GW1--00876_Well Construction - GW1_20240205

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Frank Beecher 14.WATER ZONES .
Well Contractor Name FROM TO DESCRIPTION
3225-A 6.0 ft• unk ft•
ft. ft. I 1
I
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Aecom Technical Services of North Carolina, Inc. FROM TO DIAMETER 1 THICKNESS MATERIAL
ft. ft. I in`.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#:N/A FROM TO DIAMETER ' THICKNESS MATERIAL
List all applicable well construction permits(i.e.IBC,County,State,Variance,etc.) 0.0 ft• 3.6 ft. 2 ; in. sch 40 pvc
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3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural 0Municipal/Public 3.6 ft. 8.6 ft. 2 in. 0.010 sch 40 pvc
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) fn ft. in.
Industrial/Commercial D Residential Water Supply(shared) 18.GROUT
Irrigation FROM . TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: _ 0.0 ft• 1.0 ft• quikrete by hand
X Monitoring QRecovery ft. . ft. -- -_
injection Well: ft. ft.
Aquifer Recharge DGroundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery 0Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test I0Stormwater Drainage 2.0 ft. 8.6 ft• #2 drillers sand by hand
Experimental Technology DSubsidence Control 1.0 ft. 2.0 ft. holeplug by hand
Geothermal(Closed Loop) DTracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness;soiVrock type,grain sire,etc.)
Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks)
0.0 ft- 1.0 ft• loose grey/orange sand
4.Date Well(s)Completed:1.26.2024 Well ID#MW-1 R to ft. 3,0 ft. orange red clayey sand
5a.Well Location: 3.0 ft. 6.0 ft grey/;redish clay
Speedway 6992 00-0-0000011818 6.0 ft• 8.6 ft• grey and
Facility/Owner Name Facility ID#(if applicable) ft. ft. r n 7,�:n ti-. ,5 r , 1
101 South Eastern Blvd, Fayetteville, 28301 ft. ft. t 6.,%.,°'g.�,i ' a
Physical Address,City,and Zip ft. ft. i I-CD 0 e024
Cumberland 0447024246000 21.REMARKS
County Parcel Identification No.(PIN) Inforr,: =?'•z n Pri t-.7.ga ng ufi'A
i.k N ls:i_i J41
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one 1at/long is sufficient) 22.Certification:
35.0471155 N -78.8649762 �, -)
� e 1.31.2024
6.Is(are)the well(s)JPermanent or [jTemporary Signature of Certified Well Contractor Date
By signing this form,I hereby certify that the_well(s)-was.(were)constructed in accordance
7.Is this a repair to an existing well: QYes or Xl No with 15A NCAC 02C.0100 or 15A NCAC 02C.020(1 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: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 8.60 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdii different(example-3@200'and 2@100) construction to the following: 6
10.Static water level below top of casing:6.01 (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:2 (in.) 24b.For injection Wells: In addition to sending the form to the address in 24a
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.c.auger,rotary,cable,direct push,etc.)
i
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service;Center,Raleigh,NC 27699-1636
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 the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016