WI0800522_Report_20190509

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information;
John Salmon
well Contractor Name
3497-A
NC well Contractor Cenification Number
Applied Resource Management, P.C.
,•Nam` 2. WellW10800522
2. Well Construction Permit N:
Lat all applwahle veil cmwvuctionI onom (i.e. (IICI Catnn), Sale, Foran", elcl
3. Well Use (check well use):
(Heating/Cooling Supply)
Recharge
Storage and Recovery
Test
rental Technology
mal(Closed Loop)
©Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
QGroundwater Remediation
--TSalinity Barrier
IJStonnN ater Drainage
❑Subsidence Control
QTracer
4. Date Well(s) Completes. 6 19 Well 1D# N/A
5a. Well Location:
Charles Neal N/A
Facility/Owner Name Facility Ing (ifapplicable)
7508 Dunbar Rd, Wilmington, NC 28411
Physical Address, City, and Zip
New Hanover R06709-004-003-000
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees
ur a - t. o Is . I'
For Internal Use ODIy:
14. WATER ZONES
FRONI
TO
DESCRIPTION
ft.
ft.
ft.
R.
15. OUTER CASING for multi -cased wells OR LINER ife Iieable
FROST
TO DLASfETER THICKNESS SIATERIAL
+/-0 ft•
205 It. 1 in HDPE
16. INNER
CASING ORTUNG eothermalclosed-too
BIDIASIEfER
FROSI
TO
TNICNNESS
SLATI:RIAL
ft.
ft. in.
ft.
ft.
17. SCREEN
Most I
TO I
DIASIETER
I SLOT SIZE.
THICKNESS
SIATERIAL
fL
ft.
in.
ft. I
ft.
18. GROUT
INO)I
TO
SIATERIAL
EwPLACESIENT SIEMOD&AMOUNT
0 ft.
205 0-
Thermex
Pumped
D.
ft.
ft.
ft.
19. SAND/GRAVEL PACK
ife c
FROST
TO
MATERNL
EsOLACEldENTIaETIIOD
ft.
ft.
ft.
D.
20. DRILLING
LOG attach
additional sheets ifnecessnn
FROST
TO
DESCRIPTION mlar,haMneo,saiUroekn e, ,ni�sim, mr.l
0 R-
45 ft-
Sand shells clay
45 "'
205 fr•
Clay and limestone
ft.
ft.
n.
R.
ft.
ft.
ft
ft.
ft.
R.
2L RESIARKS
(ifm ell field, one latAong is sufficient 22, Cer Mention:
See Attached N See Attached II,
S•
6. Is(sre) the well(s)Gx Permanent or uan
Temporary St reofc,mi Well Contractor Dam
y signing This form, I hereby r,rafy that the relt(o vas (n'erel eonnruemd in aeron(nnce
7. Is this a repair to an existing well: DI es or QNo n'alt IAA NCAC02C.0100 ar I5A N(AC02C.0200 O'ell Corriou,non Sztndords and that a
If do, 0 a repair, fill om known yell cmrstruorian injornrmmn mid erpleua the noun of de copy of this record has been provided to the well owner.
repair under v11 remarks .section or an the husk, jdostorn.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 6
9. Total x'ell depth below land surface: 205 ft.)
For andople welly lea all depiks if different (evample-?,^0200' and 2 a)OJ)
10. Static water level below top of casing; N/A
!(eater level is abase casing, use ' -
11.Boreholediameter:6 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotay, cable, direct push, etc.)
23. Site diagram or additional well details.
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this foot within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the fonn to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699.1636
13a. Yield (gpm) N/A Method of test: N/A -24c. For Water Sunoh• & 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: N/A Amount: N/A completion of well construction to the county health department of the county
where constructed.
Fonn GW-1 North Carolina Department ofEnvironmental Quality - Division of Water Resources Revised 2.22.2016

ARM Project Number: 7508 Dunbar Road Pagel
Wilmington, NC 28411
Driller: John Salmon
Date Drilled: Loop No,
GPS Coordinates
3/2/2019
2
205
34 16 34.8269
77 46 55.1176
3/3/2019
3
205
34 16 34.4119,
77 46 54.945.
3/4/2019
4
205
34 16 34.7132
77 46 54.8659
3/4/2019
5
205
34 16 34.853
77 46 54.2953
3/5/2019
6
205
34 16 34.2381
77 46 53.8557
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WaterQuality
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