GW1--04739_Well Construction - GW1_20230724

1: 'Print Form
WELL CONSTRUCTION RECORD(GW-11 For Internal Use Only:
1.Well Contractor Information: 1
William Matthew Wiggins .1a.WATERZONES . t
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
(NCWC) 4366-A i
ft. ft.
NC Well Contractor Certification Number 15.OUTER•CASING,(for multi-cased Wells)OR LINER(if ap`licable)
Mid-Atlantic Drilling, Inc FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. 2 in. SCH 40 PVC
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop) - ,
2.Well'Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U1C,County,State,Variance,etc.) 0 ft, 2 ft. 2 in. Sch 40 PVC
3.Well Use(check well use): ft. ft in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural DMunicipal/Public 2 ft• 12 ft. 2 in. .010 Sch 40 PVC
Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. in.
Industrial/Commercial DResidential Water Supply(shared) 18,GROUT a
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
_ Non-Water Supply Well: 0.0 ft. 0.5 ft. CemenBBentontte Mix Hand pour(outer casing)
x Monitoring DRecovery 0.5 ft. 2 fa Cement/BententeMix Han�Our(inner casing) -
Injection Well: ft. ft.
Aquifer Recharge 1DGroundwater Remediation 19rSAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery 0Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test DStormwater Drainage 2 ft• 12 ft- #2 Filter Sand Hand pour
Experimental Technology DSubsidence Control ft. ft.
Geothermal(Closed Loop) OTracer 20.,DRILLING LOG(attach additional sheets if necessary) .z' •
Geothermal(Heating/Cooling Return) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
( gl g (Other(explain under#21 Remarks) 0 fL 10 ft.
4.Date Well(s)Completed:4/26/2023 Well ID#MW:4" 10 ft. 12 ft. _
t,, �$��
5a.Well Location: ft. ft. e
SOCOL LLC ft. ft.
Facility/Owner Name • Facility ID#(if applicable)
ft. ft. JiUL 2 4 2023.
7617 Carolina Beach RD Wilmington NC ft. ft. Iflft3rma;it►a Pracsoaira Unlit
Physical Address,City,and Zip ft. ft. I Y4t1Qfl3OG
New Hanover R08514-003-005-001 2L,REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
34 .064845, N -77.897756 W (MAC,
ACn 4/' /(1 5/20/2023
6.Is(are)the well(s)0Permanent or Temporary Signature of Certrfied ell Contractor
Date
By signing this form,1 hereby certfy that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: QYes or xDNo with 15A NCAC 02C.0100 or 1SA 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 the well owner.
repair under#21 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: 2 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'and 2(43100') construction to the following:
10.Static water level below top of casing:3.52 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter:8 1/4 (in.) 24b.For Infection 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&Injection 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-1 North Carolina Department of Environmental Quality-Division of Water Resources, Revised 2-22-2016