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Home My WebLink AboutGW1--04034_Well Construction - GW1_20240708 • • WELL CONSTRUCTION For Internal Use ONLY This form can be used for single or multiple wells 1.Well Contractor Information: 14.WATER ZONES Eddie Swain FROM TO Ut>(Itll'I IHv Well Contractor Name ft. ft. 4632E ft. li. NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-loop) 1 ROAt TO DI:Aill-r1-R l III(hVI,ti> \I-VII RI AI CATLIN Engineers and Scientists 0 rt. 5 ft. 2 ttt. Sch. 40 PVC Company Name Ifs.OUTER CASING(for muttimused wells)OR LINER(if applicable) I ROM I0 DI.A'.stl-IFR I I11(K,NFS' AI AllRI AI 2.Well Construction Permit#: N/A ft. ft. is. List all applicable well permits(i.e.('ounit,ate, I'artance,Injection,etc.) - It. ft. tn. 3.Well Use(check well use): 17.SCREEN... Water Supply well: IRON! TO 1)1 vvII TR_ .I OI wl MI(l.yl vI vII RI vI ❑Agricultural ❑Municipal/Public 5 tt. 15 ft. 2tn. Slot 010 Sch. 40 PVC ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) It It. ❑Industrial/Commercial 0 Residential Water Supply(shared) 18.GROUT FROM lO Vt A11 RI:Al. 1A11'1_ACI.AII-Al MMET1101)h 1A101-,I ❑Irrigation Non-Water Supply Well: 0 li. 1 rt. Portland Cement Surface Pour ®Monitoring ❑Recovery 1 II. 4ft- Bent. Pellets Surface Pour Injection Well: It. ft. ❑Aquifer Recharge 0 Groundwater Remediation Is.SAND/GRAVEL PACK(if apppsabte) ❑Aquifer Storage and Recovery 0 Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test DStormwater Drainage 4 ft. 15 ft. #2 Medium Sand Surface Pour ❑Experimental Technology 0 Subsidence Control ft. ft. 20.DRILLING LOG(attach additional sheets if necessary.) ❑Geothermal(Closed Loop) ❑Tracer I Ro\t I() ht-st RIPTION(color.hardness.sodirock type.Brain svr 5'1,) ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) n. ft. -_ 4.Date Well(s)Completed: 05/29/24 Well 1 D#: MW-04 It. ft. ic,tole OIt. ft. 1n' ^ 5a.Well Location: DEQ SLP Wananish rt n l ■� L,•l_: ‘/E Q NCDEQ Store ft. p:c 174 Facility/Owner Name Facility ID#(if applicable) It. 1306 Sam Potts Hwy,Lake Waccamaw, North Carolina 28450 r �- r "` Physical Address.City.and Zip 21.REMARKS _ COLUMBUS Count\ Parcel Identification No.(PIN) 5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 2 22.Certifcation: (if well field,one lat/long is sufficient) 34.32210227 N -78.50020371 w 7/02/2024 Signature of Certified Well Contractor Date 6.Is(are)the well(s): ®Permanent or OTemporary By signing this form,/hereby certify that the well(s)was(were)constructed in accordance with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of 7.Is this a repair to an existing well: Dyes or ■No this record has been provided to the well owner. If this is a repair,fill out known well construction information and explain the nature of the repair under e21 remarks section or on the back of this form. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well 8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary. For multiple injection or non-water supply wells ONLY with the same construction,you SUBMITTAL INSTRUCTIONS can submit one form. 9.Total well depth below land surface: 15.0 (ft.) 24a.For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths in different(example-3@200'and 2@100') construction to the following: 10.Static water level below top of casing: 8.2 (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: 4.25 (in.) 24b.For Infection Wells ONLY: In addition to sending the form to the address in 24a above,also submit a copy of this form within 30 days of 12.Well construction method: HSA completion of well construction to the following: (i.e.auger,rotary,cable,direct push etc.) Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONL\': 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) Method of test: 24c.For Water Simply&Itileetio.Was: Also submit one copy of this form within 30 days of completion of well 13b.Disinfection type:_ Amount: construction to the county health department of the county where constructed. Adapted from Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016 ENVIRONMENTAL.CIVIL W E I_ L I_0 G GEOTECHNICAL CATLIN N5lniTEC NICA.Washington. Charleston Engineers and Scientists 22,o7o.oa SHEET 1 OF 1 PROJECT NO.: 221070.04 STATE:NC COUNTY: COLUMBUS LOCATION: Lake Waccamaw PROJECT: DEQ SLP - Wananish Store LOGGED BY: Ashley Jessen WELL ID: DRILLER: Eddie Swain MW_04 NORTHING: 34 EASTING: -79 CREW: Andrew Dunivan SYSTEM: NCSP NAD 83 (ft) DRILL MACHINE: CAT1303 CME-550 93% 03/05/2024 T.O.C.ELEV.: VERT.DATUM: NAVD88 (USft) METHOD: HSA 0 HOUR DTW: 9.1 TOTAL DEPTH: 15.0 START DATE: 5/29/24 END DATE: 5/29/24 24 HOUR DTW: 8.2 WELL DEPTH: 15.0 DEPTH BLOW COUNT OVA LAB o L SOIL AND ROCK WELL 0.5ft 0.5ft 0.5ft 0.5ft (PPm) S G DEPTH DESCRIPTION DETAIL 0.0 Land Surface o.o 0.0 '' `°,. (SM)-Orange-brown,Silty,medium to fine SAND. 0.0 ?;. - 2 - a 4 0.0 D .�' _ y•t. d 1.0 6 4 :�,r > e•- o_ v - .('�'i - .;. tV �. — ',. — 4.0 - .i.,: r`r 1 VJOH : — WOH 2.7 W •.� . — — WOH • : _ tip — 1::. - - v: - - {; ; 8.5 - (ML)-Light blueOgray mottled with orange-brown, _ medium to fine Sandy SILT. - _ of oa=ir 10.0— sQ- 1 iv .• - 2 2 3 268.3 M - � 13.0 - - 97.4 M — _ 1 14.5 _ 15.0 //, 15.0 (CL)-Dark gray,Silty CLAY. 15.0 = . 15.0 BORING TERMINATED AT DEPTH 15.0 ft w - o — Ix - _ _ h — _, . _ _ Z c, lr _ _ Q Z.. — F- _ _ /:' i.�:1 Concrete :.1;Bentonite Pellets Ej#2 Medium Sand