GW1--05799_Well Construction - GW1_20230901

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4,' .WELL.CONSTRUCTION RECORD " Far latemal Ose ONLY: ',
This form can he used far single ot mania/a wells.
1.WelliContrattor Information:
alfWATER ZONES .., . .
• Scott Hunt', Jr - FROM - :TO DESCRIPTION , • '
Well Contractor Narti4 9 R. 14 ft. whitel iilty sand
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4561-A r.t. ft. I. I
'15.:0131'ER CASING fforitutti=nisettliettsIOR•LINER fife lifabk)
NC Well CannadorCerlification Number
PROM To • • DLOIETER• Inic.t0165 MATERIAL
SAEDACCO ' f•tt ft. • , .1n.: •
• • • •ComanName ICINNER CASING OR RING dosed-loopt..•-.
py . IL
FROM TO ' • DIAMETER. MUCKINESS MATERIAL • . .
2.-Well ConStruttion igrinit io: . .
0 -ft. 4 - It 2 1 • 'int. SCH-4 0 • PVC
List oil aPplieable weir ixiinite(i.e.Cawley.StAy,yariante.Iffect#1,oc.) . „L• .. . ; — . •
3.Wilt Use(Cheek Weil oSe): 172 SCREEN . .
Water Supply Will:,-- . .-. - PROM • TO InAAIETER MATT SIPE TMCKNPS9 1 MATERIAL
4 R. 14- . R. 2 -1114 •.010 SCR-4 0 • I .vd
CiAgiicuittuut . rittpnicipaliPttIgic
lc
CIGeotheimal(likatingiCooling Supply). IResidential Water Supply(single) fr! . .ft. 1
• - •:-IlL GROUT - .
• ClIndustrial/Comntemial CIResidential Water Supply(shared) .FROM• TO. • MATERIAL EMPLACEMENT/1E1110D 6:AmouNT
1:1IrriPallan , • • 0 ft. 3 ft. Portland Poured.
Non-Watcr Supply Well:
ft. ft. . - ,
. IZI'Monitneing . DRccorcry ..
• . - . •
' Injection'Weltr , - .] ft.. • ft.• , . .
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C/AquiferEccharge 173Crotindwater Remediation . ,IESAND/GRAVELPACKlif upplieibtef,
'FROM ' TO • MATERIAL EmPLAcEmEvr mrritOn
• nAtttlifer Wrigi anal 1tOovcry l:ISolinity Vanier 143.5R. 14 ft.' Sand: : #2
• • Cl/aquifer test . 1:1510mi/inter Pratt:age • •
. • 'ft
gem:red:Imolai Technology 0Sobsidoisc Conk& • i . . , . .
Itt DRILLING LOG(Mack additional abeeta if oecessirvi
EIGeolIMMtal(Closed Loop) LlTracer FROM 70 DESCRITTION none.liartfaem.warden ise,Larain tare,dr.)
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13Geothert3al(lleatineCooliug.Return). 1:10iber(explain under#211 Retnatts) • 0 - f•4 3 . ft. concrete fill •
3 ft._ 9 It. silty sand • •
4.Date Weil(s)ccimpleted:.7-21-23 - irirdl ID#10-o 2, .,
9 6.„ 14 - 0., silty sand•ra,„c -14
white t....L..t/ i.,..,
. Sa.W4.41 Location.: • : • ft.,. -:ft.• , .
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SEP q) 1 2023
MCAS Camp.Lej eune ft; : ft..
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Facillly•Owrieriiame' . Facility 1Ltkir aPpikable)
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R. • ft. , Inn Proc-so.rg,s4.2 L Mk
4400 Douglaser.Rd, , Jacksonville, NC, ,28540, . (r.• ilt.• 1. • . - LiVV-1.1/11.1LAzi
149ffical Adttss,citY-an4ZiP 1.1".REMARKS
Ons low Bentonite seal from 3-3.5' .
Caput). . Parcel IdonitiOliot:NO;WI* • ,
. " • •‘ ,
Sk.1.:,alitutleUnd LOrrgittrde in.deptesiminutes/scarnds or decinril dekrecn 2L ca,tirmviion:, ,
(itWelt field,one 1.11,11mg Is sufficient) .
• N . .W c49-5' tt-' yi7uott- . 7./16/2023
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.iallallirobrCOtir.OWell coli :/. tWf
6.is(are)the.well(s): XIPertnanent or. pTemporary ay;signing this foam I hereby eel:*Mai the Begs)sras(stir)ararimered in'accordance.
• 'with ISA NCAC 02C.0100 or ISA NCAc,02C.0200 Well ConstrocilonShuniards and limn a
7.Is this a repair to an edging well: 0Yes .or KIN° .topyahhir record has hei7a provided ta Oki trill'miler.
Odresis a repair,Jill oat ktrthirt Meltemrstruc;loa inicorartrioa and explaht the IlandIe of the • ' , • "• . . I' '-- '
reinzii-inder.921 reinarki'seiiiiin or an rbeinal:of this faint 23.Site diagrain or additional well details:
You May use the back of-this page to provide additional well site details or well
.
S.Numberof wells constmeted:1 • ' -
• - construction details.. You May alio dtiach additional Pages if mass*.
Poe maid*lideerhyi-or awi-!eatersuppireel,Lt ayLirridi the sahie constrirition, an can - __,__. ___ ,•
siMmiram,form. SuBbfriTAIL,INSTUCtiONS
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9.Total well deeithtelow.land surface: 14 (no -SIM.Prir All Wells:- Submit this,firm within 30 days of completion of well
For multiple was list off treptbs if diflinenr fexaMOfer-3@200'mil 2@ ietTy construction to the following: I
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10.Static water level below top of casinw.5 . (it.) Div4inn of Water Resourtei,firforniatioriPinicesOng Unit,
filmier!arils above maw;ate"+" . 1617 Mail ServieeICentei,Rale10,NC 27699-1617
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ILL.Borehole diameter:6" (in.) ' 2-1b.For Infection'Well‘ONLY: .ht addition to sending the form to the address in
244 above,also submit a,copy Of this fonn within 30 days-of completion of well
12.Well construction method: sonic - construction to the following: I I
lie.Mgr..raw,cable.dimet Push.M.) :
• • Division of Water ResoureeS,411nderground injection Content
. Program,
FOR WATER SUPPLY WELLS ONLY:' 1636 Mail Serviee'Center,Raleigh,NC 27699-1636
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-tic.For.Water Supply&Injection Welts:
pa,Vidd(gip!) Method of test ,
Also subMit one copy of this Or&.Withiti 30 days of completion of
113h7 Disinfection . .n Wu::.. .„ Amount: - • well construction tO the county 11.4•1011h department of the conoty.whem
constrotted. I
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Farm GW-t North Catalina Dzpartntem of Emiconmetu and Natural Resources-1)ivisionefWaterE1Mcarces Revised August 2'013
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