GW1-2022-06274_Well Construction - GW1_20220628

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
George R. Bridger 14.WATER ZONES
Well Contractor Name FROM TO DESCRUITION
ft. ft.
2393A ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a liable
Bridger Drilling Enterprises, Inc. FROM TO DIAMETER THICKNESS MATERIAL
Company Name 0 ft. 14.1 ft. 2 in. sch 40 PVC
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): fL ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
1 Agricultural [31viunicipal/Public ft. ft in.
4.1 14.1 2 .010 sch 40 PVC
-! Geothermal(Heating/Cooling Supply) DResidential Water Supply(Single) ft. ft. in.
Industrial/Commercial DResidential Water Supply(shared) 18.GROUT
I I ri ation FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 1 ft. Neat in place
X Monitoring ORecovery ft. M
Injection Well:
ft. rt.
1 Aquifer Recharge Groundwater Remediation
19.SAND/GRAVEL PACK if applicable)
i Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test OStormwater Drainage 2,5 ft. 15 ft. Sand in place
Experimental Technology OI Subsidence Control ft. ft.
Geothermal(Closed Loop) Tracer 20.DRILLING LOG attach additional sheets if necessary)
Geothermal(Heating/Cooling Return) i Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soil/rock type,grain size,etc.)
0 fL 0.2 ft. Asphalt Pavement
4.Date Well()Completed:leted:June 17,2022 Well ID#MW8 0,2 It. 0,6 ft. Base Coarse
^�
Sa Well Location: a ft.
s 11 It. Gray and Broom Sand ri 19
Exxon Site 3323/GPM Investments 11 ft. 15 ft, Dark Gray Silty Clay
Facility/Owner Name Facility M#(if applicable) ft. ft JUN2 S 2022
5325 College Road,Wilmington, 28412 ft. ft. Y^
Physical Address,City,and Zip ft. ft.
New Hanover 21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification.
34.14046 N -77.89261 W
(�f� ( . 6120/22
6.Is(are)the well(s)E?Permanent or OTemporary SignzW ofC rt red Well Contractor Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: QYes or E)No with 15A NCAC 02C.0100 or 15ANCAC 02C.0200 Nell Construction Standards and that a
ffthis is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under#21 remarks section or on the back of 1his•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 if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 14.1 ft
( ) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdierent(example-3@200'and 2@100) construction to the following:
10.Static water level below top of casing: 6,72 (ft.
Division of Water Resources,Information Processing Unit,
If water level is above casing,rise"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: $ (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
12.Well construction method:
HSA above, also submit one copy of this form within 30 days of completion of well
(i.e.auger,rotary,cable,direct push,etc.)
g construction to the followin :
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 Supply&Iniection 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