GW1--07394_Well Construction - GW1_20231117

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
_William J. Miller 14.WATER ZONES ti '
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Well Contractor Name FROM TO DESCRIPTION
2927A ft. ft.
ft. ft. 1
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
Catlin Engineers and Scientists FROM TO DIAMETER ; THICKNESS MATERIAL
ft. ft. i' in.
Company Name N 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. ! m•
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO _ DIAMETER SLOT SIZE_ THICKNESS MATERIAL
Agricultural Municipal/Public 4.14 ft. 14.14ff• 1 '"' 0.01
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ft. ft. in.
Industrial/Commercial Residential Water Supply(shared) 18.GROUT
Irrigation FROM TO MATERIAL EMPLACEMEM1T METHOD&AMOUNT
iMonitoring
on-Water Supply Well: ft. ft.
Recovery ft. ft.
njection Well: ft. ft.
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Aquifer Recharge QGroundwater Remediation' 19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL EMPLACEMEM1T�IEThOD
AquiferTest QlStormwaterDrainage 1.0 ft• 13.0 ft. Gravel Pack
Experimental Technology Tracedence Control ft• ft•Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size•etc.)
Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks) 0 ft. 2.0 ft. Black,,Stiff, Clayey Sand, trace organics
4.Date Well(s)Completed:O9/19/2023 well ID#26O3-TWO1 2.0 ft. 4.0 ft• Black,'soft, Clayey Sand,trace organics
5a.Well Location: 4.0 ft. 6.0 ft• Black,;soft, Clayey Sand
Camp Lejeune 6.0 ft• 8.0 ft• Gray, soft, Clayey Sand
Facility/Owner Name Facility ID#(if applicable) 8.0 R. 12.0 ft• Gray, very soft, Sandy Clay
Bld 2603, Camp Lejeune, Jacksonville, NC 12, ft. 15. ft• Gray,very soft,Sandy Clay
Physical Address,JCity,and Zip 15.0 ft. 16.0 ft• Gray, medium dense, Sand
NA D/l`_�I ) 21.REMARKS ;__. - __._,_ .,,.-b!^
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County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: qq I 2023 .
(if well field,one'at/long is sufficient) 22.Certification: 1 ��
34.707235° N -77.379202° w ;:, "' °`' ' 111/7/2023
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6.Is(are)the well(s)JPermanent or IpTemporary Signature of Certified Well Contractor Date
By signing This form,I hereby certifr that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: FYes or iX No . with ISA NCAC 02C.0100 or 15A NCAC 02C'.0200 Well Construction Standards and that a
If this is a repair,fill out known well construction information and erp/ain 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 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled:1 SUBMITTAL INSTRUCTIONS
16.0
9.Total well depth below land surface: (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list al/depths if different(example-3@200'and 2@100) construction to the following:
10.Static water level below top of casing:11.7
(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: 1•O (in.) 24b.For injection Wells: In addition to sending the form to the address in 24a
DPT 9600 Power Probe above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following: 6
(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-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

PROJECT: Bldg.2603 WELL IDENTIFICATION:
MEADOWS 2603-TWO1
CONSULTING I MANAGEMENT I PLANNING
WELL COMPLETION DIAGRAM •
PROJECT: Bldg.2603
DRILLING CONTRACTOR: Catlin-Bill Miller Latitude:34.707235° Longitude:-77.379202*
DRILLING METHOD AND EQUIPMENT USED: DPT 9600 DC Power Probe
WATER LEVELS:0 hr: 11.7'bgs 24 hr: bgs DATE: 09/19/23 LOGGER:T.Moore
3
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3b 2 1 1-Ground elevation at well Unkown
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2-Top of casing elevation Uknown
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W 3-Wellhead protection cover type: NA
46 a)drain tube? NA
b) NA
8 AH 0.00'
4-Die/type of well casing 1"
1.0'
3 f
u „. 3r
d emu, 4.14' S-Type/slot size of screen 1"/0.01"Screen
2
14.14' I 6-Type screen filter Well Gravel Pack
4—.' a)Quantity used
7-Type of Seal Bentonite
a)Quantity used
8-Grout
a)Grout mix used NA
b)Method of placement NA
— c)Vol.of well casing grout NA
Development method Peristaltic Pump
10.00' 6
Development time 25 min
Estimated purge volume 2.5 gal
Comments
Well purged dry during well development.
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