GW1--02444_Well Construction - GW1_20240422

•
•
.
Y .
WELL CONSTRUCTION RECORD Fpr[rttsrnrl Use ONLv:. { •
Thn brinecull be ussd for single or tnultipk wells .
• I •
• .We1ii:Coutraetur t'itftirutation:
• . `IA.WAGLRZONFS . . j , .. • .
Chris Ruffer .. FROM TO ' I Pi-SCIUP11ON i - - •
' Wen Coniraciar Nanie . . R., ft. I
•
4223A re. ft.. I
NC Well ColarCcni1attoiiNinitier - AS:O iTERCASiNGfteeinuti[ sed Ut KcOs}ORLrN (Hal fleabtcl- '
. .. Pant TO DTAMETfili,r T1rICKNESS• \rATEn1AL•
SAEDACCO • 0 1L 30• • iL 6,25" in.• • SCH-40 • PVC
Comp:ury N.uiie . _ ' . t6t'[NNiER:CASING OR:TUBING(e bannal•diused-loop)P;
Fno\r - To- n1A:\METBR.-• ' •TttICYvNESS , 1LaTEfLAL
- . 2.iVclt:Constructeon Pel•iuittr: . ' 0 it. 137 .ft.-2" .'it. SCH-40 PVC ' . ,
List 4111rp0404b1e ttrll penult:f County,SratC:.Vorla'K'r.flgct CI1 e1;.1
$.iWC1t.Uie(ChCC1i Well Use); • C 7;5f:RCEN
- `Voter Supply Welt. , •
mom.' 'TO PtA'I TIR •St,O1sirs. Ti11CKNMS MATFti1AL
137•R. 157 ;ft: 2" • .in:• i'
-,.010 SCH-40 PVC
. .. : Oligticultittal . ' . • .TIMunicipaliPitbl-ic- . ..
®Geothefml{Heatingtooting Supply} DResideutiat Water Supply(single)•'
7� If'. M. i .
®TudustrialIConta erciai • , ®Residential Water Suppl}•(sl ted) -:tR:GROBT .
FROM' . TO . 'AIATERL\I. • ENIU[ACENIENT•TEfuonsAiIO NT
flkngation - 0 ft. '130 'IL Portland:_ , Injection • ' ' •
Non-Wilter Supply Fall:: ,, .
•
• flMonitonng • .ElRcccn'ery . . - tt j
Injec(iott'Wett . :: rL
• QAriifcrRcthargc DGtoundl:tcrRencdlation•• . ,19.SAND1GRAVELlACKPtapplltbtir- -. . _:. _ - • .- -
g - • ' PROM' • ''TO • •NINO:RIM. . ' ' • 'RAIPI CtIOINT miToon
AAnifcrStoalgc"and Rccovety. GlSalinity Battier • • 135. R... 158 it. Sand #2 -
' pAquiferTast. •• .f35tomnrlter Drainage•• . .. - - •. . . . ' . .
ft. •.. 'tL: ; . .
EJE�ptdmcntal ethnology. • • Il tibsidcncc Control
20:DRILLInG'LOG7atlaeh additional shees'if occecsar I '
i]Gaothennal(ClosedLoop) . . • • Neater. . : .FROM 2. It) PFscRIt'rlONitbbr.Irtvncet,;uuttxktrnrn>Y+nairacaet '.
. EiGeotltenlsal(FleatingtCao11ng Return) : I7tlther(explain wider 421 Retnatl n} It..
•fL . ••ft:
. . : 4.DateWiit(s)Conpletcd:'1/11/2024 .welt iDpMW-B03PD . . . .
•
5a WellI ocatinns . . - .fL See GHQ:S Notes '.3'•4 i,.,.E..}-5r' 1..,. ,,, . .
Chemours'•• . . - n, fL V c. �, '
• Facilit)•,tt WnerNntoc. ' . FaFacilityWD,:.(ifapplicablc) : R;. It, i A U •— -- -
1000.Carver Moore Rd:., Lake Waccaraaw, NC, '28450 . ' . ft. ft.: �;;r"">r 'S r'
_ • • •
. Prti; Ades-Ci}- Zipg:1tEtARKs, a : 3
• Bentonite seal from 130-135t
Columbus •
•
. C<runty. Parrot Id..itteaUou No,(PIN}
SI, R.;ttitiideand I.00getude hi deg eciftwiitutcstsecondsor.decimal deg! 22.Cain �. .- .
(lfticllIkId,ak;I;tU90f t%'gttPtiekiu}
i .
• vaRu1 �r .N 1/16/2024
. - SbruteCeily7ciCractar•• ' Date ••6.is fare)the ti'ell(S):.%IPeeitlaueut. .or lJTem[wrnnt it signin Mir form,'f hereby rerfi(1y that th a elll's)was f mrru J arayrruetett hr at ardance '
• . • iiith13ANettCOW,0100or15tNCAG(J2C.0t200LillConstriciicurStaiklardsanddsat<r "
7.F.this-a repair to an Misting welt D'ilty or k2No ct:lirif(tit i<yroirl itt'S 1h ere nmridcd taltre it•i:JI owner.
tithis Is a tr,tixtlwfill otrtkrwitvi utll two/tic/Ian btfotmrdon and espial;the-no-are of rile ' '. - '' '
' 'repair"irderPIivrurrks-srctiurr di-ita the bark ofthisform. - . 23,Site diatrawor additional well details:
• •You may.usethe back of this page to.Provide additional well site()Oats or.welt
• . • - S.Nutuberof-wells constructed: 1 . .. . • cotut1UCtiotr details. You may also attat[tadrliliouat pages if titeessary. .
For'rtrnfrtp/e lrttecilcin ar nrut-yrrer supple teens ONLY n'ldi the rattle consiru lwr,}jai con '
cabnrh and MA. '• - . SUBM[Tl'.&L iNSTI}CTIONS. '
9.Total well depth below land surface:. 157 C.R.) Zia. Air All•Wells:-Submit this!nisi Within 30 da3's af.'cotitptefien of well •
. . Foradiptewells'li rtr siallcicprksifd!(',i rent(cxornpte-3e021117'ttrul.2@WO) ' onstmuctin to die following: - ,
• 10.Static water level below tap of eosins: • • ' ((h,) Division of Water Resources,tlnftirmatian Processing Unit,•
' If rthper level!,above Casimir;rue^+" 1617 lifaiISenice Center,Iltile1 NC 27699=[617 • ,
II.BnrchnIc ianietere l0"/6" • ..(yn.) 24h.Far Infection.Welk;ONLY: In addition to sending
d the form to ihe.adtiteas in . -
• - .24a above:also.submit a copy of this'fonts within 30 days of.coutpletioit of well
' 12.Well construction'tne;hod:Sonic . _ - • . cotlsiniction to the following:, -
(i,c:auger.stay,cable_dir ct pink eta} _ ' 1
Division of'Water Resources,Underground Infection Control Program; •
• - FOR WATER SUPPLY WELLS ONLY: • t636 hfait Service Cent e 1Ruleigh;NC 27699-1636 -
• f3a t.7dt1 - 24e.ForiVatce Supply&Injection Welts: •
• (gltrn) htcdtod.of test: ' Also subauit one CO3pt'of'this form'WIitltin 3i),days of completion of
'WI
WI*
Disinfeetinn type: •Amount: • . • well i anstmetian to the county health department of the.tonne-whets . • .
constructed. I
Fonts GW,L • "Montt Carolina tkpanmeni of Enrironnr n amid Ntantril Resources-Division of Water R otrtn -- Revised August 2013