GW1-2021-01486_Well Construction - GW1_20210429

W15LL CUNbTRUCI'ION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information.
Jason P Morton 14:)iATERZC)1VES # t
Welt Contractor Name
FROM TO DESCRIPTION
2953_p ft. lam') b ft. r ; �
ft. ft.
NC Well Contractor Certification Number
15.0.UTER CASING:forPmulti-ciisedmclls;OR 1 11`IEI;-'ifa liceblei
Morton Drilling FROM TO DIAMETER ' THICKNESS MATERIAL
Morton�t Drilling t�. fl. fL 4 in.
Company Name "76.INfVR'CASINC CIR'PUB1iVG`: eotherm31 closed-loo _ _
2.Well Construction Permit#: _5 7 ,9�-6 FROM TO DIAMETER I THICKNESS MATERIAL
List all applicable well construction permits(i.e.UiC,Couniv,State, Variance.etc.) ft. 0 ft. in. CA th) lT C'-
y..
3.Well Use(check well use): ! !t. [t. in.
Water Supply Well: I?:?S`CRCEN"
FROM TO DIAMETER SLOT SIZE THICKNESS I MATERIAL
❑Agricultural �'Residential
❑Municipal/Public ft, in.
OGeothermal Meating/Cooling Supply) esidential Water Supply(single) in•
0tridustrial/Commercial Water Supply(shared) tS,GROUT h
❑I ri ation ❑Wells> 100,000 GPD FROM TO I MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well:
OMonitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
;.19:SAND/GRAVEL PACK If a'_
OAquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL I EMPLACEMENTMETHOD
❑Aquifer Test OStonrlwater Drainage ft.
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG aitiicli odditioiial sheetaif necess ir," r h:' ,_
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soillrock type, rain size,etc
ft. ft.
4.Date Well(s)Completed: 2 7 ( Well[D# ft, 96) ft. Uj
Sa.Well Location:
ft. 'rOn.
r->A-Y I 1 13 RLun"i eq 7�ft. C7 r,.
Facility/Owner Name Facility ID#(if applicable) ft. ft.
i
ft. ft,
�SS � �Pw hJe 2 S �1�� A4 Z ,5S 7
Physical Address,City,and Zip
Carteret 2I:REt13Ai2KS " :_
County Parcel Identification No.(PiN)
51b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: aWR Section
(if well field,one[at/long is sufficient) 22.Certification:
6.is(are)the well(s): ermanent or ❑Temporary tarure of Certifies a Contractor Date
4v signing this form,l herebv certify that the wells)was(were)constructed in accordance with
7.Is this a repair to an existing well: es or InNo 15A AICAC 02C.0100 or I SA NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well consu'uction`e_t formation and explain the nature oJ'!he of this record has been provided to the well owner.
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 I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).;You may also attach additional pages ifnecessary.
drilled: 24,SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (� (ft,) Submit this G W-1 within 30 days of well completion per the following:
For multiple wells list all depths ifdtjferent(example-3tu,)200'and r2@100')
10.Static water level below top of casing: 24a• For All Wells: Original form to Division of Water Resources (DWR),
lfwater level is above casing,use"+"
Information Processing Unit,161"7 MSC,Raleigh,NC 27699.1617
•—� 24b. For Injection Wells: Copy to DWR,Underground Injection Control((UC)
11.Borehole diameter: K ti(in.)
Program, 1636 MSC,Raleigh,NC 27699-'1636
12.Well construction method: 24c.For Water Supply and Open4,00p Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department oft e county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpm) C_J•0 Method of test: Ai R
Permit Program, 1611 MSC,Raleigh,NC 27699-161 1
�' PlZ-
13b.Disinfection type fVA f4kLi Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources aevisr+t_r,_�nt u