GW1--05758_Well Construction - GW1_20230901

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W E4 CONSTRUCTION RECORD Rif fricrnal I.4.c 014L1':
. This Toni)cos be uscd•Erir Single ormultipk wells
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1;‘Wai:ConiractiiithifOrnii4on: - . . . . .„ . • •
,-14:AVAIERZONES',. ' . - '. •-
Chris Ruffer. FROM 70 " OFSCRIPtION• '
Well.Cohltudor*MHO It . .
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Ft. ft'. :
4223A. . . ' .
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,IKOUTEft CASING iftletriallizelisid•neRifORLINER411'irr fliatrle):;.,,:,_ . .
NC Well CoMmeior Ccurattion Mather
FROM• • •TII ' -TRAMETER S' 1 .TITICKNESS • ' 'MATERIAL •
.04:. • .ft; .•; .. .!hi; -.
. . - SAEDACCO ' . . . .
Comply N'aine. • • ' • ,16...INNERCASINGORTUBINGSkiNitheithit
FROM •70 . • DIAMETER. Thicalass MATERIAL•
two Construttion#ertni1-0; +3 ft, 62 q. 2 lilt. Sch 40 PVC
List 4r11 roil-keit*',kit(prmiit.!;fi-e..Caunty.,.Sico;Aristiarreejigeahykisqr-
.ft.. . ''tr!. . ' ' •
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3.'W_el t.Use.(cheek Well•tts0. .17iSCREEtt ".. , • "
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' '7 WatcrSupply Weil: blio'n- • „TO - DIAMETER "SrOT Sin 7111CKNESs• MAMMA t, .
, • 62 -0:: 72 it,-- 2 •. 'iii,i! • ..016 SCH 40 ' pvcI;lilitilieipaliptildic
• ,—CiGeothermat(Heating/Cooli ogSupplY) CIRestdential Water Supply(single) •- ... ., , . .• . •
El inditstriallcontutcrcial .C1Residential Water SttpOy(shard) '
',EMPLA(ENMT METHOD•&AMOUNT
. -0 kTigatiD D . .. . . ... • - 0 'ft, 56 ft. Portland Pour • .
' Nno-WiterStipPly . ,Welk, .
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.iihlonitori4 . . IJRccorciy . . . .
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IttlectiOn.Welt: . • • . a: • ft,
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ClAiwifcr-Rcelidrge-- rlqii;iiindnutctrItcnteiliation ;19:.,,SANDIGRAvELTACK Oritplitie.inte)., ' - --...-7„ . :-.--.,. . . ,.- .;----- •
Taos:- -To • • NIXIE:REAL' •' umpt..iameNT mutton. - ...
-1;14. ili!tt.mStoi.;484A41* .1:1$alinity tiOnt4t. 59 .R. •.72 ft,. sand 1: #2
El&mit&Tog . ' . . 138116ioii‘atet ittattitte-
. .m,.....
171perittimital TOmoto.V. • Pittiiidciice.totaiol. • , - .
2.02-0nttiLlNG,LOGIfitnieli4idditicifiatsheititribeeessa6)'• ' . ' .
Elgeoeheonal.( loSed.1.,eop) . ElTnIcer - - FROM• . TO• . DESCRIPTION(coht,hiniarscionktictium'Araki.Ate:dr)
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DGeotitemial(Mating/Cooling Return)- bother(explain under di Reinarks 'ft. . 'ft.. . .
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. Date 4.))a NVi4i(s)Completed 8/3/23 - . AVdi MO 014732 . - •
... ,. ... ft.- !i• ' RECEiNjPr
sSa;Well Laotian:. rt. See-Gerp's Notes
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. Chemours • , • , .. ft.. it. . SEN 0'1 2023 . . . .,
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FacRitptiffinerNmuc ' - - fac.ilitylDN Of apOltab)0.' .- - '
- - -ff•-. ft. . .
• • linframe^VCril.Pfr.-C•504.*41 Ur •
1248 Bill Hall Rd. , Fayetteville, NC, 28.306. : . . - fi, , " iri., .
. . PhYikA. AdAi0.5--cit3:7-P nd Zip . '211lEMARKS:
Cumberland ..
, Bentonite seal from-56.L-59. - •
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CimclY. Parcel Itin4HICatipc t`10.,(PIN)
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$iii•i.:iiiiiide and Liinittitittfiftiggtii0tiitigiii4ciiiitds.de ikciiiii1 iitit#: - 21-Cccatin tn...
.• •• (lt ix 441,iti :14:101.12,1,sOlieleILI . ' , . - ' - ' -
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N• . • ., . Ruffer.. •
w Chns. . ,. 8/4/2023
5 iegarbari Of Certillif Welt comMetdr i • • Date • .
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6;4(.ire)the well(s): 14Petinaitent or -mIttott9ratip By.sigrik g.li4t Ann;ilrergIty verrey ilia *we..1441 Ivo'(yew)‘lerr_rtrifited,fir;fituggerace.. .
lY 15.1 Arcric 02C..gior)..•if:154 ATCA.0 07c.,'020 Bill Construction SratalartIF ancliiiirt a
7..IS this 4t=irenali•'01 411k.,t4tArt*well, OVes ..or. ENn tpir:y of il.lif ir.roiil 4.0 bicvi&mitred•4 ifiri•miTii(Amer.,
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iphi.s:ls,o fikfr;Of oat kNi.vit wg,17 coAyitikitorr brAirnallor eaitlespiahr th.efliMOre of Ole
repair aide's-421 rernada.i*iidroiron she hark tif INN/aim, .;23:-Sit diaginm or ad4itionaludi iletaits:• . ,
Iieli tuak:Use the bade of this pag ..to',0,1Oyiefe additional well site details Or Well
- . •8,"Ntintherof Wells'Cotistructed: 1• • • . . . Oust/0061 iletaiti:You niakalso:aijackadditiotininages if iteceKsatk.
For maihlinte frifeczhm Of'rtot):1kirre shpplymeth ONLY with"fheidinfoopstriii.IlarT,you t:tot
stibinit 04:fem.: . . "' - ' " StilIMIT'AL INSTETtlIONS
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9,..Total iielldeptli.belan-land snifaie: 72 • . ,01) •.24a, For All AVellii:."SSidnit this faun Within'.36 ilays..-of eoniletion Of well
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For nink,ple iviliti-lisi(1.11 depths V dtrr Itixample-.:3@.:200'and 2(0!ROI .:C011stitid**to the foltonliv. - . .
10: ,t-,itie wateilevel heti*nipof easing: (R.) bfkisiiiit a(Water Retickui.4.*;Intiii-nwitin iiixicOsiing trpit,
. Ifyame kvel ii abaFt:rasto*.die"+" 107 Mail Service Center:Raleigh,NC-27699-1617. .
U.gorehotO dionteter:.6 • - (In.) 24b,Fnr Infection WrIlq 014X: In Addition to sending thc.fomt to the addiesS.in
244 absie,'AO submit a.copy of this;.form within 30.days:of cOnipletioitit welt
1,2:-Virclicons1ruction method: sonic - colistruitfun Co the follOWing::. 1 •
fie-mi,..*.'.ii:44y.".0.21;46,:direct push.etc.} • ., _, . t
. . •W11110110 Water..Resources,Uudergnnmd Injection Control PingrOtt,
FOR-WATIERSUPPLY WELISONpif 1636 Malt 8eiticeteitter. nielgliiNC 27699-1636
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•Ile,Par Water Stienlv.&ilnjwiOu NVells: - -
lla;Vieldigpmy :Melba il"of iteSU
Also'submit one copy of this ford,-Within.30:03.i.OfecimpletiOn of
13.1t.Disinfection Mier :Antannt: well constntetiOn to the-county health!dOartrnent of theconitty.whcie.
• constructed.
Form GW-,1- North Carolina bcpurtment.or Eiwironmentand Natural Resources-DJvisfork ot-Water Roatron Revised August NB-