GW1-2022-09270_Well Construction - GW1_20221003

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
William J. Miller II.WATER ZONES
FROM TO DESCRIPTION
Well Connactor Name R It
2927-A ft I D.
NC Well Contractor Certification Number UL OUTER CASING far mWti-eased webs ORLINER ifa hk
CATLIN Engineers and Scientists FROM TO DIAMETER m TIIICR E15 M{TERL{L
D. n.
Company N. lC RINER t.AS6NG OR TUBBVG MtMraW clinedaoo
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERLAL
Lin a//appluable well comnvnn r permits(i.e.UIC,Coumr.Suite. Irurimtce.eta) R Is. in.
3.Well Use(check well use): f. h, in.
Water Supply Well: 17.SCREEN
PPY FROM I TO I DIAMETER I SLOTSIZE I THICKNESS MATERIAL
DAgncultural OMmucipaliPublic 0 fL 6.8 a 1 in 0.010- SCH.40 PVC
OGeothermal(Heating/Cooling Supply) DResidentud Water Supply(single) h 0 ft I iR.
Olndustrial/Commercial OResidential Water Supply(shared) I&GROUT
01nnstation OWells>100,000 GPD FROM TO MATERIAL I EMPLACEMENTMETHOD&AMOUNT
Non-Water Supply'A ell: R ft
OMonitoring ORecovery rt ft
Injection Well:
ft. ft.
DAquifer Recharge OGroundwater Remediation
1R SAND/GRT PACK Ba e
DAquifer Storage and Recovery Dsalinity Barrier FROM TO SiATF.RIAL EM NTPLACEME METHOD
DAquifer Test DStormvvater Drainage 0 ft 6.6 ft I Natural Backfill
DExperimenml Technology OSubsidence Control h. ft
OGeothermal(Closed loop) OTracer 20.DRILLING LOG inlMh additiaW eheela if.ec
DGeothermal(Heating/Cooling Return) OOther(explain under#21 Remarks) m
omTO DESCRIFIRON oast bardness.wwrux see,etc.
ft
4.Date Well(s)Completed: 2/1/2022 Well ID# UST-BLDG-MH4-TWOI Is.
f.
59.Well Location:
Meadows NA n
F.Any/Owner Name Facikty lDM(ifappliceble) R
NCSPA-Morehead City, Building MH4, 28557 It. I, I r1 `, 70,9,'
Physical Address,City,and Zip h. ft
Carteret NA 21•REMARKS
Cowry Parcel ldemification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifivell field,one let/long is sufficient) 22.Certification:
34.718256 N -76.698807 W 9/21/2022
6.Is(are)the well(s): OPermapeat or OTemporary Signature ofCerofied Well Connactor Date
By signing this form,/hereby certify thin the uell(s)u as(were)conmuned m accordance with
7.Is this a repair to an existing well: OVen or ONo /SA NCAC 02C.0100 or IdA NCA('02C.070(l Well Canmu,I,.S/amdards mud/hula cop'
If this is a repuiq fill out known well emutrao0on atfin nation unit erplmn the na0me of the of thus record has been prodded to/he wdl saver.
repan under=2/remanbr section or on the back oJlhis 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 construction info
construction,only I GW-I is needed Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You may also attach additional pages if necessary.
drilled 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 6'8 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For mn/nple wells hn all depshs fdgerent(esamp/e-3@200'aM 2@100')
10.Static water level below to of easing: 3.7 (fl) 24a. For All Wells: Original form to Division of Water Resources (DWR),
P E/Jxnter/me/is abm�e ing,use
Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
nos
2.25 24b.For Injection Wells:Copy to DWR,Underground Injection Control((UC)
11.Borehole diameter. (in.) Program, 1636 MSC.Raleigh,NC 27699-1636
12.Well construction method: Direct Push
24c.For Water SuppLand Open-Loop Geothermal Return Webs:Copy to the
(it.anger,rotary,cable,direct paste,etc.) county environmental health department of the county wfiere installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin over 100010 GPD: Copy to DWR,CCPCUA
Permit rogra n, 161 I MSC,Ra eig ,NC 7 99-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
I.GW-I North Carolina Depamrunt of Envvonmental Quality-Division of W ater Resources Revised 6-6-201 S

PROJECT:BLDG MH-/ WELL IDENTIFICATION; UST-BLDG-MHO-TW01
MEADOWS WELL COMPLETION DIAGRAM
6GpISULTING MANAGEMENT PLANNING
PRO=:MIISP Bldg MIW
DRLLLINGCONTRACrOR Call, Nordaing: Existing:
WATER LEVELS-0 hr.3.70'bmc Installation Date:02/01/22
3
31, 2 1 1-C xl elevation at w 11:
2-Top ofcasing elevation: Illmown
by
3- Wellhead pmteetton cover type: a"PVC Pme
a)drain mbc? NA
b) NA
g
4 Dia.hypeof.dleasing: 1"
o.
I.tl' STypelslotiiuofscrxm 0.010 "Senn
7
g 4 6 TypcscreenfilW Well Gmvol Pack
a)Quantity used: Lelia,
7-Typer Sed: Brnmnite
a)Quantity used: Vnkown
g 8-Cana:
a)Grow mix used: NA
b)Mothod Ofplaccxi NA
c)VOI.Ofwollcuinggram: NA
Development method: Low Flow
6
Development time: 5 m'
Estimated purge urbane: 3/4 G.11.a
Commrnla Grwadwete,named.611120 elQ.
0.2T

PROJECT
MEADOWS \IHSP Bldg%IHJ SHEET I OFI
.r..a.r.�r SOIL BORING LOG
PROTECT: BIdgMH4 _ _DRILLING CONTRACTOR:Catlin LOCATION:MHSP Bldg MHJ
ELEVATION:Ua. Latitude:34.718'_56" LaallioAc-76.69880A
DRILLING METHOD AND EQUIPMENT USED:Hand Auger
DRILLER:Bill Miller DATE:02/0IR2 LOGGER:T.Moore
DEPTH BELOW SURFACE(FT) CORE DESCRIPTION COMMENTS
INTERVAL FT DEPTH OF CASING,DRILLING RATE,
RECOVERY FT SOIL NAME,USCS GROUP SYMBOL,COLOR. DRILLING FLUID LOBS,
#/TYPE MOISTURE CONTENT.RELATIVE DENSITY, TESTS,AND INSTRUMENTATION.
OR CONSISTENCY,SOIL STRUCTURE
MNERALOUY. PM R mi10on(PPM)
0 (0.0-1.51 Open exczation
1.61" SW (1.5-3.11)Sand(SWL W to gay,shell 0agments,moist.loose (15-2Y bgs)0 ppm
Strong petroleum odm
4.7 (25-3.11'bga)28.7 ppm
1.59, SW 13.1 I-0])Sand(SW),gaY-shell Bagmeots,summed,loose (3,1147 bgs)262 M.
4_
Strong petroleum odor Groondxater enconteurcd at 3J'bgs
_
Boring Ter ounated m 3.7' Driller Noes that boring hole caves in at 4.7 bgs
8