GW1-2021-04003_Well Construction - GW1_20211114

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WELL CONSTRUCTION RECORD (GW-1 )
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Form GW-1 Well Construction Electronic Form
North Carolina Department of Environmental Quality
Division of Water Resources
April 1,2021
Submission ID#
G W 1-2021-04003
Are you submitting a printed form?* Yes
No
CONTACT INFORMATION
.......................................................................................................................
Contact Name* Email Address*
Corey Gamwell [e-mail]
Is this a revision to the form you have previously submitted?*
Yes No
WELL CONSTRUCTION INFORMATION
........ ......... ........... ... ......... ..... .... ......... ......... ......... ......... ......... .........
1.Who is installing these wells?*
Owner Well Contractor
1.Well Contractor Information:
Certiticate# Cert Level First Name Last Name Company Name
3027 A COREY GAMWELL GROUND ZERO ENVIRONMENTAL
FIELD SERVICES
2.Well Construction Permit#:
n/a
List all applicable well construction permits(i.e.Monitoring Wells,UIC,County,CCPCUA,etc.)
What type of well is this?* Injection Well Non-Water Supply Well
Water Supply Well(includes irrigation wells)
3.Non-Water Supply Well* Monitoring
Recovery
4.Date well was completed and ID#
Date Well Completed* Well ID# Well Yield
10/15/2021 2b,3b&4b (gallons per minute)'
5.Well Location
......... ......... ......... ..... .... ......... ......... ......... ......... ........................... ...

Facility/Owner Name*
Hurricane Fleet Charter Fishing Facility ID#
(Required) (If applicable)
County* Parcel Identification No.(PIN)
Brunswick
Physical Address* Street Address
9975 Nance Street
Address Line 2
City State/Province/Region
Calabash NC
Postal/Zip Code Country
28467-2715 us
Latitude* 33.8858396000 Long itude*78.5677265000
Decimal degrees Decimal degrees
...................
6.Is(are)the well(s):* Permanent Temporary
7.Is this a repair to an existing well:* Yes No
If this is a repair,fill out known well construction information and explain the nature of the
repair under#21 remarks section or on the back of this form.
For multiple Geoprobe/DPT or Closed-Loop Geothermal Wells having the same construction,only 1 GW-1 is needed.
8a.Indicate TOTAL NUMBER of wells drilled: 3
9.Total well depth below land surface: (ft.) 9a.What is the depth of the casing from ground
12 surface?
For multiple wells list all depths if different 2
(example-3@200'and 2@100') in feet
11.Borehole diameter:
10.Static water level below top of casing: (ft.) 2.25
If water level is above casing,use"+" in inches
12.Well construction method:
Auger Air Rotary Cable Tool
Direct Push Mud Rotary Rotosonic
Other
14.WATER BEARING/FRACTURE ZONES
From To Description
3 12 sand and silt
in feet in feet
15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
From To Diameter Thickness Material
in feet in feet in inches
17.SCREEN
...............................................................................................

From To Diameter Thickness Material
2.00 12.00 1.00 sch40 PVC
in feet in feet in inches
18.GROUT
.....................................................................................................
From To Material Emplacment Method&Amount
1.00 2.00 Bentonite Pour and measure
in feet in feet
19. SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
2.00 12.00 #2 Silica filter sand Pour and measure
in feet in feet
20. DRILLING LOG
From To Description(color, hardness,soil/rock type,grain size,etc.)
0.00 12.00 Sand and gravel at the surface to sand and silt to 12 ft,Wet at 3 ft with tidal influence
in feet in feet
21. Remarks
All three wells were covered with a five inch manway and 18 inch well pad. Each well was constructed with a locking cap.
22.Site diagram or additional well details:
You may upload additional well construction information here.
pdf only
CERTIFICATION INFORMATION
* By signing this form, I hereby certify that the well(s)was(were)constructed in accordance with 15A NCAC 02C.0100 or
15A NCAC 02C.0200 Well Construction Standards and that a copy of this record has been provided to the well owner.
23.Certification*
Signature of Certified Well Contractor
Submittal Date 11/14/2021