GW1--06689_Well Construction - GW1_20231024

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
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1.Well Contractor Information: I
Scott M.Werley 14.WATER ZONES t
Well Contractor Name FROM TO DESCRIPTION
3344-A 2.5 ft. 5.0 ft. an and brl n fine grained Bend wen shell fragments
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
ECS Southeast, LLP FROM TO DIAMETER THICKNESS '1 MATERIAL
ft. ft. ' -in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: N/A FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State, Variance,etc.) ft. ft. i ' in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
II Agricultural 0MunicipaUPublic 0 ft. 5 R. 2 in. 010 schao PVC
''Geothermal(Hcating/Cooling Supply) OResidential Water Supply(single) ft. ft. in.
®I IndustriaUCommercial D Residential Water Supply(shared) 18.GROUT
I I Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
®I Monitoring DRecovery ft. ft.
Injection Well: ft. ft.
ill Aquifer Recharge Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
iilAquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
lIAquifer Test QDStorrnwater Drainage 0 ft. 5 ft. #2 silica sand Pour
i Experimental Technology D Subsidence Control ft. ft.
mIGeothermal(Closed Loop) DTracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock hype,grain size,etc.)
11iGeothermal(Heating/Cooling Return) FIOther(explain under#21 Remarks) I
0 ft• 1.5 ft• crush and run gravel
4.Date Completed: 10/4/2023 Well ID#TW-2 1.5 ft. 2 5 ft. i
Well(s) p moist tan and brown sand with shell fragments
5a.Well Location: 2.5 ft. 5.0 ft' saturated tan and brown sand with shell fragments
Taylors Creek Group LLC N/A ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft. I • t '`, c'"' ,iis 7` • 17M
326 Front Street, Beaufort 28516
ft. ft. ••y.r, .; t-..-,LnJ
ft OCT `' �� Z023
Physical Address,City,and Zip . ft. r
Carteret 730617100154&730617100136 21.REMARKS i!'`�7,' :,,,,' _} '
County Parcel Identification No.(PIN) G'W+,a0=f'1�^,.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 2.Ce. ification:
34.717201 -76.666634 '
N W /
10/10/2023
/-ram• JA.I4
6.Is(are)the well(s)lPermanent or 'Temporary Signature of Certified Well ontracto Date
By signing this form,1 here v c -tifj'that the wells)ivas(were)constructed in accordance
7.Is this a repair to an existing well: DYes or 0No with ISA NCAC 02C.0100 a SA 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 r f this form.
23.Site diagram or additional well details:
3.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same Youmay use the back of this page to provide additional well site details or well
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled:One SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 5'0 (ft.) 24a. For All Wells: Submit this I'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: 2'5 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+'• 1617 Mail Service Center,Raleigh,NC 27699-1617
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11.Borehole diameter: 3.25 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
hand 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'
(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&Injectool Wells: In addition to sending the form to
' the address(es) above, also submit Ione copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to ale 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