GW1-2021-00138_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 1-2021-00138
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
5/26/2021 WTR1 175-190
(gallons per minute)"

Page 2
5.Well Location
Facility/Owner Name*
Pender Co. Board of Education Facility ID#
(Required) (If applicable)
County* Parcel Identification No.(PIN)
Pender 3293-88-6360-0000
Physical Address* Street Address
17445 Hwy 17N
Address Line 2
City State/Province/Region
Hampstead NC
Postal/ZZp Code Country
28443 us
Latitude* 34.3968300000 Longitud07.6752630000
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
220 surface?
For multiple wells Iistall depths if different 190
(example-3 a200'and 2@100') in feet
10.Static water level below top of casing:(ft.) 11. Borehole diameter:
32.80 12,8
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 80.00 8.00 Sch40 PVC
in feet in feet in inches
17.SCREEN
From To Diameter Thickness Material
190.00 220.00 4.00 Sch 40 PVC
in feet in feet in inches
18.GROUT
From To Material Emplacment Method &Amount
3.00 185.00 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
185.00 220.00 #2 Well Gravel Pour
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.
WTR1 WCR Signed.pdf 98.01 KB
pdf only
*fJ 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)
-rnnrl-orm7
For Internal Use Only:
1.11'ell Contractor Information:
Sean Cropsey
Well Contractor Nome
2485-A
NC Well Contractor Cenification Number
Applied Resource Management, P.0
Company Name
2. Well Construction Permit If: NA
l ist all applicable well construction perntus (i a U1C County. State, Variance, etc.)
3. Well Use (cheek welt use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
IndusiriallCommercial
I -)irrigation
Non -Water Supply. Well:
@Monitoring
Injection 1VeI1:
°Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Tcst
°Experimental Technology
°Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
°Municipal/Public
DRe5ldentlal Water Supply (single)
°Residential Water Supply (shared)
IDRecovery
°Groundwater Remediation
°Salinity [carrier
JStormwater Drainage
0Subsidence Control
IDTracer
['Other (explain under 421 Remarks)
4. Dale Well(s) Completed: 5/26/21 Well IDt! NTR1
5a. Well Location:
Pender Co. Board of Ed.
Facility/Owner Namc Facility ID1e (if applicable)
17445 Hwy 17N, Hampstead, 28443
Physic al Address City, and Zip
Pender
3293-88-6360-0000
Cocnty Parcel IdentifiL.7ti•n N.1 'PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if ss ell field, one laclong is sufficient)
34.39683 N 77.675263
W
6, Is(are) the well(s)rPermanent or °Temporary
7. Is this a repair to an existing well: Wes or ®No
lfthrs is a repair, fill ores rtrniwn well construction mfarnmnrur and explain the nature of the
repair ender . J 1 remark, section or on the hack of this form
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed Indicate TOTAL NUMBER of wells
drilled.
9. Total weII depth below land surface:
Par nruhrplc wells I'isr all depths rf different :.wrr n . - 3@200' and 2g100')
10. Static water level below top of casing: 32.80
limner level is above casing, use "t "
12ri 8"
11. Borehole diameter: +
12,Wcll construction method: Mud Rotary
(r a auger, rosary_ cable, direct push, etc )
220
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a.1'ield (gpm) 175-190
Method of test: Air lift
13b. Disinfection type: NA Amount: NA
14. WATER ZONES
FROM
TO
DESCRIPTION
H.
H.
rt.
ft.
15. OUTER CASING (for
multi -cased wells) OR LINER tifepp&able)
FROM
TO
DIAMETER
THICKNESS 1 MATERIAL
0 ft.
80 ft.
8 in.
SCH40
PVC
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
+2 ft,
190 Ft.
4 in.
SCH40
PVC
ft.
rt.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
1 Qn rt.
rt.
4 in'
.020
SCH40
PVC
rt.
rt.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
3 I1.
185 it
Bentonite
Tremmie
0 it.
3 ft
Cement
Pour
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
184L
220 rt•
#2 Well Gravel
Pour
ft.
ft.
21). DRILLING
LOG (attach additional sheets If necessary)
FROM I
TO
DESCRIPTION (color, heftiness. sea/reek type. Resin ilze, eic.)
ft.
It•
See Attached
rt.
rt.
rt.
ft.
rt.
rt.
rt.
rt.
rt.
rt.
rt.
rt.
2I. REMARKS
22. CcrtiGcation:
patine ofCenified Wel onlra• r
Dalc
11p sr},m+ng this firm, I hereby cent& that the well(s) was (were) cr,nsrrucred in accordance
with 15A hCAC 02C.0100 or 15A NCAC 02C WOO Will Cans:ructo tirandar& and that a
copy IOUs this record has been prnsvded w 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
Sl•BNIITTAL 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 Infection 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 of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection 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 GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revi', d 2.32-201ti

WTR1 Boring Log
Pender County
Water Tower Property
Hampstead, North Carolina
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 5/25-26/21
Depth
Description
Surficial Aquifer
0' - 20'
Dark brown, fine grained sands with organics/wood fragments changing to tan
brown, fine to medium grained sands with minor clay content at approximately 10'
deep.
20' - 40'
Light gray, sandy clay/clayey sand mixtures with wood fragments.
40' - 80'
Medium to dark gray, silty clay with interbedded fine to coarse sand mixtures to
to approximately 60', with increasing sand content to 70'. Alternating sand/clay
layers to approximately 80' where Limestone rock was encountered. Set 8"
casing to 81' deep.
Castle Hayne Aquifer
80' - 100'
Shell hash/Limestone rock with dark gray clay lenses encountered near 90'
continuing to a hard Limestone rock.
100' - 130'
Light gray, alternating soft and hard Limestone rock with interbedded sands,
shells, and dark gray clay lenses. Some phosphate nodules observed at depth.
130' - 140'
Green to gray, limey sands with shell hash.
140' - 159'
Alternating hard and soft Limestone rock with gray interbedded fine sands, shells,
grading to dark gray, silty clay at 159'.
Pee Dee Aquifer
159' - 190'
Dark gray mudstone with silty clay and interbedded dark greenish gray fine sands
transitioning to gray, coarse grained sandstone with sand/clay mixtures
encountered at 185' to 190'.
190' - 220'
Gray, coarse grained sandstone with fines coarsening downward. Clean Pee
Dee Aquifer sandstone at 190'. Medium gray, coarse sandstone with interbedded
fines, few medium to coarse mixtures and phosphate nodules.
220' - 225'
Greenish gray, coarse sandstone grading to fine sands with few coarse grains.