GW1--07333_Well Construction - GW1_20231113

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
,r
1.Well Contractor Information:
William Matthew Wiggins r14.,WATERZONE3 , .
Well Contractor Name FROM TO DESCRIPTION
ft. ft.(NCWC) 3470-A
ft. ft.
NC Well Contractor Certification Number 15.OUTERCASING(for multi-cased?;:Wells)OR LINERI(if appicable) .,
Mid-Atlantic Drilling, Inc FROM TO DIAMETER THICKNESS MATERIAL
+ ft. ft. 2 I; '' 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 I in' Sch 40 PVC
3.Well Use(check well use): ft. ft. i in.
17:SCREEN .,:` , •:; 1:; w .,.
Water Supply Well: FROM TO DIAMETER I SLOT SIZE THICKNESS MATERIAL
Agricultural OMunicipal/Public 2 ft- 12 ft. 2 - in.I .010 Sch 40 PVC -
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ft. ft. in.I
Industrial/Commercial QResidential Water Supply(shared)
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: - 0.0 ft 0.5 ft Cement/Bentonlle MIX Hand pour(outer casing)
x Monitoring DRecovery 0.5 ft. 2 ft• CemenvBentonite Mix Hand pour(inner casing) .
Injection Well: _ _ _. ft.. _ -"fa _
Aquifer Recharge QGroundwater Remediation
19.SAND/GRAVEL-PACK(if applicable) ,
Aquifer Storage and Recovery EjSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test OStormwater Drainage 2 ft 12 ft #2 Filter Sand Hand pour
Experimental Technology DSubsidence Control ft. ft. ;
i
Geothermal(Closed Loop) OTracer 20.DRILLING:LOG'(attach additionahsheets if necessary)t,.:'
Geothermal(Heating/Cooling Return) [Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type grain size etc.)
0 ft. 10 ft.
4.Date Well(s)Completed:9/05/2023 well ID#MW 6 10 ft. 12 ft.
5a.Well Location: ft. ft.
SOCOL LLC ft. ft. --
Facility/Owner Name Facility IDti(if applicable) ft. ft `5 � ' i•= i -
7617 Carolina Beach RD Wilmington NC ft. ft. Hoy 1 7023
Physical Address,City,and
Zip ft. ft.
New Hanover R08514-003-005-001\'21.REMARKS ; r r;' ,
County Parcel Identification No.(PIN) I'
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 A�I A 1A/� J //, I,�j(I
"VU dNf I / U 9/26/2023
Signature of Certified Well Contracto Date
6.IS(are)the well(s) Permanent or OTemporary a
By signing this form,1 hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: DYes or jNo - with 15A NCAC 02C.0100 or I5A NCAC 02C.0200 Well Construction Standards and that a
gigs-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. l .
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 1 GW-1 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 iform 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:3.52 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service C inter,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:
(Le.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 Sunnlv&Infection 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