GW1-2021-00137_Well Construction - GW1_20210617

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WELL CONSTRUCTION RE •RD ,
NORTH CAROLINA
EnWronmental Quullty
•rm GW-1 Well Constructon Electronic •
North Carolina Department of Environmental Quality
April 1,2021
Page 1
Submission ID#
GW 1-2021-00137
CONTACT INFORMATION
..................................................................................................................................... ...............................................................................................................................
Contact Name* Email Address*
Alyce Bean [e-mail]
Is this a revision to the form you have previously submitted?*
f Yes r No
WELL CONSTRUCTION INFORMATION
.................................................................................................................................................................................. ......... ......... ......... ......... ......... ......... ......... .......
1.Who is installing these wells?*
r Owner r Well Contractor
1.Well Contractor Information:
Certiticate# Cert Level First Name Last Name Company Name
2485 A SEAN CROPSEY APPLIED RESOURCE MANAGEMENT PC
2.Well Construction Permit#:
N/A
List all applicable well construction permits(i.e.fvbnitoring Wells,UIC,County,CCPCUA etc.)
What type of well is this?* r Injection Well r Non-Water Supply Well
r Water Supply Well(includes irrigation wells)
3. Non-Water Supply Well* r Monitoring
r Recovery
4. Date well was completed and ID#
Date Well Completed* Well ID# Well Yield
5/24/2021 EMS1 100-110
(gallons per minute)"

Page 2
5.Well Location
Facility/Owner Name*
Pender County EMS&Fire Inc. Facility ID#
(Required) (If applicable)
County* Parcel Identification No.(PIN)
Pender 3271-64-9490-0000
Physical Address* Street Address
Hwy 17N
Address Line 2
City State/Province/Region
Hampstead NC
Postal/ZZp Code Country
28443 us
Latitude* 34.3325760000 Longitud07.7512770000
Decimal degrees Decimal degrees
6. Is(are)the well(s):* r Permanent r Temporary
7. Is this a repair to an existing well:* r Yes r No
If this is a repair,fill out known well construction information and a)plain the nature of the
repair under#21 remarks section or on the back of this form.
For multiple Geoprobe/DPT or Closed-Loop Geothermal Wells having the same construction,only 1 GW-1 is needed.
8a. Indicate TOTAL NUMBER of wells drilled:
9.Total well depth below land surface:(ft.) 9a.What is the depth of the casing from ground
194 surface?
For multiple wells Iistall depths if different 58, 160
(example-3 a200'and 2@100') in feet
10.Static water level below top of casing:(ft.) 11. Borehole diameter:
46.60 16, 12, 8,4
If water level is above casing,use"+" in inches
12.Well construction method:
r Auger r Air Rotary r Cable Tool
r Direct Push r Mud Rotary r Rotosonic
r Other

Page 3
14.WATER BEARING/FRACTURE ZONES
From To Description
in feet in feet
15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
From To Diameter Thickness Material
0.00 15.00 12.00 Sch40 PVC
in feet in feet in inches
17.SCREEN
From To Diameter Thickness Material
162.00 194.00 2.00 .010 PVC
in feet in feet in inches
18.GROUT
From To Material Emplacment Method &Amount
3.00 161.00 Bentonite Tremmie
in feet in feet
0.00 3.00 Cement Pour
in feet in feet
19.SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
in feet in feet
20.DRILLING LOG
From To Description (color, hardness,soil/rock type,grain size,etc.)
in feet in feet
21.Remarks
22.Site diagram or additional well details:
You mayupload additional well construction information here.
EMS1 WCR Signed.pdf 101.43KB
pdf only
*rJ By signing this form, I hereby certify that the well(s)was(were)constructed in accordance with 15A NCAC 02C
.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of this record has been provided to
the well owner.

23.Certification*
'L rw r
Signature of Certified Well Contractor
Submittal Date 6/17/2021

WELL CONSTRUCTION RECORD (GW-1)
mint rulut.
For Internal Use Only:
I. Well Contractor Information:
Sean Cropsey
Well Contractor Name
2485-A
NC We l Contractor Certification Number
Applied Resource Management, P.0
Company Name
2. Well Construction Permit #: NA
List all applicable well construction permits (ce UIL', Count) State t-anance. erc.J
3. Well Use (check well use):
Water Supply Well:
o Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
1111mgation
Non -Water Supply Well:
Monitoring
Injection Well:
o Aquifer Recharge
Aquifer Storage and Recovery
['Aquifer Test
['Experimental Technology
fGcothermal (Closed Loop)
°Geothermal (Heating/Cooling Return)
4. Dale Well(s) Completed: 5/24/21
Sa. WeII Location:
Pender Co. EMS & Fire Inc.
Facility Owner Nain
°Municipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
▪ Recovery
Groundwater Remediation
°Salinity Barrier
Q Slormwater Drainage
['Subsidence Control
O Traccr
[Other (explain under #21 Remarks)
RellID# EMS1
Hwy 17N, Hampstead, 28443
Facility IDa Of applicable)
Pliy=!cal AM'dress, Ciiy. and
Pender
3271-64-9490-0000
County Parcel Identification No (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lalllong is sufficient)
34.332576 N 77.751277
6. Is(are) the well(s)rPermanent or °Temporaryy
7. Is This a repair to an existing well: ['Yes or EINo
if this is a repair ,f 1 out bum ri well construction information and explain the mature oldie
repair under 21 remarks sit no: or on the hack of this_limn)
8. For GcoprobelDPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 194 (ft.)
I or multiple welts ha air Jepihs if different (example- 34200' and 2@l00)
10. Static water level below top of casing: 46.60 (ft.)
1f wat er level i.r above casing, 11se " "
1 1. Borehole diameter: 1611 ,121i ,811 ,4n ((n-)
12. Well construction method: Mud Rotary
(i a agor, rotary, cable, direct push, etc
14. WATER ZONES
FRDM
TO
DESCRIPTION
rt.
rt.
rt.
rt.
15. OUTER CASING (for mull -cased wells) OR LINER (if ap
limbic)
FROM
TO
DIAMETER
THICKNESS )
MATERIAL
0 IL
15 rt.
12 in.
SCH40
PVC
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 IL
58 ft.
8 in.
SCH40
PVC
+2 fi'
160r''
4 in.
SCH40
PVC
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
162 t
1941t.
2 in.
,010
SCH40
PVC
ft.
rt.
in.
18. GROUT
FROM
. TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
3 11-
161 ft•
Bentonite
Tremmie
0 rt.
3 rt.
Cement
Pour
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FRO%I
TO
- MATERIAL
EMPLACEMENTMETIIOD
ft.
rt.
rt.
rt.
20. DRILLING
LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (calor, hardness, son/ruck lype. grain size. etc-)
ft.
ft.
See Attached
ft.
ft.
rt.
ft.
ft.
rt.
ft.
rt.
ft.
rt.
ft.
ft.
21. REMARKS
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 100-1 10
Method of test: Air lift
13b. Disinfection type: NA :Amount: NA
22. Certification:
Signature of Centfied Well C ntrac
Mat
lt
By .riganng this fi,rnr 1 hereby comb that the well(s) was (mere) constructed m accordemLe
with 114 NCAC 02C 0100. or 1SA NCA(' 02C 0200 Weil Construction Standards and that a
copy i jthus record has hcen provided to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details You may also attach additional pages if necessary.
SI:BMITTAL INSTRI'CTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following.
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Inieclion Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following.
Division (MWater Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnly & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed
Form C, W-
North Carolina Department of Environmental Quality - Division of Water Resources Revised 7-22-2016

EMS1 Boring Log
Pender County
EMS/ Fire Property
Hampstead, North Carolina
Drilled by: Applied Resource Management, P.0
Logged by: J. Zuncich
Date: 5/18-24/21
Depth
Description
Surficial Aquifer
0' - 20'
Medium tan brown, very fine to fine grained sands changing to sandy clay/clayey
sand mixtures with minor wood fragments at approximately 10' deep. Set 12"
casing 0 to 15'.
20' - 40'
Tan brown to orange, silty clay with interbedded sands and wood fragments.
Shell hash encountered at 39' deep.
40' - 43'
Brown to gray, silty clay with shell hash transitioning to Limestone rock at 43'.
Castle Hayne Aquifer
43' - 60'
Limestone. Cave 46' - 49' with circulation Toss, and then continuing Limestone
to 51'. Void encountered 51' - 54' with circulation loss. At 58', set 8"casing and
sealed with bentonite grout. Drilling continued through Limestone interbedded
with brown -orange sands with minor clay content 60'.
60' - 82'
Light gray soft Limestone. Cave at 62' - 65' and Toss of circulation. Limestone
continued with no return. Set 6" casing to 72' and sealed with bentonite grout.
82' - 95'
Alternating hard Limestone with interbedded tan brown very fine to fine grained
sands.
95' - 110'
Gray soft Limestone with shells and some greenish gray interbedded sands.
110' - 120'
Greenish gray soft Limestone with abundant shells and some gray interbedded
very fine to fine grained sands.
120' - 150'
Greenish gray very fine to fine sands with shells, Limestone, and few orange clay
lenses.
Pee Dee Aquifer
150' - 160'
Shell hash, soft Limestone, and greenish gray very fine sands with phosphate
nodules transitioning to dark gray mudstone/clay mixtures at 158'. Gray, coarse
grained sandstone with fines encountered at 160'. Set 4" casing to 160'.
160' - 180'
Gray, coarse grained sandstone with fines coarsening downward. Clean Pee
Dee Aquifer sandstone at 165'. Medium gray, coarse sandstone with interbedded
fines.
180' - 200'
Gray, coarse sandstone with increasing sand content at depth transitioning to
greenish gray, fine to medium sands with few coarse grain sandstone fragments
between 195 and 200'.