GW1--05759_Well Construction - GW1_20230901

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WELL CONSTRUCTION RECORD For imernal Use C/NLV:' '
Ilds.ferin cmi be'tow',for singte or multi*wells
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1.We4I ttontractOr htfDTRIaciatt: . . . ., . . .
f41;-...11,ATEITZONES,
Chris Ruf fer FROM TO DESCRIPTION' • •
Weli.Contratter Name ft. ft.
It. ft: .
1 :
4223A • •
45AUTERCASING ifor-iiitliTizeisiificahlORILINER f if litil fidable).t'.._ ._
NC Nt/01 Comiractorcatification Number
FRom - • To • .DIAMETER', '1 THICKNESS • - MATERIAL
_II,. ft; l:
SAEDACCO - . ,:Ju . -
--16.INNER:CASING olt.TIMINd.tgimithernial einkil4iiiiri ,. .,-. ._FROM To . DIAPIETER THICKNESS- MATERIAL
2.Witf C9nstnIttf9alialiii,t 10: • +3 . R. .68 It; 2 1141,. Sch 40 PVC
fist u#Oiliiieitio 1011 peiniJ'n fie..e'ology;Stele,ilrarioace.-Ti C4rir...)
ft. ft.
3.'NYC'l liser(clteek wet ttsel:. 1?.:SCREEN'.
• - - 'WaTer Stilipily.Well: - FROM •I.TO ntvi,tF,TER -SLOT Sim i,TittacNtSs I.MATERIAL.
68 ft.' 78 ft.' 2 ' -iii. .;010 SCE 40 pvc
ClAgItellititta1 OthplicipaltPublit. -
ClGeotherrital aleatingireotiog.SupplY.) ElResidential-Watcr5upply(slide) . . • . .
' • '18GROU17.---
I3Industrial/Oattnicrcial OResidentiad Water S'upply.(sharcil)
FRom . 7 TO- .ALI:TER. •.'i:.'1 . •ES-IPLACE' SIEVT iurn inn,, ,IL.mn-lifr-
0 Irrigation . 0 ft.,• 62 ft, Portland - Pour -
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•• Non-Water Sulkily Well:. .. . . .. ... ,.. . ._ . . , .. . , . . . . . . . . . .
1111 . . .
&Monitoring
liccoyctj' ft ft. •
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InjectiOn Well;
ClAtinifcrRceta'rge. •0.90nridnatcr-Rentediation 49:.'$ANDRIRAVELPACK fit apalleahltr,- - - --
,, ..• . ... .. . .'FROM TO '. MATER/AL ESIPIAEMENT METHOD •. . . ..... ..
PAituffer.$totageLand geecivcrY 1-101initY Partier 65 ft 7 9 ft., sand ', ' #2 .•
ClAquiki test 138fortuwatet Drainage• ' • "
;..., . It... .ft.
f3xperintentaitechncitna D.Subsidcnce c!bnirol.- • . •
ACDRELLING•LOGInitacklidifiticinal itieeti:ilbeeessnriT
lb • • .
- Owtherniat(ploied Loop) . CiTtocer • FROM .70 ' nrseturnox ttour,tirtrarivii.ioluttiek hue:emu?ire.tItl
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Odeotheunal(lleatinatooling Return)• bother(explain under#2)'lleinadis) - 'ft.
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. 4..DateWell(s)totiipleted:•8/1/23 . . Welt kW ow739 — ...... ,.....ft IT.',a (VPIE F,
K (80;1:1\I U . •
fto: ' 1:14 . •
.5a,;Well Locatinot .
fr, See GEM's Notes ,
SE
Chemours . . ... . 11.: ft, P 0 I 20Z3
Factitiptlivn9rjgarpq FacHily101:rif apptienbie): • ,
R. ft. , . Infeorikr,e4cn?mosso:el URN .
1248 Bill Hall Rd. , Fayetteville, NC, 28306. - ft. ft, ' - t..44 ..4-40Ca
Pio-Sled AddOgs:City;and Zip .:2.L.Ru.dAnks
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Cumberland .
Bentonite seal.from from 62'-65'
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Coat*. Pareei Itientifleatieti,No.(BO ,
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514 LiiTirde.aad Longitude hi degtvisfutinnioheitindid:r ookiiai degrees: 27:Cation '
(TN ott 04,4 one 1.4,104,.hi:suffielm)
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N• • -
Chris...R. :
. uffer
w ......_ . ,.. ,...:,.........,.._ , ....., , 8/4/2023
Signituri(if Cestified Well Ca=etch-- ' Dale •
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6.is(#)the wdl(u): xlitrittattent or -1Jl'etoporn4 ittsigning,4 form 1 irereby err!if y ii..u4,.lbe w410,4-oN 1..)1Vir.,1 wp.Onretettitkyceor4frocr.
widi 15A.,AT4c 02C.,01i16-or 11t NCAC(VC.(7260 3Vei!Cron.itric4{qn§rtitriards and;War el'
7..ls this it*palrfki atkeilitittg.n.c11:- DYc,s or !En)- 'cri4!of(Ilif rieroilf Ili*6kri opwid.tyl 0.14(i.illTilfilt1144;
iiMiSite,rip*,fill cm;AiNirti well comma-you.htfOrmatIon•tut!!explcapt the!ware of the •
'repair rii-Wr#21,reinorks Seilizifi:or.NI the had,,f ihi.i•Pilo: :;13-.SEt diagram or ailditio maw 01 details: , • .
You tuay,tiso the bach of this page;to..'provide additional*ell site details or*ell
8.Nuntberof Wells eonstretcted: 1 consiniction defaifs;You tba‘.-alsO.atiachadditiottif pages if Decesary.. • '
For Util#;xte Utjthion •,,-rado.i:ii.o!.ir swpirliA,11$ON!.)'with the sinit 5.cote,struilid a,von ion .
scibmit clie.firm..-..' ' - -- $11BlvtlittAE.,IkS'IlialiDisfg
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9. Totitl iielfileptii heron-hind Surfaie: 78 - (ft.) 24a. For•All Wells:. Submit this facia Within 38 clays..of completititt of well
For magpie icrlii-list all depths(f differe'm iavoTte-3@26117°and 2@ 1007 ..Cottstittctiptttp the Ottani nr. ..
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10 Static mutes lord lielov top of enSing:. 010 iliitSitin of Water Resources,Information titrociesSing Unit,
limiter levet Is ithoiv casii4..thie"+" 1617iIitifSeivic't CcnicTi Italei*NC-27699-1617
it I,Bottbste dimeterT 6 .(in.), 21h.For riticctiott Nyglls ONLY: In addition'to sending the form to the address in
24a abo.e,also submit a.copy of thisr.form within:46 days of cOtOpletion.Of well
12.Weg'constrAtion method: sonic cotistruttionfo the following;: .
(ie.-au:pr.-rotar),-Cole:direct Fitsh.etc..)
• - . • Division of Water Resources,Underground Injection Control Prog,r4ni,
FOR WATER,SUPPLY WELLS'ONLY: 1636 hial(Service-Center,Raleigh,NC 21699-1636
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For,ivi?atekSdenly Stfikieethin Wells:
13:1 VfFiti WO Method'n f teSt:
. Also'Stibtitit One copy of this fOrni'Within.30.cia--yoft:citumetOgilf .
well consnoction to the.county health'department of the Countiwficre•
f3h.Ifisinfeetitm.typer A.mount;
. constructed.
Form OVA. Ninth Carolina Ekliqament_of Esdreinmemand Natural Rew=es-DiViSfOli of Water Rotrem Reit.eti AugOst 2013