GW1-2023-01962_Well Construction - GW1_20230227

WELL CONSTRUCTION RECORD FarimcrnalUscONLY: j
V is fortn can be rind for.single or multiple xms-
1.�Vcll.Ctintracropinforutstianc I '
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Chris Ru£fer FROM TO DMCRIMON
1tr;11ComractorN;rrtw.
4223-A
NC.Well ComraciorCertifimionNurrber a15:`OUTER.CASiNGltuemufllca6rdvieflsi''ORLIl+I}]i([f.N [ica61e1'
FROM TO DtanrrssR_ TInGtMSS - MATEnTAL
SAEDACCO Inc 0 ft.. 45 ft' 21' ln. SCH-40 PVC
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Can�rurti'NarltC•• ?16;INVER.t_A,SiNt:OR-TIIHII'1G; +i�i6e�rtlal'etusadariii'i;1Y'. -
FROSI To DLOIF.TER T[II0u'YESS' 'MATEUkt.
2.Welj Constructf6h Per•arit 4, ft. ft. I is
LJrf 4r1J aRilirable weft prmeits(i.e.Caunry::Snot..,Ira dairre,lrtyerLcn a.) ft
a.Wctl j sc(k nkgk-w-diuse)? -, SCREE y
Water SupplyNVelb' Fnast 1 TID DraupTrR sr.orstzr nncxvr s srnr nr"ar,
®tlgTtcultilral �I6iiiriicipallPttblic." 45 fii 60 It.
' 2" .010 SCH746 PVC
©Geotitetmal(HeatingfCooling Supply) ®ResidentialNater Supply'(single) It: rL.
®lndustriallConmtercial ©Residential Wnter"Supply(slmred") -18;GROUT_,
FROM -To t.LtTERIAL 51PLAMMOThtMOD&MIORNT
Dltri titian 0 rr. 41 rG -Portland Pumped
Non%YsiterSutiplyNIr'ell:
6aMariitnring Qfltsnsety
Injection Welt: rt. rt
CIAgnifcrRcchargc QGiouridnslcrl{.entcdiatiou s.I9:SANDIGRAVEL,PAC&I1( 'i jiIIC:kb.) -
Fnpst. m srart;Rwr. Rs»•l,>,c;txrr:er�rtxnnu
I]AijoiferStvragcarriiltecaTeiy QSalinityHairier' 43 ft. 60 ft. Filter Sand #2
❑Agnifcr Tcst F151ortrin�tct duririaec '
0Expctinlcntal TcAnatagy Mtbsidcrtcc.Co>kTol
=.2n:"DRILL IN ihiiisifncccssanl
Wei dj;etlnpl(ClasedLbop) EiTtacer TS) t►tiSCRtP110\trnbr.h;�rvnch.s�;u'nnta n .Nrl
❑Gootliennal(HeatinWCoollttaRetum) ❑0ther(explain mider92Ullemiuks) rt, f4
1L• 7L
.4.Dote FWelt(s)C'atigrlete&1-19723 W&1D#SMW-05PR
$a:Nell I:trcatinri: See Gftpl s noteSL
Chemours U.- ft. FER 2
Facilit}.01�ncrIVnmc Fact3itj•IDkCfappiicnbie) R. ft. i
22828 NC-87, Fayetteville, NC, 28306 tL• tt. ,r �� (•
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Fltt"sj;ileliidioss_City_and Ziil 12t:Rl6L�R[C$'
Cumberland Bentonite seal from 41i431; replacement well
Ccnrw} Parcel lrt�erlifc uion No,(.PIN}
ft,_Liititudc aml H ongifndi*in d4'gnceslminut61scconds ar decimal dictrem 2L Certificatiour
(lt'uell rrCirl,vile l;ntluu}lia'SrstrlCicnl) ,
N Chris' Buffer i 1/19/2023
Sigt�3turrafCcitificifWc4Cantraiitari' Dafc
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11p srg+ri+rg this famr,.l hueby crrtJfv that nc�nrJJtrJ vxty rkerxl ctcrr-rinrrrer3 6r;mx'arrlrmar
O th JSrt YOW 02C,0100 or J.s t XOIC 02C:420tr Well Lblrstrncr&ur Standards mi4;hTr a
7.IsthkariejtdicfuaticxdstiggWeill MYtw tir ❑Nn cr�rrofdrir'rero�rJhasdrenPr»vrtkdrbrbaSR'limericr,
rhls:dtn ri rir, ilJ tort krroi}dr 1ic1J c�rutrrrrr(ati b arrraaulnn smr!�a•(abr rbc rtorur.:d.dir !' "
repair wafer#2Errmarkv sxa&n or(m the bail of rhis form, ?3:Site diagram or additional%yell dehiily:
Yoe may.use ilia back of this page to:providaaddiGaual well site details-or lii It
8:lNuntberofn'e1Ls eonstrwed: 1 ceusuuction details. You if necessavy.
For mntrlple bl ealon or aimmivaer supply 4e(Js ONLY iNtli rhr.srrmecmrstrrietfolr,)wa eaa
sahnuto�ic f¢rm. SUBMITTAL iNSTIJC`I`iONS
9.Total;tell ifepth Itetoir limd stirface, 60 (ft.).'14a..Fnr All Will xt Stibndt this form witbiti'30 dsys,of compteti,64 of well
FornrarlrJpJgi4rlfrlisralJdrprhsi/df�erritr(etrrrnpic-:�2(rq'mui:�J(r>J1 rnnslmctlontmthcfp![oitiug:
10.Static ivater level below top of eosin;; (11,) [livixEuct of Water Rc�tpurrcv,Iniorntutian PrtieessinK Unit,
if 1r>;lhY level is irbOY1 61,361k&Else"}•' 1617 hfai1.$6rs,icc Ccuter,RAlcigh,.NC 2765J-1617
114 Borebote diameter:61' (in) 24b.For Bi Stion Wells ONLY In addition to Saniling.lhe.form to ilia address in
24a above.also sOn,i(t a copy of this form within 30 d#s"of.completion of wdit
12.Well consttactioumethod: Sonic croustnictimtI&thelbHo*fi1gr
(i.c.auger laser},cable direst pasiicta:) Div(s_ioii of Water Resource,URdergromid Injection Control-Program,
FOR WATER SUPPLY WELLS ONLY:' 1636 hind Service Center,Raleigh,.lC 276"436
13;I,Yield(glim) 4lottlad of lest:
2dc.,For Water Sueyix 4t linceti`n Wells:.
Also submit one'eopy of thus fain,lrithin 3WdaYsofcbm0leliou.of
13b.disint'ietiuti tylie Amunnt: -_-_ __ 1vcfG constnution to the county health deti:trtnretrt ofi the coimh;whtci>r
cotastnlctcd.
F®r 1MI-1 NonhCamltnett.-psnmcnt.ofEndrojuucmaniNawralRmurces-DtvtIonohMatcrR�attces RcOsed August.20 13