GW1--04093_Well Construction - GW1_20240712

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
Joseph L. Zuncich 14.WATERZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
3324-A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap ' ble)
Applied Resource Management, P.C. FROM TO DIAMETER THICKNESS MATERIAL
0 ft' 8.5 ft. 2 in. SCH40 PVC
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: N/A FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.('/(',County,State. Variance.etc.) ft. ft. in.
3.W'ell Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 1.5 ft 13.5 it 2 in. .010 SCH40 PVC
❑Geothermal(Heating/Cooling Supply) El Residential Water Supply(single) ft I. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) IS.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.1 ft• 0.5 ft. Cement Poured
nMonitoring ❑Recovery 0.5 ft. 6 ft. Bentonite Poured
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 6 ft. 13.5 ft. Coarse Poured
❑Experimental Technology ❑Subsidence 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) ❑Other(explain under#2I Remarks) ft. It.
4,Date Well(s)Completed: 5/14/2024 Well ID# REC1-TW1 ft. ft- See Attached
5a.Well Location: ft. ft.
Williams Fabricare N/A ft. ft.
Facility/Owner Name Facility 1De(if applicable) ft. ft. T
3509 Wrightsville Avenue, Wilmington, NC 28403 ft. ft. .ti`4,L.'V L1
Physical Address.City.and Zipft JUL 1 2 2024
New Hanover 05513-007-008-000 21.REMARKS
County Parcel Identification No (PIN) i•s'r. r-r•-r14-4' i
D'h'Cit 504;
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field.one lat'long is sufficient) 22.Certification:
34 13' 19.19" ., 77 53' 58.58" W
Qe2eicutce.CA 6/6/2024
6.Is(are)the well(s): CIPermanrnt or ❑Temporary Signatt bfCert' d W'ell Contractor Dace
By signing this form.I herehs c•rift that the wells)was(were)constructed tan accordance with
7.Is this a repair to an existing well: Dies or InNo /5.4 Ai. -1('02(' 0/00 or/5.4.\'(:-I('01('.0200 Well Construction Standards and that a cops
11 this is a repair,fill one known well construction information and explain the native of the of this record has been provided to the well owner
repair tinder 21 remarks section or on the hack of this for,,,
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 construction info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary
drilled:Na 24.St BMITTAL INSTRUCTIONS
9.Total well depth below land surface: 13'S (ft.)
For m ltiple wells list all depths of different(example-3 a 200'and a/Oily) Submit this GN'-1 within 30 days of well completion per the following:
10.90 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft,) Information Processing Unit,1617 MSC,Raleigh.NC 27699-1617
If water level is above casing.use" "
24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter: 4 (in.)
Program. 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Hand Auger
24c.For Water Supply and Open-Loop Geothermal Return V1 ells:Copy to the
(i.e.auger.rotary.cable.direct push.etc) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) N/A Method of test: N/A
Permit Program,1611 MSC,Raleigh.NC 27699-1611
13b.Disinfection type: N/A Amount: N/A
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018