GW1-2023-01189_Well Construction - GW1_20230127

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information: _
William Matthew Wiggins, 'C 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
(NCWC) 4366-A JAN 2 7 2023 ft. ft.
ft. ft.
NC Well Contractor Certification Number p r„c.3Oq n'3 Uri t
��� ' 15.OUTER CASING for multi-cased wells OR
Mid-Atlantic Drilling, Inc FROM TO LINER if a licable
DIAMETER THICRNESS
Company Name 1rATER1AL
& ft. 2 in SCH 40 PVC
16.INNER CASING OR TUBING •eothermal closed-loo
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0 ft. 2 ft• 2 '"' SCh 40 PVC
3.Well Use(check well use): It. ft. in.
Water Supply Well: 17.SCREEN
FROM TO D1AbtETER SLOT SIZE THICKNESS MATERIAL
Agricultural DMunicipal/Public 2 ft- 12 & 2 t°' .010 SCh 40 PVC
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ft. ft. in.
Industrial/Commercial Residential Water Supply(shared) 18.GROUT
Irrigation FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 0.5 ft. Cement/Bontonite Mix Hand pour(outer casing)
x Monitoring DRecovery 0.5 ft. 2 ft, cementi9enionite Mix Hand pour(inner casing)
Injection Well:
ft. ft.
Aquifer Recharge E]Grbundwater Remediation 19.SAND/GRAVEL PACK if a licable
Aquifer Storage and Recovery ❑(Salinity Barrier FROM I To I MATERIAL EMPLACEMENT METHOD
Aquifer Test []Stormwater Drainage 2 ft- 12 ft. #2 RtiBr Sand Hand pour
Experimental Technology Q3Subsidence Control & ft.
Geothermal(Closed Loop) EITracer 20.DRILLING LOG attach additional sheets if necessary)
Geothermal(Heating/Cooling Return) nOther(explain under#21 Remarks) FROM TO DESCRUrION color,hardness,soiVmck type,gmin sae,etc.
0 ft. 10 ft.
4.Date Well(s)Completed: 1 1/03/2022 Well ID#MW-1 - 10 ft. 12 ft.
Sa.Well Location: ft. ft.
SOCOL LLC ft. ft.
Facility/Owner Name Facility ID#(ifapplicable) ft. ft.
7617 Carolina Beach RD Wilmington NC ft. ft.
Physical Address,City,and Zip
ft. ft.
New Hanover R08514-003-005-001 21.REMARKS
County Parcel Identification No.(PiN)
5b.Latitude and longitude in degrees/minutes/s.econds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Ce tificeti
34 .064845 N -77.897756 W 11/17/2023 _
� .
6.Is(are)the well(s)oPermanent or OTemporary gnature o ertified Well Co grZ7 Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: QYes or E)No with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
if this is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to he well owner.
repair under 921 remarks 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 site details or well
construction,only I 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: 12 ft (ft) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'aped 2@100') construction to the following:
10.Static water level below to of casing:3.52
p g�_ (ft) Division of Water Resources,Information Processing Unit,
Ifwater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8 1/4 (in.) 24b.For Iniection Wells: In addition to sending the form to the address in 24a
Hollow Stem 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.e.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.Yield(gpm) Method of test: _ 24c. For Water Supply&Iniection 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-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016