GW1--03309_Well Construction - GW1_20230512

-WELL CONST 2UCPION RECORD FIN ivtamalUseONLY:
This form can be used for single or multiple%sc[!s
I.IVL41 Contractor hiformatiou:
14.
Scott Hunt, Jr F14051 TO D6_SCRrP"ON
WolCormnctorNamc 0 ft. 30 ft, water and sand
4561-A fL f4
NC Well ComtaciorCenificationNuniier �`tS.OUTEfi.CASiNGtfoi,kuftliikdisclls ORLiNERtIf'a'� ia66el'.
FROMTO DIAMETER TfnCh'�iE1I MATERIAL
SAEDACCO Inc 0 fL 1 25 ft. 1 2" in. SCH-40 PVC
Cenelm:ug•NAutc 1G INNER'CASING.OR TUBING eotYermat t:Wsed-lon '•FROM TO D1A11iETER THICKNESS I MATERML
2.Well Construction Permit#: R, rt. 10L
!rua11 nlry,tiCablc tsell perrieitl(i_k.Cou„ry.5'14nr.,:Vadaurr.1j8:dC4 er'.)
ft. ft.' in
3.Well Use(ehcckwell It [7 SCREEN
_- - -- . . -_- -- -- FROM � To PtASrF.TFR SiOTSM. THF"NESS
WaterBupptt Well:
Clttg[iculntrai gtMlunicipaliFublic 25 R. 30 R. 2" in 010 SCH-40 Pvc
®Geothermal(Heado 'Coolie Supply) OResidendal Water Su rL fL !0'
IY g uFF pply(single}
®industdaUCornnicicial l311csWntial Water Suppb-(shared) 1e:GROUT '
FROM TO MATHR1nI EMPLACENHIM METHOD&ATUOUNT
Olrri ation 0 ft. 22 fL Portland Tremie
Norm-Water Supply Well: � t�
i8llYlanitaring (7Rccavmry
Injection Well:
t7AquKer13cc4arre OGroundmacrRcntsdiation M'SANDIGRAVELVAC[{(if rdlcabf�y.
- arn'rKRrar. EtNiPI tC:F:tira:NTN9t:rlrOn
ElAquit'cr-StoragcandRccovciy Q.5alinityHamer FROM To24 ft. 31 ft.' Filter Sand #2
QArlu cr Orainaq;
❑Experimental Techriolou l:1 CSrtbsidencc 1*0 re. ft.
/I07DRILLIING,LOG%attach addifonal.sliccta if'neccsmn't
OGeodleniud(Closed Loop) . ❑Tracer FRONT To DF-iCDm ON*oow.Gardno+a wa;'mckt n iir tell
OGeodiennal(IieatinglCooling Return} OOdier(e.Viairt mtder#2!Retuar&s) 0 ft: 30 ft,. sand.
tL rt N r V i. .
4.Date NWI(s)Completed: 4-12-23 Wcll[Dd12MW-23R 1L f4
SA:Well Location: ft. fL V
USCG Base.- Elizabeth City (t: fL i11E{rkrw-, M41 „r�f^Y9 r;�. lJry��
Facililyffiwopr Name Fatuity IDk(i�applicablc) R. ft, ®� i
1664 Weeksville Rd. Elizabeth City, NC, 27909 rt. ft.
Pltr'sical Addresk City.and Zip .2 L REMAfi1:S-
Pasquotank - Bentonite seal from 22-24'
Quail), Mrcel htoilific10011 No.(PIN)
5h,Iu tngitdc i 9cgiem onds or decimal degrees,_ u ee 22:Ccrtificatiteu:
(If rrcil field,olme 1.010mg is"'Idlici=rmt)
N W ��'� � 4/21/2023
Sigmtsire afCorttiled Well Co_ tar Date
6.is(are)the-well(sy: EPer Manent or OTempormry. . 1�,sfgning 1hir.nrm,i turreby cer1t t rlmar the well Y nmy %r.nj e a inrefed is'atxvrdanne
ivirh I SA NC,tC 02C.0100 ar 11%NCAC 02C.0200 Ifni!C6nstrrrcriar Srtrn cards and Mar a
7.Lc this a riepair to an existing vve11: ®Ycx or ®No rgrr njrhir record!mess Derr f,mr';r&'d rn 1IA%n Ji mcncm
if rh(sIs a repair.fill rsmrkaouvr tvellCmimn.(.Moa hrjarularlOrtand explahr the rarrure of rife
rrryQirumler$31 rrrnarfY xretiuia ar at the bark ojthir jnmr 23.Site diltgram or additional well delaits:
You tray use the back of this page to provide additional well site details or%velt
13.Numberof wells constructed: 1 consituction deiaits: You w4v also,atiach additional pages if nei;essary.
For souldple.iizjecdo,r:or ami-ir rer supply wells O,VLY ulth the saeteconswi4tiorr,you can
.ralunironc form. SUBMITTAL RVSTIIM&S
i
0.Total well depth hetmT laird surfac.: 30 ({y;) 2da. Ear All Wells: Suhirtil this form within 30 days of conviction of I'Vell
For mnmrhlple wells list atltteprhs if daveeov(extunple-3@200'euu!2491NVy con54mctipa to Cite foltoRing:
10.Stabs water level below lop of casing: l ([1,) Div'iNinu of Water Resaurces,Information Prueessing Unit,
!f uxrler level is shave ruabtg,asr"+" 1617 Mail Service Center,RAlctg e,VC 27699-I617
11..Borchotc diameter.6 OIL) 24b.For Dij�llan Aglly ONLY: in addition to sending the farm to the.address in
24dabove.also submit a copy,of this fotul within 30.days of completion of well
1.2.Well construction method:Mud Rotary consimctiouto tile following:
(Lc.augcr..rotary,cables direct paste coca
Ilivision of Water Resources,Underground fujecilon Control Prograin.
FOR WATER SUPPLY WELLS ONLY, i636 Mall Service Center,Raleigh,YC 27699-1636
13a.Yield(Rpm) Method of test: 24c.For.Watcr Supply&'Injection Wells:
Also submit one copy of this faim,within 30 days of completion of
13b.Dkinfection jh pt: Amount: %veil consaroction to the county health department or(tic counly whcM
constructed.
Fort GS<'-L Monh Caraltna Mpauntem of Endrottnrtm and;Natural Resources-Divi ion of Water Rmptl m Revised Atgtat 1t11.1