GW1--02500_Well Construction - GW1_20240422

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Th.is Rini can bc used.for Single or ourItipk wells.-
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WELL CONSTRUCTION RECORD rI eralUeON . -
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I.'Well Ctintntetor fitforniatIon: •
' .' :14 WATER ZONES . . . • •
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Chris Ruffer .• FROM • TO - • orscintsrtox• "
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Well Contractor Name • .ft,. .It.,
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4223A .
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•NC-Well ContractrirCertifialionNtuihei - . , ....AS.OUTER CASING(roe-mottl-MWaisels)OR LINER(If to
ticablel•
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FROM' TO • • - DIAMETER, ITHCKNIESS- MATERIAL. •
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• SAEDACCO • . • - • ft. " ,ft.. .411.- . ,
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'• Company Mute • _.16.INNER CASING ORTURING(geothermal clored-1001) -.
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FROM TO TIHANIETER THICKNESS . MATERIAL
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2.IYCli onstruition!emit 0: . • • . . 0 ...• 'IL 4. . ft. 2" .i'ft!. -scH-40 ' PVC
list al applicable well permits(Lv.County.S400;Yoriarrte. . •fortar0.611 ric:)' ' h .
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• 3.Welt:Use(check well uSe):
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• Water Supply Well: • • - . . • •.- ' FROM. . TO -DIAMETER SLOT Sine THICKNESS I MATERIAL .
4-- 11. 9 It.- 2" 11:r.' '.O10 SCH-4 0 - - PVC
. t2Agricultural - EIMunicipaliPublic . .
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1:IGeothermal(Heatingeobling SupP13..) I:Residential Water Supply(single) . ft._ . El. .I .
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Ift,:GROUT• •
• . Elludustrial/Conuitercial - ' OResidetnial Water Supply(shared) • •
FROM . '. To ' . NIATEREAL - EMPLACEMENT METHOD&AMOUNT
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. Difriination . - • • • 0 ft. 1' -IL Portlarid Pour -
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Nott-Water -Suppl*Well:- . • • • • • . .
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Monitoring . . pRectively ' ... • - . ' • .
Ittjection.Well:, - . " • , ft, . . ft. .. - :- . . • . • . .
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0 Aquifer Recharge '•- 1-.3Grotinawa• ter Rentediation- . • 49.SAN n/GRAVEL PACK(if applicabtet. ---- -" - -- •
;FROM - ' TO' • • NIATERI‘L • " ENIPLACEMENT NH:Toon • • - -
nAtptif,crStorage.and ReCovelzi . IDSalittity Ditticif . • • 3 ft. 9- It.. Sand : #2
1:Aquifer:fest:. ' 7. • : InStormwater Drtmlne'• . ' . . .
• . pE*gritnental Teel:norm' - . . ElSobsidc nee Control . • - , '
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• 20i•DRILLINGLOG fattacluaddition-al'sbeets,ifrieccssaol • . •
' Cleteodtennal(CIM,ed Loop). • • . lifiraeer . FROM ' TO DESCRIPTION tobr.hanIncA4.stattwk Him:min sire.clt.1 ' .
EIGeothennal(Reatinkdoling Return) . I:Other(explain under#2 l Itettiad;:l ' -rt. ft. 1
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4.1ia to Well(s)Completed:•1/16/202 4 ,wj.ft intit4B-B08 8 '
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• Sa.Well Location: . • • J r.,. ,See GeW.3 Notes •:::i..... '' --
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Chemours • - 'ft. :. •ft, .• .
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. FacilityjoWnalislank,- . : . .- , Facility II/y(ifappliFablc) . . . . -.
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" . 2815.Green.Rill.Rd. NE , Leland, NC, 28451 • . ft. ft.:, . •
• . , • • ire.c...;711-:...0.r,'. ....1:1,74:.! 43 3i: '
116-ikal Addpss.City.nitd Zip•
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. - Brunswick' • •- • • , Bentonite seal from 1-3' .
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County • • - . . Parcel Ideutifte.ilion No,(PIN) . .
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Sh.1.-ittititde and Longitude in degrees/minutes/swings or dceitnal d‘gn....s, 2
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.2 ..Centilleation: ' • .
full ricki,ow.k.unotiia is-t:ignigolo
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w.. . Chris- Ruffer - . .I. .
: 1/16/2024'
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• • - . • irglii.:netrf&7tilici ..-aia., i . , . Dan .. . .
6.Is(are)the well(S): X1Permartent. or riTentgorary . .. . . -
ny.5igning this fontr,'I!racks,certify Mai,MI!.re/ 0 vats ilverel asap-rut-red II?OCCO11/471Cr -
• ' iiitir FM JVCAC 02C,0100 oft'151NCAC,02C.0200 Weil Conitmcrion Standards and than a '
7.Is this a repair ter an existin well; ElYvi• or tilNit WAY'Of Mir record has iken provided Att*ITU int;ifer,
If roWsly a irpale,fill our knoilii well noaprualotibrforawrion and expfaio the nawre of the ' .
repzirritrifir 421 ketnarks iraidn errs,the bath of thiti form - ..24.Site diagram or additionaltrell detach
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• You mamay use the back of this page to provide additional Well site details or'well ••• - •
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- S.Number of-wells constmeted: 1 - - .. -. - • construction details. You may also attach additional pages if necessary. .
For4uniriple fafecihm(if non-buter suppli,wilt ONLY with die sani.e cOustruktka,you can . _. . .. . .
sufv.nitigne farm.. . SIIDIVIITTALINSTUCTIONS. ' , •
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9.Total well.depth below hued surface: 9 . . - •, (11.) -24a. Fur All Wells Submit this Tenn within 30,days of completion of welt .
Foe nodal&wells lisi aff ilephi tidifil•roa(owner-30200'and.2@ M). - • construction to the fottoniii: ' I .
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10.Static water level below top of casing,: . • • ft.) . • Division of Water Reiourco;Information iirocessing Unit,
linwei level Is above cxistiitz.!LW"+" . 1617 ALM Service Center,Raleigh,NC 27604617 - . •. .
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Ill.Borehole dianietert 6" '-(in.) • 2.fh.Furfirjectiog Weltc ONLY: In addition to sending the fowl to the address in
.24a above,also,submit a copy of this foam within 30 days of completion of well
112.Well Oa ostittetion'method:.Sonic ' - - construction to the folloWing: I
tic..a*r.rotary,cable.(tired task tic.) • " .• ' I .
'Division of Water Resources,Undergmottd Infection Control Program; '
'FOR WATER SUPPLY WELLS ONLY: • . 1636 Matt SerticeCeitter.Raleigh;NC 27699-1636 '
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.2:4V" , Su/10Y&Injection.A.VeMt
13a.Yield(gttm) *Mod of test: •
Also:.subritit..one copy'of-thii faint Within 30 days Of Completion of
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13b.Disinfection type: • . Amount: • r ' . . well construction to the county health department of the cOuntywhere
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Foint ,GW.1 . • North Carolina Department of Environment and Natural Resources-Incision of Water Emotion• - Revised August Iota
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