GW1-2023-01765_Well Construction - GW1_20230223

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells li
1.Well Contractor Information:
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14.WATER ZONES
Kevin White FROM TO DESCRIPTION
Well Contractor Name ft. ft.
2973 ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells OR LINER(if a licable)
FROM TO DIAMETER THICKNESS MATERIAL
Parratt-Wolff, Inc. ft. ft. ;in.
Company Name 16.INNER CASING OR TUBING(•eothertnal closed-loo )
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: n/a 0 ft' 3 ft. 2 'In. sch40 pvC
List all applicable well permits(i.e.County,State,Variance,Injection,etc.) ft. ft. 1 in
3.Well Use(check well use): -17:SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 3 f�' 15 rt. 2 1°', .010 SCh40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. rt."18
❑ FR
Industrial/Commercial ❑Residential Water Supply(shared) GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Olrri ation 0 ft. 2 fr- Portlarid Cem Tremie
Non-Water Supply Well:
ft. ft. ,
OMonitoring ❑Recovery
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation "19.SAND/GRAVEL PACK if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier 2 15 ft. #2 Sand Tremie
❑Aquifer Test ❑Stormwater Drainage ft.
ft. ft.
❑Experimental Technology ❑Subsidence,Control
20.DRILLING LOG(attach additional sheets if necessary
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,soiltrock type,gmin size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
12-14-22 MW-47 ft; rt. _
4.Date Well(s)Completed: Well ID# i
5a.Well Location:
Kinder Morgan LLC River Road et, ft. FEB
Facility/Owner Name Facility ID#(ifapplicable) ft. ft.
3340 River Road, Wilmington 28412 ft. ft.
Physical Address,City,and Zip 21 REMARKS
New Hanover R06400-001-003-000
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification
(ifwell field,one[at/long is sufficient)
34.178835 N -77.951928 W
Signature of Certified Well tVutructor l Date
6.Is(are)the well(s): OPermanent or ❑Temporary By signing this form,I hereby certh,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
7.Is this a repair to an existing well: ❑Yes or ©No copy of this record has been provided to the well owner.
Ifthis is a repair,.fll out known well construction in/bnnation and explain the nature ofthe
repair under#21 remarks section or on the hack of this fonn. 23.Site diagram or additional welt details:
You may use the back of this page,to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may alsolattach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same construction,you can
submit one fonn. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface 15 (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'and 2@100') construction to the following:
10.Static water level below top of casing 8.14 (ft) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Ce Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8 (in.) 24b. For Infection Wells ONLY: In addition to sending the form to the address in
Auger 24a above, also submit a copy ofl.tb!iis 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
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24c.For Water Supply&Injection Wells:
13a.Yield(gpm) Method of test:
Also submit one copy of this form within 30 days ofeompletionof
13b.Disinfection type: Amount: well construction to the county heal h department of the county where
constructed.
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Fortin GW-I North Carolina Department of Environment and Natural Resources-Divisimt of Water Resources Revised August 2013
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