GW1-2022-07987_Well Construction - GW1 Attachment_20220908 (2)

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NORTH CAROLINA
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WELL CONSTRUCTION RECORD (GW-1 )
EnvfronmertmfQua(Iry
Form GW-1 Well Construction Electronic Form
North Carolina Department of Environmental Quality
Division of Water Resources
November1
Submission ID#
G W 1-2022-07987
Are you submitting a scanned form?* Yes
No
CONTACT INFORMATION
.......................................................................................................................
Contact Name* Email Address*
Tracey Tapley [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:
Well Contractor Name NC Well Contractor Certification# Company Name
2.Well Construction Permit#:
List all applicable well construction permits(i.e.Monitoring Wells,UIC-Underground Injection Control,CCPCUA-Central Coastal Plain Capacity Use Area,County,
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
8/22/2021 (gallons per minute)"
5.Well Location
......... ........... ......... ......... ......... ......... ..... ...

Facility/Owner Name* Facility ID#
Buxton Naval Facility 104NC000103
(Required) (If applicable)
County* Parcel Identification No.(PIN)
Dare
Physical Address* Street Address
Old Lighthouse Road&Schooner Es Newman Drive
Address Line 2
City State/Province/Region
Buxton NC
Postal/Zip Code Country
27920 us
Latitude* 35.2581960000 Longitude*75.5203987000
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: 2
9.Total well depth below land surface: (ft.) 9a.What is the depth of the casing from ground
1@18.4', 1@16.7' surface?
For multiple wells list all depths if different 1 @8', 1 @6.3'
(example-3@200'and 2@100') in feet
10.Static water level below top of casing: (ft.) 11.Borehole diameter:
9-11, 4.5
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
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
8.00 18.00 2.00 10 PVC
in feet in feet in inches
6.30 16.30 2.00 10 PVC
in feet in feet in inches
18.GROUT
.....................................................................................................
From To Material Emplacment Method&Amount
1.00 4.00 grout tremie bottom up
in feet in feet
1.00 3.00 grout tremie bottom up
in feet in feet
19. SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
4.00 18.00 no 1 quartz sand tremie bottom up
in feet in feet
5.00 16.50 no 1 quartz sand tremie bottom up
in feet in feet
20. DRILLING LOG
From To Description(color, hardness,soil/rock type,grain size,etc.)
0.00 10.00 fine to course poorly graded sand(BNF-ZMW-16)
in feet in feet
0.00 14.00 fine to course poorly graded sand(BNF-ZMW-17)
in feet in feet
21. Remarks
.. ......... ......... ......... ..... ......... ........
BNF-ZMW-16&BNF-ZMW-17 were both installed in the sand dunes at this location.
BNF-ZMW-16 screened interval is 8-18
BNF-ZMW-17 screened interval is 6.3-16.3
22.Site diagram or additional well details:
You may upload additional well construction information here.
Buxton Fig 2 MW Loc.pdf 6.88MB
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