GW1-2021-00399_Well Construction - GW1_20210129

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information: 7
John Salmon 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
3497-A ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a lieable
Applied Resource Management, PC FROM TO DIAMETER THICKNESS MATERIAL
pp 9 ft. ft. in.
Company Name 76.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: W10800544 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0 ft• 300 11- 1 in. SDR 11 HDPE
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural rlMunicipal/Public 0 tt ft. in.
J Geothermal(Heating/Cooling Supply) �Residential Water Supply(single) ft. ft in.
Industrial/Commercial OResidential Water Supply(shared) 18.GROUT
_Irrl ation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 300 ft- Bentonite Tremie
:)Monitoring ORecovery fL ft.
Injection Well:"
ft. ft.
Aquifer Recharge E3Groundwater Remediation
19.SAND/GRAVEL PACK if applicable)
-j Aquifer Storage and Recovery (©I' Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
J Aquifer Test [3Stormwater Drainage ft. ft.
Experimental Technology []Subsidence Control ft. ft.
Geothermal(Closed Loop) ©IJ Trfoer .20.DRILLING LOG attach additional sheets if necessary)
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soil/rock a in size,etc.
- 0 ft. 30 ft- sand
4.Date Well(s)Completed:12/22/2020 Well ID# 30 ft- 120 ft- shells-clay
5a.Well Location: 120 ft• 170 ft. limestone
Whitney Blair Construction 170 ft 300 ft- sit —ci r—I
; �
Facility/Owner Name Facility ID#(if applicable) ft. ft � C l '� �m LJ
184 Station Way Bald Head Island, NC 28461 ft. ft•
Physical Address,City,and Zip ft. ft.
Brunswick 301311565037 21.REMARKS s
County Parcel Identification No.(PIN) DWRSnctlon
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one Iat/long is sufficient) 22.Certification:
See Attached N w 4f, It2eml 01/23/2021
6.Is(are)the well(s)oPermanent or ®Ij Temporary Signattfiof Certified Well Contractor Date
-- - — — --- „ " - By signing this form,I hereby certify_that the wells)was(were)constructed in accordance
7.Is this a repair to an existing well: nYes or ONo with 15A ArCAC 02C.0100 or 15A ArCAC 02C�0200 WellZbnslruction Standards and lhar a
If this is a repair,fill out known well construction injormation and explain the nature of the copy of this record has been provided to the well owner.
repair under 921 remarks section or on the hack 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 ifnecessary.
drilled: 5 SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 5 at 300(ft-) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@100') construction to the following:
10.Static water level below top of casing: 3 (ft.) Division of Water Resources,Information Processing Unit,
Ifwater level is above casing,use"+^ 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 1/4 (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
Mud Rotary above, also submit one copy of this form within 30 days of completion of well
u oa
12.Well construction method: ry 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 SunDly&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: 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

ARM Project Number: 184 Station Way Whitney Blair Construction Pagel
Driller: Patrick Cahill
Date Drilled: Loop No. Loop Depth GPS Coordinates
12/22/2020 1 300 33 50 41 2291 77 57 40 55 79
12/22/2020 2 300 33 50 40 96 68 77 57 40 01 39
12/22/2020 3 300 33 50 40 69 29 77 57 40 61 98
12/22/2020 4 300 33 50 40 51 13 77 57 40 52 17
12/22/2020 5 300 33 50 40 88 61 77 57 40 44 24