GW1-2021-01006_Well Construction - GW1_20210824

�wn
WELL CONSTRUCTION RE •RD ,
NORTH CAROLINA
EnWronmental Quullty
•rm GW-1 Well Constructon Electronic •
North Carolina Department of En\Aronmental Quality
April 1,2021
Submission ID#
G W 1-2021-01006
Are you submitting a printed form?* r Yes
F No
CONTACT INFORMATION
.........................................................................................................................
Contact Name* Email Address*
Alyce Bean [e-mail]
Is this a revision to the form you have previously submitted?
r Yes F 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
2412 A DONALD CUMMINGS,JR. APPLIED RESOURCE MANAGEMENT
2.Well Construction Permit#:
N/A
List all applicable well construction permits(i.e.IVbnitoring 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
7/27/2021 PW-1 (gallons per minute)"

5.Well Location
Facility/Owner Name*
McAdams Homes Facility ID#
(Required) (If applicable)
County* Parcel Identification No.(PIN)
Pender 3271-12-6568-0000
Physical Address* Street Address
east of sidburry rd,south of pluris rd
Address Line 2
City State/Province/Region
Wilmington NC
Postal/Zip Code Country
28411 United States
Latitude* 34.3264976000 Longitude�7.7724692000
Decimal degrees Decimal degrees
6. Is(are)the well(s):* r Permanent (" 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 GWA is needed.
8a. Indicate TOTAL NUMBER of wells drilled:
9.Total well depth below land surface:(ft.)
174 9a.What is the depth of the casing from ground
For multiplewells Iistall depths if different surface?
(example-3@200'and 2@100') in feet
10.Static water level below top of casing:(ft.) 11. Borehole diameter:
14.5 14.5
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) 13a. Method of test:
If applicable
13b. Disinfection type:* 13b.Amount:*
N/A N/A
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 33.00 16.00 Sch40 PVC
in feet in feet in inches
17.SCREEN
From To Diameter Thickness Material
144.00 174.00 8.00 stainless steel
in feet in feet in inches
18.GROUT
From To Material Emplacment Method &Amount
0.00 111.00 cement tremmie
in feet in feet
111.00 131.00 bentonite poured
in feet in feet
19.SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
131.00 174.00 gravel pack#2 poured
in feet in feet
20.DRILLING LOG
From To Description (color, hardness,soil/rock type, grain size,etc.)
0.00 2.00 brown organic rich topsoil with wood and root fragments
in feet in feet
2.00 31.00 gray sandy clay with wood fragments
in feet in feet
31.00 75.00 light gray fossiliferous and sandy limestone
in feet in feet
75.00 100.00 soft light gray limestone with intermittent sand and clay layers
in feet in feet
100.00 130.00 mixture of dark gray and green clay with intermittent limestone and sandstone layers
in feet in feet
130.00 135.00 dark gray-green clay
in feet in feet
135.00 138.00 mixture of dark gray-green clay with intermittent sandstone layers
in feet in feet
138.00 179.00 gray salt and pepper sandstone
in feet in feet
179.00 183.00 gray sandy clay
in feet in feet
21.Remarks

22.Site diagram or additional well details:
You mayupload additional well construction information here.
2037 1_PW1_printed.pdf 264.51 KB
pdf only
CERTIFICATION INFORMATION
*N7 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*
�}
dC/4i!�ldf9f�fYC��JC1
Signature of Certified Well Contractor
Submittal Date 8/24/2021

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:

Form GW-1 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:

Well Contractor Name

NC Well Contractor Certification Number

Company Name

2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)

3. Well Use (check well use):

Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrigation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop) □Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under #21 Remarks)

4. Date Well(s) Completed: Well ID#

5a. Well Location:

Facility/Owner Name Facility ID# (if applicable)

Physical Address, City, and Zip

County Parcel Identification No. (PIN)

5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)

N W

6. Is(are) the well(s): □Permanent or □Temporary

7. Is this a repair to an existing well: □Yes or □No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back 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 well depth below land surface: (ft.)
For multiple wells list all depths if different (example- 3@200’ and 2@100′)

10. Static water level below top of casing: (ft.)
If water level is above casing, use “+”

11. Borehole diameter: (in.)

12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)

FOR WATER SUPPLY WELLS ONLY:

13a. Yield (gpm) Method of test:

13b. Disinfection type: Amount:

14. WATER ZONES
FROM TO DESCRIPTION
ft. ft.
ft. ft.
15. OUTER CASING (for multi-cased wells) OR LINER (if applicable)
FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
16. INNER CASING OR TUBING (geothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
ft. ft. in.
17. SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
ft. ft. in.
ft. ft. in.
18. GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
ft. ft.
ft. ft.
ft. ft.
19. SAND/GRAVEL PACK (if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
ft. ft.
ft. ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
21. REMARKS

22. Certification:

Signature of Certified Well Contractor Date

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. 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 INSTRUCTIONS

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 Injection 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 & Injection 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.
Donald Cummings
2412-A
Applied Resource Management
NA
NA
7/27/21 PW-1
McAdams Homes NA
East of Sidbury Road, South of Pluris Road
Pender 3271-12-6568-0000
34.3264976 -77.7724692
174
37.75
14.5
Mud Rotary
NA NA
NA NA
0 33 16 Sch. 40 PVC
+1.5 144 8 SDR 17 Certa-Lok PVC
144 174 8 0.030 Stainless Steel
0
111
131
111
131
174
Cement
Bentonite
Gravel Pack #2 Poured
Tremmie
See attached.
Print Form
Poured

BORING LOG
SILO RIDGE
PRODUCTION WELL 1 (PW-1)

Silo Ridge, Pender County, N.C.

Loc: 34.3264976, -77.7724692 (approx.)

Drilled by: D. Cummings, CWD
Logged by: C.J. Cornette, PG
Date: 7/27/2021
Depth (ft.) Description
0 – 2 Brown organic rich topsoil with wood and root fragments.

2 – 31 Gray sandy clay with wood fragments.

31 – 75 Light gray fossiliferous and sandy limestone.

75 - 100 Soft light gray limestone with intermittent sand and clay layers.

100 – 130 Mixture of dark gray and green clay with intermittent limestone and
sandstone layers.

130 – 135 Dark gray-green clay.

135 – 138 Mixture of dark gray-green clay with intermittent sandstone layers.

138 – 179 Gray salt and pepper sandstone.

179 - 183 Gray sandy clay.

1. Total Borehole Depth: 183’ below ground surface
ARM
Geothermal, Environmental,
& Well Drilling