.
Fhrnl G\V-1 lash Carolina txpannicin of Emironient and Nanaral Resources-U,ii'u(an of R'atcf RMoirt- Revised August•Nt l3.