GW1-2022-06276_Well Construction - GW1_20220628

"'1`1 11 I1'1'VI111�l
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
George R. Bndger 14.WATER ZONES"
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
2393A
ft. I ft.
NC Well Contractor Certification Number <15.OUTER CASING for multi-cased wells OR LINER if a licable
Bndger Drilling Enterprises, Inc. FROM To DIAMETER THICKNESS MATERIAL
0 ft. 4.5 ft. 2 in. sch40 PVC
Company Name 16.INNER CASING OR TUBING eothermaI 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): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
1 Agricultural OMunicipal/Public 4.5 ft. 14.5 ft' 2 in. 010 sch 40 PVC
Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. in.
Industrial/Commercial DResidential Water Supply(shared)
18.GROUT
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 1 ft. Neat in place
x Monitoring DRecovery ft. ft.
Injection Well: ft. ft.
Aquifer Recharge DGroundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
I Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
i Aquifer Test OStonnwater Drainage 2.5 ft. 14.5 ft- Sand in place
Experimental Technology OSubsidence Control ft. ft.
Geothermal(Closed Loop) QlTracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION color,hardness,soil/rock e, rain size,etc.
HGeothermal(Heating/Cooling Return) 1 Other(explain under#21 Remarks)
0 ft. 0.2 ft, Asphalt Pavement
4.Date Wells Completed.June 17,2022 Well ID#MW7 02 ft. 06 ft.
() p Base Coarse
5a.Well Location: 06 ft. 11 ft. Gray and Brawn Sand
Exxon Site 3323/GPM Investments 11 ft. 15 ft. Dark Gray Silty Clay
Facility/Owner Name Facility IDII(if applicable) ft. fL
5325 College Road, Wilmington, 28412 ft. ft.
Physical Address,City,and Zip ft. ft. t (!n/'
New Hanover 21.RENIARKS ri 'O{u �Li
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certifleation•
34.14033 N -77.89241 W `
6/20/22
6.Is(are)the well(s)oPermanent or OTemporary Si of 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 EiNo with 15ANCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
Ifthis is a repair,fill out known well construction information and erplain the nature of the copy of this record has been provided to the well owner-
repair under 921 remarks section or on the back of this 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: 14.5 ft.
p ( ) 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@I00') construction t0 the following:
10.Static water level below top of casing: 7.25 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+•• 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8 (in.) 24b.For Infection Wells: In addition to sending the form to the address in 24a
HSA above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
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&Injection 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