GW1-2022-00015_Well Construction - GW1_20220103

w
®,
NORTH CAROLINA
ilk
WELL CONSTRUCTION RECORD (GW-1 )
EnvfronmertmfQua(Iry
Form GW-1 Well Construction Electronic Form
North Carolina Department of Environmental Quality
Division of Water Resources
November1
Submission ID#
G W 1-2022-00015
Are you submitting a scanned form?* Yes
No
CONTACT INFORMATION
.......................................................................................................................
Contact Name* Email Address*
Raymond W Magette [e-mail]
Is this a revision to the form you have previously submitted?*
Yes No
WELL CONSTRUCTION INFORMATION
........................................................................................................................................................................................................................................................................................................................................................................................................................................................
1.Who is installing these wells?*
Owner Well Contractor
1.Well Contractor Information:
Certiticate# Cert Level First Name Last Name Company Name
2299 A Bill Magette Magette Well&Pump Co
2.Well Construction Permit#:
List all applicable well construction permits(i.e.Monitoring Wells,UIC,County,CCPCUA,etc.)
What type of well is this?* Injection Well Non-Water Supply Well
Water Supply Well(includes irrigation wells)
3.Water Supply Well* Geothermal (Heating/Cooling Supply) Industrial/Commercial
Irrigation Municipal/Public/Community
Residential Water Supply(single) Residential Water Supply(shared)
Wells> 100,000 GPD
4.Date well was completed and ID#
Date Well Completed* Well ID# Well Yield
12/21/2021 #2 50
(gallons per minute)"

5.Well Location
Facility/Owner Name*
Gramercy Christian School Facility ID#
(Required) (If applicable)
County*
Carteret
The selected county is within the Central Coastal Plain Capacity Use Area. Please reference your Capacity Use Water
Withdrawal Permit Number(CUxxxx)in Section 2.above.
Parcel Identification No.(PIN)
Physical Address* Street Address
8170 Hwy 70, Newport N.C.28570
Address Line 2
city State/Province/Region
Newport NC
Postal/Zip Code Country
28570 United States
Latitude* 34.8291220000 Longitude*76.8784850000
Decimal degrees Decimal degrees
6.Is(are)the well(s):* Permanent Temporary
7.Is this a repair to an existing well:* Yes - 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.
For multiple Geoprobe/DPT or Closed-Loop Geothermal Wells having the same construction,only 1 GW-1 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
280' surface?
For multiple wells list all depths if different 2
(example-3@200'and 2@100') in feet
10.Static water level below top of casing: (ft.) 11.Borehole diameter:
27.75' 101,
If water level is above casing,use"+" in inches
12.Well construction method:
Auger Air Rotary Cable Tool
Direct Push Mud Rotary Rotosonic
Other
13. FOR WATER SUPPLY WELLS ONLY:

13a.Yield(gpm)
50 13a.Method of test:
If applicable 24 hr pump test
13b. Disinfection type:* 13b.Amount:
HTH 3 Ibs
....................................................................
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
1.00 20.00 10.00 SDR 21 PVC
in feet in feet in inches
17.SCREEN
..............................................................................................................................................................................................
From To Diameter Thickness Material
260.00 280.00 4.00 sch 80 PVC
in feet in feet in inches
18.GROUT
From To Material Emplacment Method&Amount
0.00 5.00 neat cement pour
in feet in feet
5.00 240.00 bentonite grout pump
in feet in feet
19. SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
240.00 282.00 #3 SP tremie
in feet in feet
20. DRILLING LOG
From To Description(color, hardness,soil/rock type,grain size,etc.)
0.00 40.00 sand&silt
in feet in feet
40.00 52.00 gray clay&silt
in feet in feet
52.00 92.00 silty sand&shells
in feet in feet
92.00 258.00 soft limestone w/hard layers
in feet in feet
258.00 282.00 white to gray limestone some semi hard layers
in feet in feet

21. Remarks
Well yield 4.5 gpm/ft dd after 24 hrs at 50 gpm
22.Site diagram or additional well details:
You may upload additional well construction information here.
pdf only
CERTIFICATION INFORMATION
.............................................. ......................... ........................... .................... .....
* 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
a'o
Signature of Certified Well Contractor