GW1-2022-10224_Well Construction - GW1_20221111

WELL CONSTRUCTION RECORD(GW-1) For Intemat Use Only: i
1.Well Contractor Information:
George Bridger 14.WATER ZONES
Well Contractor Name FROM TO DESCRIMON
2393-A ft ft
ft %
NC Well Contractor Certification Number 15.OUTER CASING for mull-cased wells OR LINER d a 'cable
Bridger Drilling Enterprises, Inc. FROM TO DIAMETER THICIQIFSS MATERIAL.
It, fL
Coy Nam 16.INNER CASING OR TUBING thermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER TMCKNESS MATERtAL,
List all applicable xeAcons&uction permits(t.e.VIC,Crnaq,State,Variance,etc) & ft. in.
3.Well Use(check well use): ft ft. in.
Water Supply Well: 17.SCREEN
FROM TO I DIAMETER IE SLOT SITE I THICKNF.Ss MATERIAL
❑Agricultural ❑MumcipaMblic R "L in
❑Geothemtal(Heating/Cooling Supply) ❑R uPPY(sinesidential Water Supply c 15 1 1.10 SCh40 PVC
gl) _ ft. it, in
❑lndustrialtCommercial ❑Residential Water Supply(shared) 18.GROUT
01trigation ❑Wells>100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply WAD: D- ft
MMOnitoring ❑Recovery ft. ft
Injection Weo:
ft ft
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK da livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL RMPLACEMENr METHOD
❑Aquifer Test ❑Stormwater Drainage ft ft.
❑Experimental Technology ❑Subsidence Control ft ft.
i
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑other(explain under#21 Remarks) FROM TO DESCRIPTION Bator,h eoWr-k rr e
8/30/22 ft ft
4.Date Well(s)Completed: Well ID#TM W-3 ft ft
So.Weti Location: R ft.
INVISTA Sarl ft rti
Facility/OwnerName Facility lD#(ifapplicable) ft. % V 11 2022
3930 US Hwy 421 Wilmington, NC 28401 % %
Physical Address,City,and Zip ft ft lrt(ofl '
i a
New Hanover 21.REMARK
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minntes/seoonds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification:
34.30.45 N -77.97.58 w 10/10/2022
6.Is(are)the well(s): ❑Permanent or InTemporary 34pature ofCcrtilied well Con actor Dane
By signing this form,I hereby certify that the we11(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes -or MNo --- 1 SA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this 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 Geoprobe/DPT or Closed-Loop Geothermal Webs 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 Over'in Remarks Box).You may also attach additional pages ifnecessaly.
wed' 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface:20 (ft.)
For multiple wells list all depths ifdii erent(exmnple-3Qa 200'and 2@100) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casting: ( ) 24a. For All Wells: Original form!to Division of Water Resources (DWR),
Ifwater level is above oaring;use"+' Information Processing Unit,1617 MSC;Raleigh,NC 27699-1617
1L Borehole diameter-2.25 (tn) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method:Direct Push
eager rotary,cable,direct push,e1z) 24c.For Water Supply and Open-Loop Geothermal RetarD Wells:Copy to the
county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY:
24d For Water Wells producing over 100.000 GPD:Copy to DWR,CCPCUA
13a Yield(gpm) Method of test Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of FaivQonmental Quality-Division of Water Resources Revised 6-&2018