GW1--07392_Well Construction - GW1_20231117

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
William J. Miller 14.WATER'ZONES .
Well Contractor Name I
FROM TO DESCRIPTION
ft. ft.
2927A
ft. ft. I '
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Catlin Engineers and Scientists FROM TO DIAMETER THICKNESS 1 MATERIAL
ft. ft. I in.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit# NA FROM : TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,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 Municipal/Public 5.0 ft• 15.0 ft• 1 in' 0.01
Geothermal(Heating/Cooling Supply) E Residential Water Supply(single) ft. ft. in.
Industrial/Commercial 'Residential Water Supply(shared) 18.GROUT
- Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
x Monitoring DRecovery ft. ft.
Injection Well:
ft. ft.
Aquifer Recharge 0Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
•
Aquifer Storage and Recovery DSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test QlStormwater Drainage 2.00 ft• 15.0 ft• Gravel Pack
Experimental Technology E Subsidence Control ft. ft.
Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,sot Frock type,grain size,etc.)
Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks)
0.0 ft• 0.10 ft• Top Soil, Organics, Dry
4,Date Well(s)Completed:02/16/2023Well ID#2637-TW01 0.10 ft• 4.0 il• Brown, dry, Clayey Sand,trace organics
5a.Well Location: 4.0 et' 8.0 ft. Tan/Orange, moist, Poorly Graded Sand
Camp Lejeune 8.0 ft• 9.0 ft• Tan/Orange, moist, Poorly Graded Sand
Facility/OwnerName . Facility ID#(if applicable) 9.0 ft• 10.50 ft• Tan/Orange, moist, Gravely Sand
Bid 2637, Camp Lejeune, Jacksonville, NC 10dit• 12fi ft. Gray/Tan, moist, Clayey Sand
Physical Address,City,and Zip 12.0 ft• 16.0 ft• Gray,saturated, Poorly Graded Sand
NA fi,,, ,/.441 21.REMARKS
County Parcel Identification No.(PIN) r's'% j... 'I'L^-•r
is
+ .c,:7 LYE i+ v41 ii.,,tS,..,‘
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (�
(if well field,one lat/long is sufficient) 22.Certification: NO� 1 1 2�23
34.7063° N -77.3782° W ��G
,- 1Jt i/7/2023
6.Is(are)the well(s)jPermanent or IX Temporary Signature of Certified Well Contractor 1 ,'._°La` Date
g l/`.;
By signing this form,I hereby cert fy that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: EjYes or 0No with ISA NCAC 02C.0/00 or ISA NCAC 02C.0200 Well Construction Standards and that a
flans 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 1'21 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:t SUBMITTAL INSTRUCTIONS ,
9.Total well depth below land surface: 17.25M.) 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@l00') 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
I
11.Borehole diameter: 1•0 in.
(• ) 24b.For Iniection Wells: In addition to sending the form to the address in 24a
DPT 9600 Power Probe above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following: I
(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 submit'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.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources i Revised 2-22-2016