GW1-2021-00139_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 1-2021-00139
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#:
NIA
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
6/2/2021 WR1 150-175
(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 3283-83-2003-0000
Physical Address* Street Address
997 Hoover Road
Address Line 2
City State/Province/Region
Hampstead NC
Postal/ZZp Code Country
28443-3325 us
Latitude* 34.3834060000 Longitude*-77.7121830000
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
205 surface?
For multiple wells Iistall depths if different 80, 175
(example-3 a200'and 2@100') in feet
10.Static water level below top of casing:(ft.) 11. Borehole diameter:
28.32 16, 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 61.00 12.00 Sch 40 PVC
in feet in feet in inches
17.SCREEN
From To Diameter Thickness Material
175.00 205.00 4.00 Sch 40 PVC
in feet in feet in inches
18.GROUT
From To Material Emplacment Method &Amount
3.00 170.00 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
170.00 205.00 #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.
HVR1 WCR Signed.pdf 96.39KB
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)
i1111111 Urr1r
For Internal Use Only:
1. Well Contractor Information:
Sean Cropsey
Well Contractor Name
2485-A
NC Well Contractor Certification Number
Applied Resource Management, P.0
Company Name
2. Well Construction Permit #: NA
1 !sr all apphcaF fc w.lt L?nstru:n,m perms ri a (11C, County, Stara. 1'ariancc. err)
3. Well Use (check well use):
Water Supply Welt:
▪ Agricultural
['Geothermal (Heating/Cooling Supply)
Industrial. Commercial
I1Irngatlon
Non -Water Supply Well:
Monitoring
�Municipal/Pubilc
['Residential Water Supply (single)
['Residential Water Supply (shared)
Recovery
Injection Well:
▪ Aquifer Recharge
DAqulfer Storage and Recovery
▪ Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Dale Well(s) Completed: 6/2/21
5a. Well Location:
Pender Co. Board of Ed.
Groundwater Remediation
['Salinity Barrier
13Stormwater Drainage
['Subsidence Control
[Tracer
['Other (explain under #2I Remarks)
Vel11D# HVR1
Facilityttwner Name Facility 1Dl! (if applicable)
997 Hoover Road, Hampstead, 28443
Physical Address, City. and Zip
Pender
3283-83-2003-0000
County Parcel Identification N.: (PIN)
5b. Latitude and longitude in degrees:minutes/seconds or decimal degrees:
Of well field one lai I.:n_ is sufficient I
34 23' 00.26" N 77 42' 43.86"
W
6. Is(are) the well(s)0Permanent or Temporary
7. Is this a repair to an existing well: JYes or ENo
df Mhrs is a repair. fill out known well conrsrrucnon information and upturn the nature of the
repair under r2! remarks secuon or on the hack r f this farm.
S. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction- only I GW-I is needed- Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 205
For mite* wells hi.: ail depths rfd fferent (example- 34200' and 2@IOO1
(ft.)
10. Static water level below top of easing: 28.32 (ft.)
if water .es .i ,.above casing, use "1 ••
16",12" 8"
11. Borehole diameter: ' (i i.)
12. Well construction method: Mud Rotary
(i c auger, rosary, cable, direct push, etc )
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -eased wells) OR LINER (tf ap icable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
0 ft.
61 ft.
12 in-
SCH40 PVC
16. INNER
CASINO OR TUBING
(geothermal closed-laap)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
80 ft.
8 i"•
SCH40
PVC
+2 '
175 rt.
4 in.
SCH40
PVC
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
Ot 7F ft.
205 rt.
4 in.
.020
SCH40
PVC
ft.
ft.
in.
10. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD iAMOUNT
3 ft•
170 ft
Bentonite
Tremmie
0 rt.
3 It.
Cement
Pour
rt.
ft.
19.SAND/GRAVEL
PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
17dt•
205 ft.
#2 Well Gravel
Pour
ft.
rt.
20. DRILLING
LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hankies,. toil/rock type. grain am etc.)
ft.
ft•
See Attached
ft.
rt.
rt.
ft.
rt.
rt.
rt.
ft.
fI
ft.
ft.
ft.
21. REMARKS
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 150-175
Method of test: Air lift
13b. Disinfection type: NA Amount: NA
22. Certiftcl>Rlon:
welt
t,
SignatureofCertifi Con ctor
By signing this farm, 1 hcnhy certify rhar the well(s) was (were) constructed to accordance
with 15A NC.e#C 02C .O WO or 15A NCAC 02C 0200 Well Construction Standards and that a
copy rf this record has been 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
SUBMITTAL INSTRIICTIONS
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 Iniection Welts: 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 & lniection Welts: 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.
Farm GW-1
N tilt Carolina Department of Environmental Quality-Disision of Water Resources Revised 2-22-21116

HVR1 Boring Log
Pender County
Hoover Road Property
Hampstead, North Carolina
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 611-2J21
Depth
Description
Surficial Aquifer
0' - 20'
Dark brown, very fine to fine grained sands with organics/minor wood fragments
changing to tan brown, fine to medium grained sands with abundant wood debris
encountered at approximately 12' deep.
20' - 40'
Continued abundant wood debris to approximately 25' changing to tan gray
brown, fine sands with gray orange clay lenses and residual wood debris.
40' - 60'
Medium gray, silty dense clay with interbedded fine to medium grained sands
grading to sandy clay/clayey sand mixtures with minor shell hash/cap rock
encountered at 60'. Set 12" casing to 61' deep due to wood debris causing
borehole stability.
Castle Hayne Aquifer
60' - 80'
Medium gray, fine sands with shell hash/ Limestone rock hardening near 70' with
interbedded greenish gray sands. Set 8" casing to 80' deep.
80' - 100'
Gray, alternating soft and hard Limestone rock with interbedded sands and
shells.
100' - 120'
Hard Limestone rock with shells and interbedded green gray sands, softening at
depth with light gray clay lenses.
120' - 160'
Alternating hard and soft Limestone rock, interbedded limey sands, shells, some
phosphate nodules grading to Limestone /mudrock mixtures with light gray clay
lenses at 150'.
Pee Dee Aquifer
160' - 175'
Dark gray mudstone with silty clay and interbedded dark greenish gray fine
sands. Gray, coarse grained sandstone/sand mixtures encountered at
approximately 170 to 175'.
175' - 205'
Medium gray, coarse sandstone with interbedded fines, some medium to coarse
mixtures. Clean Pee Dee Aquifer sandstone at 175'.
205' - 210'
, Greenish gray, coarse sandstone with dark gray silty clay and sand mixtures.