GW1-2022-10223_Well Construction - GW1_20221111

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
George Bridger 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION i
2393-A `� C
ft. It.
NC Well Contractor Certification Number 15.OUrER CASING for maNieased wens OR LINER d a lieable
Bridger Drilling Enterprises, Inc. FROM TD DTAMETRIY TlnctnvFss MATERIAL
It % in
Company Name
16.INNER CASING OR TUBING ermal closed-loop)
2.Well Construction Permit# FROM TO DIAMETER TMC[tNM I MATERIAL
List all applicable well construction Permits(i e.UIC,County.State,Variance,etc.) 0 It, It. in.
3.Well Use(check wen use): It. It. m'
Water Supply Well: 17.SCREEN
FROM TO DIAMETER I SLOT Si2z THICKNESS MATERIAL
❑Agricultu al ❑MunicipaMblic 10 It. 10 It. 1 in. 1:10 sch40 PVC
OGeothennal(Heating/Cooling Supply) ❑Residential Water Supply(single) f % in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
01rrization ❑Wells>100000 GPD FROM I TO MATERIAL IMPLACEMENTMLMOD&AMOUNT
Non-Water Supply Well: ft ft
elMonitoring ❑Recovery ft. It.
Injection Well:
1t. n
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(ifapplicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft tt
❑Experimental Technology ❑Subsidence Control ft ft
i .
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets If n
❑Geothermal FROM TO DESCRIPTION tc.
(Tieatuig/Cooling Return) ❑Other(explain under#21 Remadts) ft. TO color, wWroek e
4.Date Well(s)Completed:8/30/22 Well ID#TM W-4 ft tt
5a.WellLocation: ft R
INVISTA Sarl ft
Facility/Owner Name Facility ID#(if applicable) h'
3930 US Hwy 421 Wilmington, NC 28401 ft. It
Physical Address,City,and ft % 1,40tvWja'l PrC 9 Ufm
New Hanover 21.RENIARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Wkmg is sufficient) 22.Certification:
34.18.20 N -77.58.25 W 10/10/2022
6.Is(are)the wen(s): ❑Permanent or Temporary Sif9inture ofCcrtified Well Confictor Date
By signing thisform,I hereby certify that the eel/(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ItNo 1 SA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fiB out brown well constnmtion information and explain the nature of the of this record has been provided to the well owner.
repair under#21 remarb section or on the back of this form. 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 construction info
construction,only 1 GW-I is needed Indicate TOTAL NUMBER of wells (add,See Ova in Remadis Box).You may also attach additional pages if necessary.
thi0ed' 20 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft) Submit this GW-1 within 30 days of well completion r the following:
For multiple wells list all depths if different(example-3@200'and 2@100� y I
10.Static water level below top of easing: ( ) 24a. For Ali Wells: Original forms to Division of Water Resources (DWR),
If water level is above casing use"+" Information Processing Uni;1617 M a C;Raleigh,NC 27699-1617
11.Borehole diameter 2.25 (in) 24b.For Injection Wells:Copy to MR,Underground Injection Control(RUC)
Direct Push Program,1636 MSC,Raleigh,NC 27699-1636
1L Well construction method: 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.m%-,rotary,cable,direct push,etc.) county environmental health departmcnt of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing o ter 100,000 GPD:Copy to DWR,CCPCUA
13a Yield(gum) Method of testPermit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disiinfection type: Amount:
Form GW-I North Carolina Department of Envi onmental Quality-Division of Water Resources Revised 6-6r2018
I"