GW1-2022-06225_Well Construction - GW1_20220620

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
David E. Meyer 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
2527-A 10 ft- 14.0 ft- isurficial aquifer
fr. fL
NC Well Contractor Certification Number 15.OUTER'CASING(for multi-casidCweDs•OR LINER if a Doable '
Protocol Sampling Service, Inc. FROM TO DIAMETER THICKNESS MATERIAL
Company Name -0.3 ft- 19.0 ft 12 in. I Sch.40 JPVC
16:INNER CASINGOR TUBING' eotbermal closed-loo` r
2.Well Construction Permit#• n a FROM I TO I DIAMETER I THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,Stare,Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: .17.SCREEN.
FROM I TO DIAMETER SLOT SIZE THICKNESS MATERIAL.
❑Agricultural ❑Municipal/Public 9 ft. 114 ft- 2 In 0.010 S 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. 9 ft. in.
❑IndustriaVCommercial ❑Residential Water Supply(s ared) 18:.GROUT'
❑ltri ation -�' "9 �'r, q s , 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply el{ F, 4 - --•°-Y 0.0 ft- 6.0 ft- Portland pour
❑Monitoring ecovery 6.0 ft- 8.0 ft- Bentonite pour
Injection Well: r24` ft. ft.
❑Aquifer Recharge R o tvater Remediation
' .1 i�rCG.r�• tr f%.SAND/GRAVEL PACK if:a' licable..
❑Aquifer Storage ad6)€cfoV'fjr iaa- Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
,- rs
❑Aquifer Test ❑StormwaterDrainage 8 ft- 14 ft. #2 quartz sand pour
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothemtal(Closed Loop) ❑Tracer 20,I)RILLINGLOG(attachaddidoualsheets if,necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Re narks) FROM To DESCRIPTION color,hardness,soil/rock grain size,etc.
0 rt. 4 rc. Dark yellowish brown silty fine sand fill(SM)
4.Date Well(s)Completed: May 3, 2022 Well ID# RW-2 4 ft. 7 rt. Yellowish brown fine sand fill(SM)
5a.Well Location: 7 ft. 10 ft- Yellowish brown fine to medium sand(SM)
McKee Homes LLC na 10 ft- 14 fL Dark greenish gray fine to medium sand(SM)
Facility/Owner Name Facility ID#(if applicable) 14 ft. ft. Indurated marl
109 Hay Street Fayetteville, NC 28301 ft. ft.
Physical Address,City,and Zip
Cumberland R04806-006-131- 00 -21.REMAPM1
County Parcel Identification No.(PI ) Indurated marl layer found at-14'bis
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
petroleum odor evident in saturated soils
(ifwell field,one lat)long is sufficient) 22. ertitieation:
35.254936 N 77.929344 W U_ 6/6/2022
6.Is(are)the well(s): [']Permanent or ❑Temporary Signature of CeAified Wee Contractor Date
By signing this,form,I hereby certify that lite well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or 8No 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
lfthtis is a repair,fill out known well construction information and explain the nature o rth, ofthis record has been provided to the well owner.
repair under#21 remarks section or on the back ofthis form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the sam You may use the back of this page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 14.0 (ft.)
For mithiple wells list all depths ifdiQerent(erample-3 a 200'and 2 a,100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 10.30 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
if water level is above casing,use••+•' Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.5 (in-) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: auger
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells prodng over 100.000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program,1611 MSC,Ra ucileigh,NC 27699-161 I
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018