GW1-2021-07651_Well Construction - GW1_20211214

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Austin Fowler 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
ft. ft.
4366-A
ft. it.
NC Well Contractor Certification Number I&OUTER CASING ter attdd-eased wells OR LINER if a bte
CATLIN Engineers and Scientists FROM TO DIAMETER THICKNESS MATERIAL.
0.0 ft. 6.5 ft- 2 i" Sch. 40 PVC
Company Name
16.INNER CASING OR TUBING eothersal A' dead-loo
2.Well Construction Permit#: I y/A FROM TO DIAMETER THICKNESS NI TERIAL
List all applicable well construction pernul.s(i.e. l ilt',County.,Slate. I Ol7anCe,etc l ft. ft. in.
3.Well Use(check well use): ft. ft. is
Water Supply Well: FROM
SCREEN
PPS FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural []Municipal/Public 6.5 ft- 16.5 ft' 2 "' I Slot.010 Sch. 40 JPVC
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ft. ft. in.
industrial/Commercial Residential Water Supply(shared) 1&GROUT
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 1.0 ft- 5.0 ft- Bentonite Pellets Surface Pour, 1181b
x Monitoring Recovery 0.0 ft- 1.0 ft- Concrete Surface Pour, 801b
Injection Well: ft. ft.
Aquifer Recharge Groundwater Remediation
19.SAND/GRAVEL PACK if a bk
Aquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test [3Stormwater Drainage 5.0 ft. 16.5 ft. #2 Medium Sand Surface Pour
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) Tracer 20.DRILLING LOG atthcl additional sheets if eeeessa
FROM TO DESCRIPTION color,hardness,soit/rock type. rain size,etc.
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) k. ft.
4.Date Well(s)Completed: 11/16/2021 Well ID#118GW04R e. e.
5a.Well Location:
MCAS Cherry Point N/A
Facility/Owner Name Facility ID#(if applicable) ft. ft.
Bldg. 133 Harrison St., Cherry Point, NC 28532 Z021
Physical Address,City,and Zip
Craven County N/A 21.REMARKS +
Countv Parcel Identification No.(PIN) REPLACEMENT WELL-
SEE ORIGINAL DRILLING LOG
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Iatliong is sufficient) 22.Certification:
34.89244020 N -076.8996437 N,
11/24/2021
6.Is(are)the well(s)o Permanent or Temporary ilmatuie of Certified Well Contractor Date
By,.signing thl.c form,l hereby certify that the wells)was(were)constructed in accordance
7.Is this a repair to an existing well: []Yes or x)No with 15A NCAC 02C.0100 or l SA NCAC 02C.020I/Well Construction Standardv and that a
/jthis as a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner
repair under:21 remarks section or on the back of this Ji rm.
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 site details or well
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 16.5 (ft.)
P 24a. For All Wells: Submit this form within 30 days of completion of well
hor nwhiple wells list all depths it d/(lerew(example-3(a 200'and 2(d100') construction to the following:
10.Static water level below top of casing:dry Ift•) Division of Water Resources,Information Processing Unit,
It water level is above casing,use•' " 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8.25 (ilt.) 24b.For Infection Wells: In addition to sending the form to the address in 24a
H.S. Auger above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i a auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.l'ield(gpm) Method of test: 24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016