GW1--00804_Well Construction - GW1_20240131

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
William J. Miller 'd4am ER Zf1I1ms: a »z, ommautam Ana:,i oom t guy,;
FROM TO DESCRIPTION
Well Contractor Name y
2927A ft. ft.
ft. ft. f
NC Well Contractor Certification Number
t$: 1EXi 't1$044{f iu iiMilc4IC)'Olaf tR{ifxBpr"•-lititimmegaz
CATLIN Engineers and Scientists FROM TO DIAMETER ' THICKNESS MATERIAL
ft. ft. 'in.
Company Name
tSANNER GASI!?7+G_Y71t"t�(BE4a gaith rtoat€closedAiiiif x F..', a�,:,=. ., a_,_., „xs
2.Well Construction Permit#:N/A • FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,eta.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: '4.7 SCR N? ,r,.. . ..z,<z".....Ate.-s 1 .fT=.t ,-�...,--:',z' ? . €.._�>•.
PP Y FROM TO DIAMETER SLOT SIZE THICKNESS _ MATERIAL
Agricultural ,` Municipal/Public 4.5 ft 14.5 ft 1.0 1°' 0.010 0.010 PVC
Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft ft. in.
1 Industrial/Commercial OResideatial Water Supply(shared) .01VItt)CTfM. -., _,.__. .,, .,__. .W + . ,R;,,, 4
1 Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft 3.5 ft bent. chips Surface pour
1211Monitoring E3Recovery ft. ft.
Injection Well:
ft. ft.
1 Aquifer Recharge kGroundwaterRemediation y tryy t2 i( Liy
MOIMMAREMEteMAMEM
*Aquifer Storage and Recovery oSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Nil Aquifer Test DStormwaterDrainage 3.5 ft 14.5 ft #2 Medium Sand Surface pour
a Experimental Technology •Subsidence Control ft. ft.
it Geothermal(Closed Loop) OTracer N24141 Lt1L7.ElsEG:`1 UG fe(inch additiotus!'a efa if;rificessatis3 g _.{-..x ` '.
FROM 'TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
ii.Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) it. ft.
12/06/2023 Well ID# 7 Y SB-8 ft. ft. f =;",k ,,L' - r. ;'t_
4.Date Well(s)Completed: %
5a.Well Location: ft. ft. �4 / E �4
Pinnacle • N/A ft. ft. G
Facility/Owner Name Facility ID#(if applicable)
ft. ft. Ifl'ivr.P;i-: l Py!.^,,.I r, fin'U (jp`?f
14541 Airport Rd, Laurinburg, NC 28352 ft. ft. �w'dl :.lu
Physical Address,City,and Zip ft. ft.
New Hanover N/A 21.,1LENrATtIi ..o Diu; .. o., ,_.; i- ,.V,.: } M T t, : .,
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: ,1�r"''.-.
34.768816 N -79.377460 W �- =�'
1/22/24
6.Is(are)the well(s)DPermanent or 1:::11Temporary Signature of Certified Wckl'Contractor Date
By signing this form,I hereby certifil that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: lYes or a No with 15A 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 explain the nature of the copy of this record has been provided to the well owner.
repair under,,i21 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:8 SUBMITTAL INSTRUCTIONS
14.5
•
9.Total well depth below land surface: ft. y completion) 24a. For All Wells: Submit this form within 30 days of corn letion of well
For multiple wells list all depths ifdferent(example-3@200'and 2@100') construction to the following: '
10.Static water level below top of casing:6.5 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
1
11.Borehole diameter: 1 (in.) 246.For Injection Wells: In addition to sending the form to the address in 24a
Direct Push 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