GW1-2021-03239_Well Construction - GW1_20210628

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Michael Young 14.WATER ZONES
FROM TO DESCRIPTION I
Well Contractor Name
ft. ft.
2370-A L
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING'formulti-casedt"Wells OR LINER if a "IIcable
Fishburne Drilling Inc. FROM TO DIAMETER THICIaVEss MATERIAL
2.5 it- 0.3 2 In sch.40 PVC
Company Name
16,INNER CASING OR TUBING ebthermal'closed-loo _
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc) ft• ft. in.
3.Well Use(check well use): ft ft. in.
Water Supply Well: FROME TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 10 fL 2.5 it- 2 in. .010 j sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. 10 ft, ia.l
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT t
❑hri ation ❑Wells>100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 2 ft. 1 ft- Bentonite Poured from surface
InMonitoring ❑Recovery 1 ft. 0.5 ft- Cement Poured from surface
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19:SAND/GRAVEL PACK'if a Iicablt:
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 10 fL 2 ft- #2 Filter sand Tremied through auger
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM I TO DESCRIPTION color,hardness,soiUrock in size,etc
0 ft- 0.5 fQ Asphalt
4.Date Well(s)Completed: 05-26-2021 well ID# MW-7 1 ft• 10 ft- Tan sand
5a.Well Location: fL ft
NJ
Academi Training Facility ft ft
Facility/Owner Name Facility ID#(ifapplicable) ft. tt• 11
850 Puddin Ridge Rd., Moyock, NC 27958 fL ft qtoress1119
Physical Address,City,and Zip ft. ft. SeC't60h
Camden 21.REMARxs
County Parcel Identification No.(PIN) g
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certit- r•
36.461551 N -76.202522 W
� 6/17/2021
6.Is(are)the well(s): IJPermanent or ❑Temporary Si rc of Certified Well Contractor I Date
By signing this form,I hereby certify,that the wel(s)vas(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ItNo 1 SA NCAC 02C.0100 or 1 SA NCAC 02C.010 11 Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature ofthe of this record has been provided to the well o
repair under#21 remarks section or on the back of this form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMMAL INSTRUCTIONS
9.Total well depth below land surface: 10 (ft) 1 I
For multiple wells list all depths iii different(example-3@200'and 2@100� Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original fo I to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Rali igh,NC 27699-1617
If water level is above casing,use"+"
11.Borehole diameter: 8 (in.) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Hollow Stem Auger
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing I ver 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

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LEGEND
Previous Temporary Monitoring Wells Associated with Impacts
• Current"Shallow'Monitoring Well Locations
OCurrent"Deep" Monitoring Well Location
Proposed"shallow"Monitoring Well Locations
FIGURE 4
PREVIOUS AND PROPOSED RAM PAD
SOURCE: MONITORING WELL LOCATION MAP
GOOGLE EARTH Ram Pad Area
IMAGE TAKEN MAY 2,2018 ACADEMI Training Facility
SCALE AS SHOWN ABOVE 850 Puddin Ridge Road
Moyock,Camden County, North Carolina
ANNAMMMMUL-MTM ECS Project No.49:8246-F