GW1--05761_Well Construction - GW1_20230901

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• WELL CONST.REICTION:RECORD ,
1.11[5,SOIrlil Op bc:usvcifin gnglo or-multiple:wells• F..c.ir trafloll*‘0111;.-)1':- - '
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I- l'.WelICOntractertifOrniatiott:
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,--11:AVATIIRZONFS- • •
Chris Ruf fer PROM TO - bEtiCRIPTIONi
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Welt COilmeior Name• • ft. . . it.•
4223A
rt. .6. 1, -
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NC Wc.11Comfactor Ccaiffdation Number ,1SZ OUTER CASING ildielifuliklis-id:We1601t LINERfiViiii"Ileatileit:,
FROM - TO "". ' DIAMETER, 1-• THICKNESS '. • 'MATERIAL
SAEDACCO . . -f•L.: . .114J . •
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. CcYnifliniy!lain. • . - • - ' ' ' • •.-16ANNERVASINGORTUBINGAimillMiniateiiised-Ilion);".,"...L :.. .--•,_
• -FROM • -TO • • DIAMETER.. ' .THICKNESS •MAIEREAL.
i. .WCO-Citustruettoit ii.etinit ih•• . +3 -ft. - 51 • it; 2 • !1:IL 'Sch 90 ' PVC • .
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flist,oftai-Ocrabfe ullifpiisfLe.t7nguy.,•52400.-Variarree,filettic4.ele....)', __ _ - L . . ,. .-. -- -. _ -
..N*Ol.165c.-(01.41:.%To.1(14 - - • II:SCREEN:- . . . .
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Water SiMply.Well: • . PROM ..TO DIAMETER '$IOTSI7X .TIIICKNESS, 1.MATERIAL
..-, - . . •ttifii6WITEbliC 51 1L:; 61 ft.L 2 ' All; • ...010 - SCH-46 I pvc
EJAgfidtliiira.1 1:11ti .. -
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•ft; M. - 4m4 • ' ' ' - - - -
.. • CIGeothemtai tticatingiCeoling.SupplYi• .C1Residentiaf Water Similk(Single) . I
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ClIndustrial/Conunercial Lrqte5icktlial Water SuPOY:(shared) - -FR051 -. -113‘ • ItLiTERiAL.• . .1311TPLACENEENT ALETHOD.&AMOURT .
. Elkiigation. . . -• - - • . . . - •• 0 ft. • 45 • ft. Portland Pour . ' • • .
Non-WiterStipply Well: . • • .
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• •ilApnitoritig • . . likecovetY • . _ - . . . I •. . . . •
'InjectiOn•Well:- ft, ' 04.: - ; • .
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rlArtnifefltd6hige . opii,iini4-ilawr ROkiiiiirioii - ..,'.17:SAND/GRAVELPAC_K ririipplkabtoti",' -'-- --7-.77:---
. ,.. . ,., . , . -•• •,--- .- FROM• -TO -- . M,VITtrAt., ' EMPLACEMENT mrtnott • -
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- • P'Aitititerl$Minteanil 4*etii,*tY• ElSatinityl3aniei...
, . .• 48 .8:- 62. ft., sand I . #2
IDArtuifei'rest • 1:1$MititWatct Prnttiage,, .It.. .f.f.• . '
0Eincal Tccluofo& pSihaideNeontio1. . - . 24.2 •
. -. ,..N -.G.'fii- iadiic isiiiif•hessaf '
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. . ' •2DRIfliGOitl nt cer - - •
1: ve0OleOa(Closed LdYl) tTprir tlom
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- .10 . DESCRIrTION fo;44r:liardp ,igilh*RtYPt.'011111 SiM Oka
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OGt.,othettnal4Fleatine/CoOlingRtunty bilker(explain under#2..1 Retnadis) 'It. . ft.: .
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. It - "ft.'.. ' • !. • -
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t.Dilte'Wtili(s)Catitpleted::8/1/2 .. .. iiike Ibi$OT174R ' . . .. .. • , ,
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s„„%Ill Lociatitioi. - - ,
ft, See Goa!s Notes i' -
' . . . SEP 0 1 .2023 • -.
.. Chemours . . • _ " • ,ft.;, :04.- • - - I'
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FeFilt-09.WnerName - - . .Ficflijyipg oi**„*F.-• - • . .
"(,-- • ft ' IfIfegfiCe441til Ptc-c-anoi-g urta
1248 Bill Hall Rd.„Fayetteville, NC, 28306 , . , . . • • rt, . • • ] DVINZA,.:.''3G1 •
likviical:A00-i."qq..,04:Pli . ' .REMARKS . . . . •
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Cumberland • Bentonite Seal from 45' 48' -
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GiMuli' parcel Iticilifleation No;(PLN)r
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Of:lij4iilitde7aUil Lotikitntisin;degreesiniinniiii44iindsnr-decitianitOipes;• • 22:;.cei.fift.e.i'606:, . ' . • •
(itwelt I)ettlio4.10104,.iisOnelaitty• • '. • " •-•".' .• .. . . . .
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N' •W. ChtisAuffer .8/4/2023
• -..., •: ....,,..1.,.::.,;..:A.,
Sigyi4.4 tic Certilied Weil-camejem t. . Date •
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6.is(sit).the well(s): wwritiaitent . or .6Teinpoca0 '14,.iignbig.ihit fano,-1.hereby t!ergfy(Fiat the ireji(r)tettr.icreret 4vi1it110eit lir;poporgarice,
- . *irk'/SA ircfric 02.0i!OlOcr I Sit NeitC 0:2C:WOO itiell epniituctioir Sto4dard,F and-sjoar t.T.
7,ii.i this a repair to an 44**iy'elh EIYes .Or fdlNa •tv0ilf Oaf ironl liiV:Wen'linafirtaioiti101oityufr.
1.10(i'LT.o riimik;fill oar kr?..iy.i ill eanypuerlotritrkienami eiNti.e.ipM01 Oe.wage of the,
repitir Olittiri121,retnorits Eeriiiirior7ott the hod:of this foini. 23 Site diagram or adtiOiotall,BAll details: - . . , ' •
Yon may.use Me l.tacit-of.0;page to provide additional well site details.Or Wilt .
S.Niuttherof wells eintStructed: 1 • • . - eetistpietien details":You Mayalsipahaelt additicniai pages if iieeeisary: - '
For mailr6n1e kiln:cr4o.p! uuatt velar dy seine cvisimiitfoir..,pit Alil • • •• , • ........ . .. -•.. •
..1101!11 avikryt- . . - . .SUBMITTALINSTUCTIONS , .
9.Ta Wellilepth betoW Lind kitfoie:. 61 • • . ..- • - • .(ft.) •24a: Par All•Wells:--,Sitinnit(his fur within 30.days.,of..'ioreptetititi.Of Well
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. Kir nifiltipht i;,•!Iiillit'aliiii.,p0s h'tlygreta kromple--30200'aott2G1110T • - .' .COt151kocikOta tpllidfoitow:i4, • ' . •
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. 10...Static w,ater 104 belus hifi.of eaSing: 4.) Di won of Water.ReSoutiers;litfilimatitin yew eitiiing Unit,'
. . Illoier kvel 4 eib6k.i..a444.14e. 4." 16ilMito-sei•oct er,ti:ici.';ita1A0t,1117.699401.7-
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it,Swank dinicteri.6 • - (Ii!) 2lb.Far Twitectien,WelIN.Ofitti In addition to sending-the fonn to the address in. '
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240"-abei,e,also submit.a.eopy of tInS.:foun within 30 daYs•of completion.of Well' •
17.Well oattstruction Method: Sonic • . •eatistniitionto the.following!:
(i.e.au*rotily.tatile;..diMci push etc:1
DivIslon of Water.Resources,Underground Injeciktn.c'oittrtil Program; •
FORWATEUSUPPLYINELLS'ONlLY:' - .1636 Malt-8ervIce Center.Raleigh,NC 1T991636 ' -
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. . .; ,.• - •Sit.For.WatteStiOply&Injection Welts: - .
Ila,:'Yield(glimi: • ' •Method.91 test: •
.Also submit one copy of this fentitWithitt.301aYSorcomPleticin Of
43h.Ilislufeetitiii ti .per : .Aniniit; • - Well,constOction to the-dottrof itcalth departMent of die't outdir where
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Form.GW:.I. Norilt Corollito11.1mamont.of Environimntart9,19aniral Resources-Division oiWainiketrcas - Revised Aggust2013.
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