GW1--03307_Well Construction - GW1_20230512

I
WELL CONSTRUCTION RECORD Rif timnid Use ONLY: �
This form can be used for single of multipk wells-
1.�V@hl Cautnctar Ittformatiun:
tJ:IVATER_ZONFS
Scott Hunt, Jr FROM - TO bFiCRIMOY
1VellCoiAmclorllnrnc 0 R. 42 ft. sand�wnd water
4561-a (L ft.
NC Well CommcforCer ification Ntnrbcr .11 OUTER CAiSiNG Moi enutIl cis it vWTs1 OR=GiNE7t fle'I6k1:
FROM TO DEA31F,TER TrrlQ:ttNESS MAMIL
SAEDACCO Inc 0 ftw 32 tL 2" id SCH-40 I PVC
Cowp;uty Nana td.INNER CASING OR BINaIgpikrrAil clowd•loo
FROM TO DVO ETER THICKNESS MATERIAL
2,Well Construction Fer•t;Rit R ft, ft,
Lift Oil applfrable wrli penidls(i.r..Cmmry,S1wv.%2 amrr,Ay-drA efr..) -
ft. ft. 1>e
3,Well Use(chcelcwell uNO., t1:SCRIKEN
---. _"— FROM TO� orAlrr6:TF.it srnrS1jW. TrtrCMNFSS
Water Sut►plr W��1L• — srArnRtst,
Clttgzicitlnital: ONfunicipal/Pu lic 32 ft. 42 Q. 2" in. .010 SCH-40 PVC
13Geothertual(1fleating1Cooliog Supply) ®Residential Wirer Supply(single) rL R-
OludustriallCommefcial DResidential Water Supply(shiired) tit.GROUT
FROM TO HATEMI, ENIPLACENHINT WFI110D S AMOUNT
01rd lion - 0 ft. 29 fL Portland Tremie
Non-Water Supply Well: ft. rf� .
pilh9onitoring QRCC* cry
Inject Ion Well: ft. rL
C]Agttifcl-Rcc.barge E713tollmllatcrRcutcdialion IMSANDIGRAVEL PACK(fa tdirable)
FROM TO T MATPIUM, RMPI.A(:F:SrH:VT HtZnOn
CIAgnifcrStorageandRccofcry O&Ilinity13arC1C( 31 R. 43 ft. Filter Sand 1#2.
❑ quifct-Tcst CIStonmsaterQmIffli o ft. ft
I]Expcdmcntae TWIlnotogy C9Sobsidcocc Con rot
1W DRILLING'I.OG(attach additionakhects if acccssan•l
OGeatheniml(Closed Loop) OTracer FROM TO DF,SCRFIMON mbr.t,ardnea enirlrnck tv x'" 'n*e,tie l
Meothenlial(Ileafing[Cooliu Retumi -;]Other(explain under A21 Retnatls) 1 0 [L 43 ft, sand,
fL fL
4.Date Wetl(s)Congllelet& 4-11-23 Well iD#12MW-14R ft.. rL
54,Well LAIC:0011: '� ^,
USCG Base.- Elizabeth City ft. A.
FacilityODwrxr 74am Factlfty ADM(ifapplicablc) A�$ d
1664 Weeksville Rd. Elizabeth,City,'.NC, 27909
Pfryskd Address City,ana zip zt:Rr ntAIeKS
Pasquotank Bentonite seal, from 29-311
County t orec]Id mlifnC rllou No.(PIN)
56.I ititudc and Longitude in degmceslminutestsceonds or dechiml degrees: 22.Certification,
(if trcl!ficord,tare 1,010112,Is Sniiiekod) (�
Ik W �« / 4/21/2023
Sigr>3weaofCcitifictl PicllCont Dale
6.is(dCC)tb@.{YCIIQs)r �PerinaneRt oc 17T@WllOt"IL}'. ( •.fignbtg tirlr form.1 hereby cerfife char the irY11(s9 erne form)cura inrered irr a contan e
id1h 15A NCAC 02C.010)or 15A NCAC 02C.,0200 lVelf Consinoct(ou Srarkiards and Am a
7.Is this a repair to an exhUng well: OYcs or MNo rrlrr gfrhlr woirf has be a PM1,4A.4 ra 04'.brrl Mellen
lfthld is a rs Xrlr,fill neat kalAlli tuff cmism(cftoa hifurmarlon dart explain Me lulrare of rile
relrair aieler921 remarks•nrctian or rm the Lark ofdhrs form_r. 23:Site diagram or additional well devails-
You may use lice back of this page to'provide additional well site details or well
8.Number of{yells cotlsimcced: 1 constiuctiott detaifs. You amy also attach additional pages if necessary.
Fur)il+ltiple 1ri Mom or orut-barer supplrnells ONLY m1rh die s7me eortatrireflon,yblt card
snfntftanejorrn. SUM TPTAE iNS'fLTC'f'iONS
?.Total welt depth below L•Lad surface , 42 24a. Far all Wells:. Submit this farin within 30 days of completion of well
For nralrlpfe;lefts.Mir affdepfhr ltdi/ferem(trample-3@ 00'arks 2@ 1001 con-51mction to lire folloniog:
10.Static water level below(at)of casing: 1 A) Dir•irian of Water Resoumces,tnformatian Prucessiug Unit,
If hitter level&above easfo,mm '+" 1617 NWI Service Center;Ralei*NC 17699-1617
11,Borehole diamctcr.6" tin,) 246.Fur Infect; n'WeIIa ONLY: in addition to sending the fort address in
Ilia addr in
24a abmve.also submit a copy of this fo to within 30 days of completion of well .
12.Well coustmethoumethod:Mud' Rotary constmetionto tile fouavving:
(i.e anger..nAaq,cable.direct paste etc4
Division of Water Resourc@g;Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY' 1636 Mail Service Center,Raleigh,N.C.276"-1636
Mal,Yield Wm) Method of tat:* 24c.For W;rtcr Sup&.Sr Inicetro'a Wclls:
Also subruit one copy of this forth'{t-ithin 30 days of completion of
13b.Disinfection ih p. Amount: well constmetion to[tic county k4alib dcpanment of the county when:
rnnstnrctcd. j
Ferny G{V-L Noah Carolina Depulment of Envirm meta aid Mintral Resources-Division of LVoler Remlraes Revised August 2013