GW1--02456_Well Construction - GW1_20240423

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' WELL;CONSTRUCTION RECORD • For trxatttal use ONL1:
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TIti form can be'used For'single or nudtiptc wells
L Wdt_Ciintrictorittforrnatioci: _ ' • -
• e,Y..WACElt-LANES'I
Tyler Brown FROM. ' ' TO DESCRIPTION
%VonCommclorNamc . • • -: ft. .. ft.. I 1• . •
462SA .ft. ft.• • •I.
NC Well CoiulauorCcrtlfmalioar.uii ci `It'OUTER•CASiNG`(Coe^tariff-cased wcIM OR LINER'(liaall abkh. -.
FROM' -TO DIAMETER IIIIC N SS- MATERiAL
SAEDACCO . . 0 ' ft,. 42 fL' 6.25" r In, .SCH-40 PVC
• Company Name, . :i6 INNER CASING ORTURINGfierielterital cfuscdaoij)i).''
• 'FROM TO - - DLLMETER' Tt teKNESS MATERIAL •
2.WcltCoistructfnn-FFrmit'#: 0 • ,R. 50 ft. 2" - ' la.• SCH-40 - PVC
Lisruff ppIn-ablcrseNpenairs(in..Coun%.Stu,M1},yariarrz infeCdr/1eir,). '
3.Wcil.Usc(check Well use):• _It:SCREEN' - - - -
• Water SupplyWelt - . . -' . . . . - FtiONI• - TO -DIAMETER M Ors;73: THICKNt5 I MATERIAL, •
ClAgficultluul, . . •' ••D141iunicipaUPnb ic: 50 ft: 65 ft. 2" •In• O10 SCH-40 I PVC
OGeotlhermat(Hcaatibg`Cooling•Supply}: ®Residential Water Supply(single) R. f[ im I
-A82GROUT`• . •. • Dlndusltial/Ctaiiniercial DResidcntiat Vir ater Supply(61.K4- d), num •TO- rtIATER1A1: EAfP1ACEMENT MEiHOD&AMOUNT
❑Itrigaficn . - - - 0 ft. 44 it• : Portland • Tremie • • • .
• Nod-Water Supply�Vetl:' ' •
®Monitoring .DRccovrty .
Injection Well: .. • . , :ft.' . . ft,. - -
DAglliferRccfiarge . . OGtoundtratcrRcntcdiation ' . '19.-sANDiGRAVEL1ACKOreitplk:,bte)"t -:
'1rn0\1 •TO MATEftt i, FOIP1.ACEVENTMITHOD
DAquiferSioiagc•andRccoFrt3• 17SalinityRanier 48' •IL 65 • ft. Filter Sand #2 •
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EAnuifcrTest I7Storim`atcr.Dlaittos. •R. ft .
Dt:gicrimentalTechnoto�s• ❑Sidtsidcncctonirol:, .. ' .
10.BRILUNG LOG7aitackadilliinnal altos if neccssart l:
DGeodiennal(ClosedLoop) OTtaeer ..FRONT ' TO DPSCRIITiONkobr,uanfricA,suwmckore:crainWa(lea• .
DGeotltenttal(HeatineiCooliug Return) D011ter.(avlaitt under#21.Retuadks) ft.. ft•
ft.. ft..
..t Date'4ViU(s)Coniple:ted:• 2-7=24 Well ID#MW-PWO1-PD I-- - :
•ft. 'rt: • • 2 '.. 1.-.L:i; ix. L..l...
5a.Wtill Location: f(; I it I . •
Chemours ' ' . • . . it. APR 2 2024
FacildyMutxrName Facility ID.(fappli;ablo}..• • R. It, <.�.._ ?c,. fir;;-.`: v?k
lrrv„ r.. .
121 Whitman.Ave., Castle Hayne, NC; 28429 . . . g�. ' n, 1p'.,Lr;=Uv •
Pikyikii Address._City'_and Zip •r2t:-REMARK$
New Hanover • Bentonite seal 44'-48'; ' ' - -
. ' County . Pati:e bkiititleMleoNo, .(PIN) ' .
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5h.Latitudeand l.quetudcin degrees/minutes/3ceitndsoritceMO degrees: 22,f crgircadoa: • 1,
' (if well tii;IJ;Oth i iUlonig;i5'sufttcknl) .
W -'Z �--- 2/7/2024 '
' S.ignitu..afCcrtilcdW.ellConiractar Date
6.is Q nr);We:atrcll(s)i RIEctmtanent or I7Tentporarg th•,signing thfr Ana,!-irrrehr certify rliur dig:wets))t+us{hare)=corirmried in Weer lance
with 154 NC AC o2c.0IOO or 154 NCrlC.02C,.,0200 Well Coirstnacrlon Starxfarels.and!Isar it
7:Is thiut a repair to an euigting•ne:t DVe or El , ropr opdiut mcr;trf has been P.royal 4 ro thv�tiir:ll awaer. -
Ifrhrs:isaripair fillsvrrkruirva.tin!!eonorircrlon.hiftimufiost mad appal"Ste mature:ofale. , S • - '
' repzor wofer931 rrrearix srr$dn.or ari fhe hark of fhls form. 23.Site diagrams or additional well details:
You may use the back of this page to provide additional well site.detaiissor well
$ Nuntberof Wells constructed: 1 consttuctian details. You ivaa:also atuacli additional pages,if necessity.
For mtilriple iricclion or eras-atiree.s:q pI,'migfy ayLY.HMI the swinge construcrlwr,year can
• sabniit.mnc form, . . -. •SUBMITTAL iNSTUCTIONS
9.Total Well depth below hind surface: 65 - - (tf.) •24a For1Atl Wcllrr• Submit.this ftimi•wilhtn 34 days of compklioti•of well
• Foe atalflpfo Weds iii hir rrf!rfepihs ifAireretir(e.Tdit!pte 3@200"pnd 20'1Otr'I • ,consitttetton to the following:' ; ,
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10.Static water level below top of casini t - . . (ft.) .Division of Water Reraurces.Infitrniatioti Praiessing Unit,'
• - i/nn,er teem!is abate cnsirt$;we"}" . . 16i7.Maii'Senice Center.Raleigy NC 276l9-I6 t7 . .
IL Borehole diamcter:,10"/6" ctn.) 244.Far Infection Wells ONLY: iri addition to sending the fomt to the address.in
24aaboi`e.also submit.a:copy-of this foam t%ithin 30,days-of conviction of well
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- 1;,Well oonstractionmethod:Roto-sonic coustiuchtiii to-the followine: i 1 .
(i.e.Auger;rotary,cable dicta push.e(c:t • • 'Division of Water Rcieur'cei,Underground Injection Control-Prograllt,
FOR WATER SUPPLY WELLS ONLY: -1636 Mail Serried Ccter,Raleigh.NC27699-1636
pat lr"tdd(gltm) aYlctitoti of test: - 14e.ForVater Supply&lnjcctfoo Wells:
Also submit one copy'of this:fain withiit 3O daasaifcotnpletionof
• 13I.Disinfetition,tipe: Amount: . well construction to the county ltc iltfi department of the canny whom'
. constnictcd. .
.Dann GW-t ' Rosh CarolinaEklianm Emit-mum aLz RevisedAtgust?DI3. .
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