GW1--04453_Well Construction - GW1_20240730

•WELL CONSTRUCTION RECORD r.l•It,;r,4,,,',e()NI
The fern can t.c aced for single or multiple tells
1.Weil Contraetur Information:
114.WATER ZONES
Tyler Brown mow to 1 m.a PIP,ION
Well('ontrw:ter Nan*: ft. ft.
4625A fe ft.
NC Well Coniiucnor Cat ifi.anion Number j 11.OIITRR CASING(for ue i-cai d it OR LINER tit a doable)
Tanta To DIAMrTf t THICK:NE: MA1TRIILI
SAEDACCO 0 fl. 49 rl. 2 ia. SCH-40 PVC
(;outran, N.tile If,INNRR CASING OR Tt'RIN(.(jeulheraral clued-hoe -
retOM TO on,,METER THICKNESS MATTRIRI
2.Well construction Permit R: ft. to. W.
Las all appli.able;aril penny(c r.Cowan.Starr.t'nriamer,livereart e1...)
R. , ft. I le.
sr 3.Well I' (cheek well awl: • 1 S(K t► _ 111
Water Supply Weil:
.,i</t,l IS, Dt.4MITTR StarSl7.1 111K14 Nleix I MATxdtAL
LlAgricultural DMunicipal:Public 49 59 ft. 2 HI. O10 SCH-40 PVC
DGeotheintal(Hearin 'C'ooli Supply) DResidcntral Water St '' f t' i..
R nB. tpp tpply lsingl.
OhldustriaUComntercial DResidential WaterS( I" (.lend 1
Ivp1y'(SICIR':1 1 ulna P, si t i i to V i EMPLACEMENT METHOD a AMOUNT
❑Imgation 0 ft. 45 It 'Portland Tremie
Non-Wrier Supply Well: ft
ft.
XManitonne ❑Recoccn ,.._._
Injection Well: rt. /I.
OAtprifcr Recharge DGmnndw:atcr Rcmcdiation 19.SANU(.K ss 1.1.P..(k 1if a icablel
.RUM i Il, - ,I.It III ti PMPt.A('tMrsit MF1HOfl
❑Aquifer Storage and Rccoccn' OSalinit% Hamer 47 ft. 60 ft. Gravel pack ill
❑Agnifcr Test ❑Stomns;act Drainage ft, ft, 1 _
❑Experimental Technolog` DSabsrdencc('onml
❑GooU►emal(Closed Loop! OTracer 2s.DRILLING LOG taltach additional,theat if acceuaryl
p PROM TO DPS RIPT1ON itslor,hoedown.,eOkrnel.tipe.olio.ire.elk.i
DGeodkmWl(Heaong"C'ooline Return) OOther(explain under a21 Remarks) n R
h, ft.
4.Date W'elksl Completed: 6-13-24 µe'11 ll►001-11R
R, ft.
Si.Well Location: ft. n. ` '{
L.`--`-'' fir _�.i I
Chemours fl II.
Fae din-OanerNam Facdth tDM(if applicable) • r •
(I. JUL 3 9 2024
22828 NC HWY 87, Fayetteville, NC, 28306 h n.
Pim steal Address`City.and Zip 21.REMARKS - -
Cumberland Bentonite seal 45'-47'
P.Irc.l kkmdtcailai N., IPI\I
ih.Latitude end Lnngitutk•in degrers.mimitt-A...'nnds or decimal doge:s: 22.('criificatinn:
tit sell held.mt l O k nt Is sidt'rcteral
J,.
N W L._1_ 6/14/2024
Sidnata.of Ccntl,cd Well Contractor Li u
6.Is(are)the well(s): XPennanent or 'I rnqutran
lit trgnintr Thu lone.I herebr.ertify Mar die wigs)Isar(wrn'I irisi'W(ied it°reminisce'
II'Itl1 154 NCAC OK.0107 or 1 SA NC.4C 02C.0200 Wail Construction Standards and,hat a
7.Is this a rtpalr to an existing well: ...A es or IL Nit rapt of Ail record has berm pnnLwd rn The well earner.
11016 It O repair.oill tset knuww w'ell.lMnI,u.two In/orM471NM11 1141 rtpioei file notate of the
repair ceder Ill ensueSr serlee or and the heel of this form 23.Site diagram or additional well details:
You may use the back of this page to prosaic additional well site details or well
8.Number of wells earstnrcted: 1 annuli:lion details. You reay also attach additional pages if n ecesaaty.
For maUiplr 1njerrN•n.M Mfal-N'ater Hipp!,edit ONLY with the soil eastsen ettns vow too
sabnrrir eMe Joraa. SUBMITTAL INSTUCTION S
9.Total well depth below lard surface: 60 (ft.) 24a. for AU Wells: Subtle! this form n uhut 'III days of completion of well
For naltipk wells list On thigh,rfdgkrenile'.arnpler rtaltai'ani e'Ifien construction to thefolknsing
10.Static water level below tap arming: (ft.) Div isinrn of!later Resources,Information Processing Unit.
Il Wale.71•,r1 n el' our,(!Sleep wR' . 1617 Mail Service(eater,Raleigh,NC 27699-1617
I I.Borehole diameter:6" tia l 24b.For Inketlon Weill ONLY: In addition to sending die form to use address in
24aabove. also submit a copy of this form within 141 days of completion of well
I2,Wet cosstrwetlon method:Roto-sonic cotLstnuction to the following.
tic.auger.retan.cable.direct puck etc i
Dhision of Water Resource,.I inks-ground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Sets ice Center.Raleigh,NC 21619-1h36
24e.FOS'hater Supply $Injection Welk:
13a.%idol mono data%of test
Also submit one cope of this limn is thin 30 day s of completion of
IJh.llisinf�Ytion h Amount: well constniction to the counts health detainment of the comity'where
constructed
Fenn CiW-I Non►(.,nine:IA>ptnrnrcnn of Eau uorun u acid Naniral Resources-Dwssion of Wat.r Resoiro6 Res nod August Nil