GW1-2021-00631_Well Construction - GW1_20210331

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WELL CONSTRUCTION RECORD (GW-1) For Infernal Use Onlx':
L W"cal Contractor Infor nation:
Sean Cropsey 14.WATER ZONES
MI 'ITl DESCRIPTION
1\�' C�I111A�fUr�tlnlC
' ' 120 na 150n
GreyLimestone2485 A i't,ling nl.
V( VAdl( mre ol(ullli.voov awn her
IS.OUTER CASING for mold-rased wells ORLINER Ka lie o
Applied Resource Management, PC FRONT Ill DUVEIIR TNIf"K 51 s NilltRIAI.
oft. 1 501' 12 in Sch 40 PVC
` pain Cana 16.INNER CASING ORTUBING eothermaldused-too
2.Well Construction Permit d: PRONI TO "I"IFTEK '1'lll('KN155 MiTERI\L
v...,ll appha✓,l.,rrll......,r,mn,n.I..n,m,1,r /dr (,,,,,,n,y, l.- 0 D' 70 D, 8 in Sch 40 PVC
3.'A ell I'se(check well use): 0 ft' 1 120 fa 4 in- Sch 40 PVC
NN ater.Supph Well: 17.SCREEN
FRONT TO DIAMETER 7i1TSILF. THICKNEss xIAI'ERIU,
A-ncultural E]Municlpul Tuhllc o D, ft. in
Geothermal(Heanng/Couhng Supple) Residential l4 ate.Supply (sln@le) 120 ft, 150 f'. 4 in. 20 SCh 40 PVC
Industrial/C'ornmernal QResidcntial U Ater Supply(shored) 18.GROUT
Irrigation ERo\I TO xIATERIAL Ii:b1PLA('VIOnAl Af:THOD&AxlOCNT
Nori ater Supply Well: O °' 110 °' Bentonite Poured
Monitoring DRecmen
Injection Well:
Aquifer Recharge 130ruundvater Rcm,,ciation
19.SAND/GI7AVEL PACK ife livable
Aquifer Storage and Reto,crc [3Saliuitc Barrier FRO" I To AIATERIAL ExIP 're'd NT Nit I Too
Aqudcr Test �Stnnmwater Drzmaee 115 A 150 ft' #2 Poured
-11\perinlertal'I'eehnulogc E)Subsideli Control H. ft.
Geothennal(Closed Loop) Tracer 20.DRILLING LOG attach inditioodiflai ifnece Ru
DESC WPTIONIculnr,kaNncss,mil'rnck n' a e,e¢.
Gco[hcrmtll(Ilcating/CouLng Re¢.m) Olher(expinin tinde FROH TO rN21 Remarks 0 H. 10n.
Sand
4.Date Well(s)Completedr 04/11-04/22/21 WcII ID# loft' 3011' Clay sand layers
5a.W ell Location: 30h- 50h- Shells clay layers sand
Caliber Car Wash 50R 55 ft' Limestone-open hole
EIJI, 0„nur Sonic Fft,du.-nl-Ill,dr-,lO,) 55 ff 150 to Limestone
38 Dan Owen Dr. Hampstead, NC 28443 f` f.
Phcsi..I AJdt,,, ('ity.coal/I, ft. 1't.
Pender 3282-86-7568-0000 21.REMARKS
('Olin.\ Parcel Id"arkanua\,,.(PIS)
56,Latitude and longitude in degrees/minutes/seconds or decimal degrees:
l it,,ell field.Onc lat/long is,oictem l 22.Certification:
342431 N 773730 W
�aCrL 03/29/2021
6. Is(are)the well(s):©Permanent or 0Temporary Signalnre of Cenland NS'v ( oovOKIT T nmc
8l vyrun,,lho fain., 1&I'llf rdrun Jn,r O, re11P,an, rarer r.m ,11II"d in n.ourduner
7. Is this a repair to an existing well: 01'es or QNo 101 1;1 Stir'nit' n/hu,.. /it y1 11 n','.o:1L1 uLl1(bmrr.,ru,•n jrnn,lenl,and/ha,a
I/If,narepnn'.fill ou/knn,n.,,,-f.,nnvn,.,,nn inj Inrolin,.cold.aplu Ithe III uveq//hr ,„,I ,I,h,,rr:.III/hoa hi m,pr,nnd.d,u rill a el/Dialer.
rape,.node,-2l bins,*,ar.lmn nI ran lire hn.k nI Ih,x/ann
23.Site diagram or additional well details:
8.For Geuprobe/DPT or('lased-Loop Geothermal W"ells huv,ill,,the some )ou mac also the back of this page to provide additional well site details or well
construction.only I 1-1 1st needed Indicate'10'1 A],NI-SIFILR ofwclls construction details. You ma}also attuch additional pages it necessarc
drilled
SCRNITT:AI.fNS7"BCCTfONS
9.'1 otal well depth below land sat face: 150Cri 24a. For %II Wells: Submit this form within 30 dacs of completion of well
b.....ndeplr , 11,hO,O//d,,1Ii odAl......[ample-J,d.,un nu.0 1,1,,(' constnictmtl to the folloAome
10.Static water level below top of casing: 15 (ft) OiNrdar of Water Resources,Information Processing I nit,
1/ „n.,d.Ie/n ehn,r ca,n... Inc 1617%fail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 1 3-10-8 (hi 24b. Far Iniection Wells: In addition to sending the term to the address in 24u
ahocc also submit one cop, of this Toni within 30 dacs of completion of well
12.W"ell consti ti clion method: Mud Rotary cnnstrucnon to the folluwm
oc i rmurc,cable.Ai¢a Pusb.c¢i
Ilixision of W'aler Rc,.u,ces,I ndergromtd lujection Control Program,
FOR AA=A'fEl SOPPLY WELLS ON11: 1636 Nlail Serhice Center,Raleigh,VC 27699-1636
13a.field(gpm) (Method of test: 24c. For Haler Smi & Injection Wells: In addition to sending the form to
the addresses) above also submit one copy of this form within 30 dtrys of
13b.Disinfection type: Amount: completion of well construction to the county health depallri ol'tile County
where consn'ucted.
Poem Go,-1 NOill,Carolina Depanmen.It 1im ironincnul VuoWe-D,isiun ofNair Re.ouic, Rm"d'-"-016