GW1-2021-00580_Well Construction - GW1_20210224

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Sean Cropsey 14.WATER ZONES
FROM To D69/]IRTON
wall Camrxtwxame �. ti 120 I. 1180 I• Gray salt 8 pepper sandstone
2485A m rL
NC Well Coatractm Certification Number Is.OITTERC-ASMG far maW-ored wells OR LINER iraMe
Applied Resource Management 1° 01A"Q"" T LW[rss a'"T�'""'
pp 9 0 rL 47 fL 1 10 is. Sch. 40 1 PVC
Company Name 16.INNER CAMG OR TUBING(mustered destal4
2.Well Constmetion Permit N: mom ToI DN 11 TmCa0eP55 v MATuAL
LW all applleable well mtwtrvei penaUT fire.U1C.County,Star"Yarim,c"ere) t2 IL 123 R. 6„ 1L Seh. 40 1 PVC
3.Well Use(check well use): ft. R[Indotrial/Commirciall
Su 1 Wdle 17.SCREEN
PPy AM Tit DU snot SLOT OMmicipd/Public 0 I. fL laermal Meating/Cooiing Supply) Residential Water Supply(single) m• rL In.
OResidential Water Supply(shared) IL GROUT
ion ►ROM TO MATLRW. EMPU OaterSupplyWdl: O • 123 n• Bentonite Poured
oring Recoveryn well: R m•
Aquifer Recharge QGmundwater Remedimion
1s.5ANDM,RAVEL PACK f bk
Aquifer Storage and Recovery Salinity Barrier most To MArnuL 1301A mrt almost
Aquifer Test �Smrmwatcr Drainage ft. R.
Experimental Technology Subsidence Control (L n.
Geolhennel(Cimcdlmp) QTmcer 21 DRILLING LOG atnaci erldlteW siceu if necessary)
Geothermal(Heating/Cooling Return) nOther(explain under N21 Remarks) mov' TO DETCnV71uN tkolar,suaveness.seaA.ca m a
0 IL f'' Brown and pray medium to fine silty sand,wood
4.Dale Well(s)Completed: 1/22/21 Well IDN PW-1 45 I. 70 IL Gray fossiliferous sandy limestone
sa.Well Location: 70 n. 115 fL Gray silty clay with limestone layers
115 m 120 I• Transition zone with limestone,clay,&sandstone
Facilityi0wry Name Facility,mP(ifapplicabie) 120 I' 170 "- Gray sag&pepper sandstone
North of Cameron Trace Drive 170 " 180 fL Gray clay with sandstone layers
Physical Address,City,and Zip ft. It.
New Hanover 21•REMAIM
Covaty Parcel Identification No (PIN)
5b.Latitude and longitude In degrees/miautea/secaods or decimal degrees:
(ifwell field,one WUba9 is sulficicnn) 22 Cerdac don:
34.304172 N 77.835719 W 2i & ,
6.failure)the well(s)(]Perntaaent or ®Temporary Sitiunae fccrtifiah Well C alosettev
Data
6,1
By signing this form,I hereb err dot die well(j)war(were)corterucred oraccardarca
7.Is this a repair to on existing well: []Yu or ®No with USA NCAC 07C.0/00 or ISA AC 07C 070d WeU Cautruetim Srardrrdt and thm a
lithe it a repair,All out known well constrvctim ar/brmmtm and vplam the nature afthe copy of due recordhm been prurtdedro the well owner
repair under s7I remaka redta,or ear the back oftho faraa 23.Site diagram or additional wall details:
g.Far Geoprobe/DPT or Closed-Loop Geothermal Walls having the same You may use the back of this page to provide:additional well site details or well
construction,only I OW-1 is needed. Indicate TOTAL NUMBER of wells construction dctails. You may also Coach additional pages if necessary
drtiied: SUBMITTAL INSTRUCffOz4S
9.Total well depth below land surface: 180 (fit.) 24n. For All Wells: Submit this form within 30 days of completion of well
For arulapk welIf list aU&fine rfdrf(erent(eranple-3@200'ard 2®I00) eansin Ctiou to the f0110Wing:
10.Static water level below top of cuing: 38.27 (ft) Division of Water Resources,Information Processing Unit,
Ifware,kyd is above carorg,at"+" 1617 Mall Service Center,Rakigb,NC 27699.1617
11.Borehole diameter: 8 (110 24b.For Iniectioo Wells: In addition to sending the fam to the address in 24a
Mud Rota above, also submdl one copy of this form within 30 days of completion of well
li.Well construction method: Rotary construction to the following:
0e sager,rotary,ubl-.dimctpmh.de)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yidd(gpm) Method of test: 24c.For Water Supply& laiettion Walls: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disiofecdan type: Amount: completion of well construction to the county health department or the county
where constructed,
Farm GW-I North Carolina Department of ErivimomcaW Quality-Division of Water Resoutees Raved 2-22-2016

Alyce Bean
From: CJ Cornette
Sent: Monday, February 22, 2021 9:55 AM
To: Alyce Bean
Subject: Cameron Trace Drive Well RID
Howdy,
We drilled these temporary wells on an easement between two houses. The RID for the easement is R02700-001-114-
000.
The PIDs for the two houses the well was between are R02700-001-105-000 (west of the well) and R02700-001-181-000
(east of the well).
Let me know if that helps. If you need anything else I'm happy to provide it.
Thanks,
C.J. Cornette, PG
Applied Resource Management, PC
ARM - Well Drilling
111
P.O. Box 882
257 Transfer Station Road
Hampstead, NC 28443
910.270.2919 (Office)
910.512.7156 (Mobile)
910.270.2988 (Fax)
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