GW1-2022-08373_Well Construction - GW1_20220530

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
I.Well Contractor Information:
Lewis LeFever 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
2480 ft. ft.
NC Well Contractor Certification Number '15..OUTER CASING=.for m 4t—sed,ieDs OR LINER if a `ticable
, q p FROM TO DL IETER THICKNESS MATERIAL
Parrott-Wolff, Inc. + -> � SoN' 0 fr• 20.5 f[ 12 '" seh30 steel
Company Name
O 16.INNER:CASINGOR.TUBING eolLei:mal closed-loo . .. -
WS0801065 MAY 3 L FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: J ft. _ 61 ft. 6 '" sch40 stainless
List all applicable hell permits(i.e.Coutgv,Slate,Variance,hyection,etc.) U
3.Well Use(check well use): In�v'�o� g 91 ft 96 ft• 6 '"' sch40 stainless
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 61 ft. 91 fr. 6 i"• 0.015 sch40 stainless
❑Geothermal(Heating/Cooling Coolie Supply) ❑Residential Water Supply(single) ft. ft. in.
( � g PPY) PPY( g )
❑O industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 fL 44 rL Portland Cem Tremie
Non-Water Supply Well:
❑Monitoring ❑Recovery
44 ft. 50 ft. Bentonite Chil Tremie
Injection Well: O ft. 20.5 ft- Portland Cem Tremie(12" Isolation Casing)
❑Aquifer Recharge ❑GroundwaterRemediation 19.°SAND/GRAVEtiRACK(ifijillilk"Iel, ;
❑Aquifer Storage and Recovery ❑Salinity Barrier
FROM TO MATERIAL EMPLACEMENT METHOD
50 rt• 96 ft. #1 Sand Tremie
❑Aquifer Test ❑Stormwater Drainage
ft. ft.
❑Experimental Technology ❑Subsidence Control -,..
20i:DRILLiNG COG,(attich addifioii di'sheeta iCrieeessa. u
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness,soil/mck type,grain size,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 ft- 18 ft. Sand
4.Date Well(s)Completed: 5-3-22 Well.ID#WW - 21 18 '1- 25 ft. Clay
25 1" 71 ft. Sand
5a.Well Location:
General Electric Company NCD050409150 71 ft- 96 ft. Limestone
p y ft. ft.
Facility/Owner Name Facility ID#(if applicable)
f[. ft.
3901 Castle Hayne Road, Wilmington ft. ft.
Physical Address,City,and Zip
'.21.'REMARKS.... ._.. < . -,.:. ,- 7.
New Hanover R01700-001-001-000
County Parcel identification No.(PIN)'
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(ifwell field,one lat/long is sufficient
34.330891 N -77.934019 W �_� C:a b- 30
azure o Certi red W I Contractor Date
6.Is(are)the well(s): ©Permanent or ❑Temporary y g g f y fy (J ( J
B signing this ornt,1 hereby corn that the wells u•as were constructed in accordance
will;i5A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or ONo copy ofthis record has been provided to the well owner.
If this is a repair,fill out known well construction h formation and explain the nature of7he
repair under=21 remarks section or on the back ofthis form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-water supply ire/As ONLY with the same construction,you can
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 96 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ilidifferent(example-3CZ00'and 2 ct l00') construction to the following:
10.Static water level below top of casing: Unknown (ft) Division of Water Resources,Information Processing Unit,
Ifwaier level is above casing,use'•-'• 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 16712" (in) 24b.For Injection Wells ONLY: In addition to sending the form to the address in
HSA and Fluid Rotary 24aabove, also submit a 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) 75 Method of test: 24-hour pUmp 24c.For Water Supply&in_lection Wells:
Also submit one copy of this form within 30 days of completion of
13b.Disinfection type: none Amount: well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Department of Environmem and Natural Resources-Division of Water Resources Revised August 2013