GW1-2021-00625_Well Construction - GW1_20210326

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Onh:
I.µ'ell(ontractor Infurmatiun:
Sean Cropsey 14.WATER ZONES
FRO\I Tfl DEscll 'w "T
U ell Cuntrsetor Nanm
2485-A 155 ft 175 ft. Sandstone
a.. ft.
Ncµ'eii Conlraxrer Certification Namher 19.OUTER CASING for mRlfi-ovsed wells OR LINER if v linable
Applied Resource Management, PC FROwI TO DL\Nh TfR CKNfsS ER I.
Of, 65D 81a. Sch 40 PVC
f ompon,\1111e 16.INNER CASING OR TUBING eothermal closed-too
2.Well Construction Permit a: FRONT TO DI AJIETER 71 IT NI:S$ MATERIAL.
1.+,+„n�fi�11,alhn 111¢..„+.IIO.O1:+Ire1 II1IIe o..-. 1ar.r„IIII�t.sl„I,. '+..1 Gu. 155ft- 41a. Sch 40 PVC
3.µ'ell lase(check well use): ft. ft. m
\\- Supply AN ell: 17.SCREEN
a[er Su
PP FROM 10 DL\NIETER SLOT S1 llrl(KNESS NLATERIAI.
Agricultural OMuniClpaUPublic 0 ft. ft. in.
Geothermal(Heating/Coolma Supple) Ol2esl den tial µrater Supply(s'ingle) 55 ft, 175 H. 4 in 20 Sch 40 PVC
Industrial/Contmcrcial ORcsidenual Water Sill (shared) IS.GROUT
Intoatlon FRONT TO MATERIAL. EMPIA(ENt192'METHOD&AMOUNT
Nart ater Supply Well: 140 fL 150 f` Chips Poured
Sfonitormp Oka...etc 0 ft. 20 1° Chips Poured
Injection Well:
ft I It
Aquller Recharge [_](irounduater Rcnu-diution
19.SAND/GRAVEL PACK(if amp liable
4qm fer Stooge and Belo%er, OSallnin Barrier FWL1 "fO MATERIAL Ee1P1_ACF_MF_NTNIETHOD
.Aquifer Test OStormHmer Drainage 150 TL 175 f` #2 Poured
L'xperimentaI'fechnaloyw' OSubsidence Control fr. I'L
Geothermal(CluNed Loop) 13'1 racer 20.DRILLING LOG vnvah additional sheeb if accessary)
Geothermal(Heating/Coulig n Rcturr) rJ0mer(explain under all Remarks I FRONT '10 DESCRIPrIOsmlo,p hard.......it r,Iik lo.ii,sl. n,is.
0 fr. 201- Clay - sand layers
4.Date Wru(s)I ompleted:03/04/2021 Well Ina 20 R 60 TL Sand Clay layers - Shells
Sa.Well Location: 60 D. 120D' Limestone
Caliber 120" 150D- Grey mud-clay
Fa l i ownerNamo Foram ID=of nppl¢ablel ft. ft. _
7032 Market St Wilmington, NC 28411 150ft 175 ft Sandstone
I')......I ldd,e,,C,ty.and 7, ft. ft.
New Hanover R04409-003-027-000 2LREMARKS
Counre Parcel Idnmlicalim,No (PIN)
SIT.Latitude and longitude in degreeshnitmtes/seconds or decimal degrees:
nt ,,It it'll.line Ia'long is sat c"or 22.(ertification:
34 16 5 7749 19 µ
�' � 03/15/2021
6.Is(are)the well(s):OI'ermanent or OTentporar}' sa,,w a,,fcemffxd NU' II cone- mr Doc
li, aAvu e IGr,1m / "'hi If I Ihr veI/(,,� . un.++nremd m n ..bt er
Yn "IJr � .er
7.Is this a repair to an existing well: Oyes or ©NO vuhIntl V 0't'.0100 l-d R'df'n'+'.0200 rf dl Iv.nm,. 1 trnnA+bmn
1++A„r,,',pain fill..u+kno„,i ,,it,I lm.../ aI..nl mu1 c,lmn d, nan",o/IL.- �,l ,I,hI.reu.rd ha,hurl prorn(.J+.,rb'md!mm�n.
''pale vu.kr 2/,,nark,,enl....n'on+he hook 1/1hu Inrrn
23.Site diagram ur additional well details:
8.For Geoprobe/DPI or Closed-Loop Geothermal Wells haying the same N on mm use the back of this page to pro\ide additional well site details or well
construction,onlyI GW-I is needed Indicate 1-0'1AL NUYIBLR of wells ansmictlon details. You mac also attach additional pages if necessan.
drilled St Ill 11 Al,INSTRI('I IONS
9.'1mal well depth below land surface: 175(fl.) 24a. For All Wells: Suborn thin form ,,;thin 30 da%s of completion of well
F or nvrllgdr ve@v liv all Arprk„/dtprrnrn mxmnply-J(d,'UU auJ`<i ilia'I construction to the lollowme
10.Stafic water level below top of casing: 38(fr) Bivision of µrater Resources,Information Processing I nit,
11 o.u.r le,',I,I,/.... ........,o.. - 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8 (in.) 24b. Fur Injection Wells: In addition to sending the form to the address in 24a
Mud Rotary above_also subnlil one cop% of this Ilion within 30 da%s of completion of och
u
12.Well construction method: Y construction to the Ibllooimg
iowrs,..tole,direct pit+h u.i
Division of Water Resources,Fnderground Injection Control Program,
FOR WATER SUPPIA µ'ELLS ONIA: 1636 Nlail Service Center,Raleigh,NC'27699-1636
13a.A-field(grin) Method of test: 24c. For µrater Sunni) & Imectiun µells: In addition to sending the torn to
the addressles) above. also ,submit one cop, of this form .alhin 30 days of
13b.Disinfection hype: Amount: compleu0n of well construction to the count, health depanmeot of the count,
Isherc c0nstructcd.
Form GR'-I M1'onh t'umlma D'partmcn[of P.m......moral Qualn.-IJrvlvuo of N'as. Rxanar..s Rc,,,d'_-22-10I6