GW1--06931_Well Construction - GW1_20231027

• WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1 .1....7.
1.Well Contractor Information:
Redox Tech, LLC 14.WATER ZONES I ! _ - -
Well Contractor Name FROM TO DESCRIPTION
3516-A • ft. ft.
ft. ft. 1.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Redox Tech, LLC FROM TO DIAMETER 1 THICKNESS MATERIAL
ft. ft. i in.
Company Name
Redox Tech, LLC 16.INNER CASING OR TUBING(geothermal closed-loop) • -�
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U1C,County,State,Variance,etc.) ft. ft. + in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN.
FROM _ TO DIAMETER SLOT SIZE ' THICKNESS MATERIAL
Agricultural DMunicipal/Public 0 ft• ft. in. '
QGeothermal(Heating/Cooling Supply) IDResidential Water Supply(single) ft. ft. in.
Dlndustrial/Commercial OResidential Water Supply(shared) 18.GROUT -i .
•
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT_'
Non-Water Supply Well: • ft. ft.
.• fMonitoring DRecovery ft. ft.
Injection Well: ft. ft. .
Aquifer Recharge Eil Groundwater Remediation ' '
19.SAND/GRAVEL PACK(if applicable)
cilAquifeI Storage and Recovery Salinity Barrier FROM . TO , MATERIAL EMPLACEMENTMETHOD
• E3Aquifer Test 0Stormwater Drainage ft. ft.
DExperimental Technology 0Subsidence Control ft. ft. . I '
)Geothermal(Closed Loop) OITracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain sire,etc.)_
OGeothermal(Heating/Cooling Return) [Other(explain under#21 Remarks) •
ft. ft.
4.Date Well(s)Completed:10/5/23 Well ID#IP 1 through IP-7 ft. ft.
•
5a.Well Location: ft. ft.
Daikin Applied Americas, Inc NCD 057 451 270 ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. • ft. I
i _
602 Sunnyvale Drive Wilmington, NC 28412 ft. ft. r , :; .;. ii ;-
Physical Address,City,and Zip ft. ft. R
• New Hanover 28412 21.REMARKS OCT 7 2023
County Parcel Identification No.(PIN) !DI,-rT^-c- =L
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
D:, � 3
(if well field,one lat/long is sufficient) 22.Certification:
34.176774 N -77.935281 W
�1,' • 10/23/23
6.Is(are)the well(s)DIPermanent or x3Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby certifi,that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: ®Yes or }No with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If•this is a repair,fill out known well construction information and explain the nature of the copy 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 Wells having the same You may use the back of this page to provide additional well site details or well
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells ,construction details. You may also attach additional pages if necessary.
•- drilled:7 SUBMITTAL INSTRUCTIONS
1@15',1@28•,1@25•,1@2n',1@22•,1@24•,1@35' i
9.Total well depth below land surface: (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdifferent(example-3@200'and 2@100') construction to the following:
10.Static water level below top of casing:N/A (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
I
11.Borehole diameter: 1.5 (in.) 24b.For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: DPT construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
l '
13a:Yield(gpm) Method of test: 24c.For Water Supply&Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to tie bounty health department of the county
where constructed. I
i
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources 1 • • Revised 2-22-2016

•
North Carolina Department of Environmental Quality—Division tof Water Resources
INJECTION EVENT RECORD (IER)
Permit Number WI0800556
If yes,please provide the following information:
1. Permit Information
Number of Monitoring Wells:N/A
Daikin Applied Americas,Inc.
Permittee Number of Injection Wells:N/A
•
Former Heatcraft Remediation Site Please include a copy of the GW-30 for each well
Facility Name ' abandoned.
• 602 Sunnyvale Drive; Wilmington,28412 4. Injectant Information
New Hanover
Facility Address(include County) Emulsified Vegetable Oil [EVO];Zero Valient Iron
• [ZVI]; approved potable water;gargum [thickening
2. Injection Contractor Information agent] i \
Injectant(s)Type 'AEC.+ (6Yo 'd I
Redox Tech LLC
200 Quade Drive Concentration: 21bs A-6 C per »°`� D�
� u�'d-}c,
Cary, NC 27513 NJ
919-678-0140 If the injectant is diluted please indicate the source
dilution fluid. DWR Approved potable water, Lower
Cape Fear Public Utility.
3. Well Information •
Total Volume Injected(gal) 3 0 0 D
Number of wells used for injection 7 i o,r,sect i t�'
Volume Injected per well (gal) v
y �,r�p L i
Well IDs;N/A Direct Push Method � L9d et Q
5. Injection History •
Were any new wells installed during this injection I i
event? Injection date(s): 10-3 to 10-5-2023
❑ Yes X0 No
/ Injection number(e.g. 3 of 5): 1 of 1
If yes,please provide the following information:
Is this the last injection at this site?
Number of Monitoring Wells 0 CI Yes X,® No
Number of Injection Wells: 7 I DO HEREBY CERTIFY THAT ALL THE
Type of Well Installed (Check applicable type):
INFORMATION ON THIS FORM IS CORRECT TO
El Bored El Drilled XQ'. Direct-Push THE BEST OF MY KNOWLEDGE AND THAT THE
❑ Hand-Augured ❑ Other(specify) INJECTION WAS PERFORMED WITHIN THE
STANDARDS L D OIUT IN THE PERMIT.
Please include a copy of the GW-1 form for each /o/a 3/Z 3
well installed. IG A URE OF INJECTION•CONTRACTOR DATE }'
jvo,../ an►c ) elv.
Were any wells abandoned during this injection PRINT NAME OF PERSONIPERFORMING THE INJECTION
event?
❑ Yes X❑ No
•
Submit the original of this form to the Division of Water Resources within 30 days of injection. Form UIC-IER
Attn:UIC Program, 1636 Mail Service Center,Raleigh,NC 27699-1636, Phone No.919-807-6464 Rev.3-1-2016

. , .
| : ,
\-.-...a‘
‘..
. e , .
§ { & ( 7
; . cam ;
\ k//
f } .
7
. ■ • � �� ��
F . ° <� .
� _
!�
m o*) i A
V. N&! / 1
00Q• . '/ • 1 § \0044101k
', 1
q ! .
o
§ § / §
! ! g 2•
eW4i {
§ '
E § § ( /dit
` § .
^ . in
ei
, A 1 ' \ / e >P: .
ei )
) /
P
4
\x
zli, K . . g «
. \ * .
§
i
0
4:-f214:....
� .
I : � .
9fIi . .
� hill".
� � �19 ' , �
! 2¥ ! f(
. \
E `8
7-,
. § 2 ,
)
- 7
/ / n
;d! ` \
§ ) kdm§2 0
2 § § 0;0 . . ,
Sgli 5' ; \
/ D' -g< . ) 1 ,
2 § ( |
_ | / ' c
WO A.....,
!o i ) %
j / ' b
. I
1
'EV. DATE COMMENT 1 ' .
. 5-23-22 To scale building base map;UIC proposed bore locations U
��j �a�VBcw�. 1 _� _*_ ma _ C%rlg2mSe
mom m___ ,Oct2
, 'INJECTION LOCA eon
� oco�m2
FIGURE VERIFY SCALES:
w " BM " o<Nemma�7%I�
; op m f 120/ .
• I wemm%&
9CANDLESTICK;GARLAND,TX . APPROXIMATESCALE CII �\ cDAA m�2 ecP
I :