GW1-2022-10220_Well Construction - GW1_20221111

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
George Bridger 14.WATER ZONES
Well Contractor Name
FROM TO DESCRIPTION,
2393-A ft f
ft. %
NC Well Conhactor Certification Number 15.OUTER CASING for multi<ased wells OR LINER d a livable
Bridger Drilling Enterprises, Inc. FROM TO DIAMETER THiC[�IESS MATERIAL
ft ft iin.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#• FROM TO DIAMETER THICENM MATERIAL
List all applicable well construction permits(i.e.UIC,Cowry,State,Variance,etc) 0 % fL in
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3.Well Use(check well use): R' ft.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER I,SLOT 517E THICE30M MATERIAL
❑Agriailtmal ❑Mumcipal/Public ft. 15 ft- 1 in. 110 sch40 PVC
❑Geothermal(Heating/Coohng Supply) ❑Residential Water Supply(single) ft R in.
❑lndustriaUCommercial ❑Residential Water Supply(shared) 18.GROUT
OlTrigation ❑Wells>100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: % R.
OMonitoring ❑Recovery ft. ft
Injection Well: ft. ft
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK a likable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage % ft
❑Experimental Technology ❑Subsidence Control it. % k
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG fattach additional Acets If necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCREMON color,hudgess,sollfroct etc.
fL &
8/30/22 �
4.Date Well(s)Completed: Well ED#TMW-1 ft ft i
Sa.Well Location: D fL
INVISTA Sari ft ft NOV 1 1 202
Facility/Owner Name Famlity 1D#(if applicable) M ft
3930 US Hwy 421 Wilmington, NC 28401 ft ft
Physical Address,City,and Zip ft ft
New Hanover 21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutea/seconds or decimal degrees:
(ifwell field,one fat/long is sufficient) 22.Certification:
34.18.20 N -77.58.24 won� 10/22/2022
6.h(are)the we0(s): ❑Permanent or Temporary Sign4&e ofCcifffied well Contmeff Date
By signing this form,I hereby certify that the wells)wtis(were)constructed in accordance with
7.Is this a repair to an eristing well: ❑Yes or 8No ISA NC4C 02C.0/00 or ISA NCAC 02C.0200 Well Construction Standards and that a copy
91his is a repair,fill out known well construction information and explain the nature ofthe of this record has been provided to the well owner.
repair under#21 remarks section or on the back of this form. 23.Site diagram or additional well details:
8.For GeoprobeMPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only 1 GW-1 is needed Indicate TOTAL NUMBER of wells (add'See Ovee in Remarks Box).You may also attach additional pages if necessary.
filled' 24.SUBMITTAL INSTRUCTIONS i
9.Total well depth below land surface: ( ) Submit this GW-1 within 30 days of well completion r the
For multiple wells list aQ depths/f differem(¢sample-3ta3200'and 1(a�100'j y � per following:
10.Static water level below top of casing: ( ) 24a. For All Wells: Original form Ito''Division of Water Resources (DWR),
Ifwuterlevel is above casirr&use"+" Information Processing Unit,1617 MSC,
r Raleigh,NC 27699-1617
11.Borehole diamete.2.25 (m) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method:Direct Push
(i.e.anger,rotary,cable,direct posh,etc.) 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 6
24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Fmnonmental Quality-Division of Water Resources Revised 6-&2018
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