GW1--07335_Well Construction - GW1_20231113

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WELL CONSTRUCTION RECORD(GW-11 For Internal Use Only:
�\ 1.Well Contractor Information:
William Matthew Wiggins 14.WATERZONES' . . ! "' '
Well Contractor Name FROM TO DESCRIPTION
(NCWC) 3470-A ft. ft. 1 1
ft. ft. 1 1
NC Well Contractor Certification Number Inc15.OUTER CASING(for multi-casediwells)OR LINER(if ap licable)
Mid-Atlantic Drilling, c FROM TO DIAML1•BRi THICKNESS MATERIAL
Company Name 0 ft. 32 ft. 4 in. SCH 40 PVC
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.UIC.County,State,Variance,etc.) 0 ft• 37 ft• 2 , 1D• Sch 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: '17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural DMunicipal/Public 32 ft. 37 ft. 2 in•I .010 Sch 40 PVC
Geothermal(Heating/Cooling Supply) QResidential Water Supply(single) ft. ft. in.!. '
Industrial/Commercial DResidential Water Supply(shared) ,18.GROUT i ; '
Irrigation FROM , TO MATERIAL I EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 30 ft. Cement/Bentonite Mix Hand pour(outer casing)
x Monitoring DRecovery ft. ft. Cement/Bentonite Mix Hand pour(inner casing)
Injection Well:
-, ft. ft.
Aquifer Recharge 0 Groundwater Remediation - - -
19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test DStormwater Drainage 37 ft. 32 ft. #2 Filter Sand Hand pour
Experimental Technology OSubsidence Control ft. ft.
Geothermal(Closed Loop) OTracer 20.DRILLING.LOG(attach additional sheets if necessary)
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
0 ft. 26 ft• sand
4.Date Well(s)Completed:9/05/2023 Well m#DMW-1 26 ft. 37 ft• limestone
5a.Well Location: • ft. ft.
SOCOL LLC ft. ft. • _
Facility/Owner Name - Facility ID#(if applicable) ft. ft. ,,,,e,•+i._„i a.; ;1.,..,,u"
7617 Carolina Beach RD Wilmington NC ft. ft. NOV 1 4- 7073
Physical Address,City,and Zip ft. ft.
New Hanover R08514-003-005-001 21.REMARKS • lr� :' - `- •'
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:
34 .064845, N -77.897756 W JA.kjAANI li(J 9/26/2023
Si ture of Certified Well Contractor Date
6.Is(are)the well(s)Jii Permanent or l jTemporary g0°
By signing this form,I hereby certifythat the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: DYes. or EI1No __ 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 hack 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: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 37 ft (ft) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@.200'and 2@100) construction to the following: 1
10.Static water level below top of casing: (ft) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter:8 1/4 (in.) 24b.For Infection Wells: In addition to sending the form to the address in 24a
Hollow Stem Auger above,also submit one copy of this,form within 30 days of completion of well
12.Well construction method: 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
i , •
13a.Yield(gpm) Method of test: 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) above, also subniit:one copy of this form within 30 days of
13b.Disinfection type: " Amount: completion of well construction to the county health department of the county
where constructed. I 1
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016