GW1-2023-00355_Well Construction - GW1_20230124

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NORTH CAROLINA
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WELL CONSTRUCTION RECORD (GW-1 )
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Form GW-1 Well Construction Electronic Form
North Carolina Department of Environmental Quality
Division of Water Resources
November1
Submission ID#
G W 1-2023-00355
Are you submitting a scanned form?* Yes
No
CONTACT INFORMATION
.......................................................................................................................
Contact Name* Email Address*
Travis Frazier [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:
Certiticate# Cert Level First Name Last Name Company Name
2610 A BOBBY ALLRED, II Charles R. Underwood Inc
2.Well Construction Permit#:
21-00786
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.Water Supply Well* Geothermal (Heating/Cooling Supply) Industrial/Commercial
Irrigation Municipal/Public/Community
Residential Water Supply(single) Residential Water Supply(shared)
Wells> 100,000 GPD
4.Date well was completed and ID#
Date Well Completed* Well ID# Well Yield

1/6/2023 15 400
(gallons per minute)"
5.Well Location
Facility/Owner Name* Facility ID#
Cape Fear Public Utility Authority NC0465232
(Required) (If applicable)
County* Parcel Identification No.(PIN)
New Hanover
Physical Address* Street Address
7543 Elkmont Ct
Address Line 2
City State/Province/Region
Wilmington NC
Postal/Zip Code Country
28411 US
Latitude* 34.2815506000 Longitude*-77.8113197000
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:
9.Total well depth below land surface: (ft.)
180 9a.What is the depth of the casing from ground
surface?
For multiple wells list all depths if different
(example-3@200'and 2@100') in feet
10.Static water level below top of casing: (ft.)
48 11.Borehole diameter:
If water level is above casing,use"+" in inches
12.Well construction method:
Auger Air Rotary Cable Tool
Direct Push Mud Rotary Rotosonic
Other
N/A
13. FOR WATER SUPPLY WELLS ONLY:
13a.Yield(gpm)
400 13a.Method of test:
If applicable Pump Test
13b. Disinfection type:* 13b.Amount:*
HTH 9 oz

14.WATER BEARING/FRACTURE ZONES
...............................................
From To Description
140 180
in feet in feet
15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
From To Diameter Thickness Material
2.00 -140.00 8.00 SCH 10 Stainless Steel
in feet in feet in inches
17.SCREEN
From To Diameter Thickness Material
140.00 180.00 8.00 SCH 40 Stainless Steel
in feet in feet in inches
18.GROUT
From To Material Emplacment Method&Amount
0.00 3.00 Neat Cement Pour
in feet in feet
3.00 20.00 Bentonite Grout Tremie/Pump
in feet in feet
19. SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
20.00 185.00 #3 Well Gravel Tremie
in feet in feet
20. DRILLING LOG
From To Description(color, hardness,soil/rock type,grain size,etc.)
in feet in feet
21. Remarks
Installed a stainless steel liner with stainless steel screens inside the existing open hole well that was cased with 12-inch
carbon steel pipe down to 140-feet.
22.Site diagram or additional well details:
You may upload additional well construction information here.
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
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Signature of Certified Well Contractor