GW1--07211_Well Construction - GW1_20231108

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' WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: '
1.Well Contractor Information:
Connor Cording le
Y ;14.WATER ZONES ' . -.,.,:
Well Contractor Name FROM TO DESCRIPTION
4568 A 202 ft. 212 ft. CAPE FEAR
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased'.wells)OR LINER(if ap licable)
A.C. Schultes of Carolina, Inc. FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 40 it. 10 I !I m• SCH40 PVC.
Company Name
16.1NNER CASING OR TUBING(geothermal closed-loop) _
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0 ft. 202 ft. 4.5 I I in. SDR-17 PVC
3.Well Use(check well use): 212 it217 ft• 4 j I in' SDR-17 PVC
Water Supply Well:
FROM TO DIAMETER , SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 202 ft. 212 ft. 4 in. 1 .20 SCH40 304SS
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. -- ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared)
❑Irrigation ❑Wells>100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 197 ft BENTONITE SLURRY TREMMIE
l Monitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)' ' ' ' ' - • ' _
DAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 197 ft. 220 ft. #2 i. TREMMIE
❑Experimental Technology ❑Subsidence Control ft. ft. i, ,
❑Geothermal(Closed Loop) ❑Tracer .20.DRILLING LOG(attach-additional sheets if necessary)".' ' •
❑Geothermal FROM TO DESCRIPTION(color,hardness,soil/rock type,grain sue,etc.)
(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft
• SEE ATTACHED
4.Date Well(s)Completed: 11/2/23 Well ID# U48V3 ft. ft.
5a.Well Location: ft. ft. I ,-. _ p' i
NCDEQ- DWR ft. ft. ry(y
Facility/Owner Name Facility ID#(if applicable) ft. ft. N O V ) 8 2023
ft. ft. ;
Physical Address,City,and Zip ft. ft. I D,';`�i�;"��^;7
2T.REMARKS ,
Scotland
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
N W �
j /g/
6.Is(are)the well(s): 19Permanent or ❑Temporary Sigmartrfie oti�actor j Date
By signing this form,I hereby certt&that the wells)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or niNo 15A NCAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain'the nature of the 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 construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Ove?in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONSS`
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9.Total well depth below land surface: (ft.) Submit this GW-1 within 30 da s of well corn letionper the following:
For multiple wells list all depths if different(example-3@200'and 2@100') y P
10.Static water level below top of casing: 26 (ft)
24a. For All Wells: Original form .,to Division of Water Resources (DWR),
If water level is above casing,use"+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: (in.) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Mud Rotary i
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 1.0,000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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Formation Description for Well Record
C-1407 NCDENR—Lumber River State Park—U48V3
0-20 Pea Gravel, Coarse Sand
20—30 Coarse Sand,Trace of Clay
30-40 Orange Clay
40—50 Pea Gravel,Sand, Clay
50—60 White Firm Clay/Sand,Trace of Gravel
60—70 Mostly Sand,Trace of Clay
70-80 Firm White Clay,Sand
80—90 Firm White Clay,Some Sand
90—100 Firm White/Red Clay,Some Sand
100—110 Firm White Clay, Sandy Clay
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110-130 Clay/Sand
130—140 White/Red Sandy Clay
140-150 White/Red Clay,Sand,Trace of Gold Sandy Clay
150—160 Mostly Sand,Clay
160—190 Sand/Clay
190—200 Course Sand,Trace of Clay
200—210 Sand/Clay
210—217 Mostly Clay,Trace of Sand
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