GW1-2021-00214_Well Construction - GW1_20210628

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WELL CONSTRUCTION RE •RD ,
NORTH CAROLINA
EnWronmental Quullty
•rm GW­1 Well Construdon Electronic •
NorthCarolina Department of •
Division
April 1,2021
Page 1
Submission ID#
GW 1-2021-00214
CONTACT INFORMATION
..................................................................................................................................... ...............................................................................................................................
Contact Name* Email Address*
Steve King [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
4055 A JOEY VELASCO CRAIG'S WELL DRILLING
2.Well Construction Permit#:
..........................................
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.Water Supply Well* r Geothermal(Heating/Cooling Supply) r Industrial/Commercial
r Irrigation r Municipal/Public/Community
r Residential Water Supply(single) r Residential Water Supply(shared)
r Wells>100,000 GPD
4. Date well was completed and ID#
Date Well Completed* Well ID# Well Yield
6/18/2021 50
(gallons per minute)"

Page 2
5.Well Location
Facility/Owner Name*
Arris Holdings Facility ID#
(Required) (If applicable)
County* Parcel Identification No.(PIN)
New Hanover
Physical Address* Street Address
Ansley Park Apartments
Address Line 2
Beverly Cove Way
City State/Province/Region
Wilmington NC
Postal/ZZp Code Country
28412 USA
Latitude* 34.1640200000 Longitude'f7.9142600000
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 F No
If this is a repair,fill out known well construction information and e)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 GWA is needed.
8a. Indicate TOTAL NUMBER of wells drilled: 1
9.Total well depth below land surface:(ft.) 9a.What is the depth of the casing from ground
185 surface?
For multiple wells listall depths if different 145
(example-3 a200'and 2@100') in feet
10.Static water level below top of casing:(ft.) 11. Borehole diameter:
20 12
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
13. FOR WATER SUPPLY WELLS ONLY:
13a.Yield(gpm)
50 13a. Method of test:
If applicable Air
13b. Disinfection type:* 13b.Amount:*
HTH 2 Ibs

14.WATER BEARING/FRACTURE ZONES
From To Description
135 I oD Medium Sand
in feet in feet
15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
From To Diameter Thickness Material
1.00 72.00 Sch 40 Steel
in feet in feet in inches
17.SCREEN
From To Diameter Thickness Material
145.00 185.00 4.00 Sch 40
in feet in feet in inches
18.GROUT
From To Material Emplacment Method &Amount
3.00 20.00 Quick Grout Pump, 3 bags
in feet in feet
0.00 3.00 Hole Plug Gravity 3 bags
in feet in feet
19.SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
143.00 185.00 #2 Well Gravel Gravity
in feet in feet
20.DRILLING LOG
From To Description (color, hardness, soil/rock type, grain size,etc.)
0.00 55.00
in feet in feet
55.00 75.00 Shell
in feet in feet
75.00 85.00 Limestone
in feet in feet
85.00 100.00 Mud Rock
in feet in feet
100.00 115.00 Black Clay
in feet in feet
115.00 118.00 Soft Rock
in feet in feet
118.00 127.00 Sandy Clay
in feet in feet

127.00 135.00 Fine Sand
in feet in feet
135.00 185.00 Medium Sand
in feet in feet
21.Remarks
22.Site diagram or additional well details:
You may upload additional well construction information here.
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*
Signature of Certified Well Contractor
Submittal Date 6/28/2021