GW1--06690_Well Construction - GW1_20231024

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use. Only: •
1.Well Contractor Information: r._::,
Scott M. Werley '
14.WATER ZONES I
Well Contractor Name FROM TO DESCRIPTION
3344-A 0.5 ft. 3 ft. tan avid brown fine grained sand with shell fragments
ft. ft. I '
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
ECSSoutheast, LLP FROM TO DIAMETER THICKNESS I MATERIAL
ft. ft. 1 in.
Company Name
N/A
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.UIC,County,State, Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural OMunicipal/Public 0 ft. 3 ft. 2 i"• .010 Sch 40 PVC
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ft. ft. in.
Industrial/Commercial 0Residential Water Supply(shared) 18.GROUT-
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft. I '
X Monitoring 0Recovery ft. ft.
Injection Well: - - ft. ft.
Aquifer Recharge IDGroundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery Elsalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test DStonnwater Drainage 0 ft. 3 ft. #2 silica sand Pour
Experimental Technology DSubsidence Control ft. ft.
Geothermal(Closed Loop) ,©Tracer 20.DRILLING LOG(attach additional sheets if necessary) -
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
Geothermal(Heating/Cooling Return) EllOther(explain under#21 Remarks) I
0 ft. 0.5 ft. moist tan and brown fine grained sand with shell fragments
4.Date Well(s)Completed:10/4/2023 Well ID#TW-1 0.5 ft. 3 ft. i
P saturated tan and brown fn gr sand with shell fragments
5a.Well Location:
ft. ft.
Taylors Creek Group LLC N/A ft. ft. , , - .r;�
ft. ft. - $,." -' s..! : , )
Facility/Owner Name Facility ID#(if applicable) `
326 Front Street, Beaufort 28516 ft. ft. I 0(,f 0 �� 2023
Physical Address,City,and Zip ft. ft. ! in`.-N• ^- , P
Carteret 730617100154&730617100136 21.REMARKS ! , "';',' ,..'- ".;:; .n l,4,
W aA,Alv,;, : p -•.4,
County Parcel Identification No.(PIN)
513.Latitude and longitude in,degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
34.717201 N -76.666634 W
c--__ , 10/10/2023
6.Is(are)the well(s)rjPermanent or IX Temporary Signature o Certified W I C tractor 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: Yes or EiNo with 15A NCAC 02C.0100 or I5A 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:One SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 3.0 (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 a 100)
construction to the following:
10.Static water level below top of casing:0.5 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"1-" 1617 Mail Service Center,Raleigh,NC 27699-1617
II.Borehole diameter:3.25 (in.) 24b. For Injection Wells: In addition,to sending the form to the address in 24a
hand auger er 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& Iniectionl 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.
Fonn GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016