GW1-2022-05386_Well Construction - GW1_20220608

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NORTH CAROLINA
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WELL CONSTRUCTION RECORD (GW-1 )
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Form GW-1 Well Construction Electronic Form
North Carolina Department of Environmental Quality
Division of Water Resources
November1
Submission ID#
G W 1-2022-05386
Are you submitting a scanned form?* Yes
No
CONTACT INFORMATION
.......................................................................................................................
Contact Name* Email Address*
Corey Gamwell [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
3027 A COREY GAMWELL GROUND ZERO ENVIRONMENTAL
FIELD SERVICES
2.Well Construction Permit#:
List all applicable well construction permits(i.e.Monitoring Wells,UIC-Underground Injection Control,CCPCUA-Central Coastal Plain Capacity Use Area,County,
etc.)
What type of well is this?* Injection Well Non-Water Supply Well
Water Supply Well (includes irrigation wells)
3.Non-Water Supply Well* Monitoring
Recovery
4.Date well was completed and ID#
................... .............
Date Well Completed* Well ID# Well Yield
5/27/2022 GW1-4 (gallons per minute)"

5.Well Location
Facility/Owner Name*
Peter Gratale Facility ID#
(Required) (If applicable)
County* Parcel Identification No.(PIN)
Brunswick 23100049
Physical Address* Street Address
Seashore Rd SW and Pirate Shore Dr SW
Address Line 2
City State/Province/Region
Holden Beach NC
Postal/Zip Code Country
28462 Brunswick
Latitude* 33.9249639000 Longitude*78.3036734000
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: 4
9.Total well depth below land surface: (ft.) 9a.What is the depth of the casing from ground
6 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:
3 2
If water level is above casing,use"+" in inches
12.Well construction method:
Auger Air Rotary Cable Tool
Direct Push Mud Rotary Rotosonic
Other
14.WATER BEARING/FRACTURE ZONES
From To Description
2 6 sand and silt
in feet in feet
15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
From To Diameter Thickness Material
in feet in feet in inches

17.SCREEN
From To Diameter Thickness Material
2.00 6.00 0.75 n/a Stainless Steel
in feet in feet in inches
18.GROUT
..........................................
From To Material Emplacment Method&Amount
in feet in feet
19. SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
in feet in feet
20. DRILLING LOG
From To Description(color, hardness,soil/rock type,grain size,etc.)
0.00 6.00 sand,wet at 2 ft
in feet in feet
21. Remarks
Install a screen point water sampler at four locations using a DPT rig.All locations were water screened from 2 to 6 ft.All
sampling tooling was retrieved from the ground immediately after sampling and the boreholes were properly sealed.
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
Signature of Certified Well Contractor