GW1--01462_Well Construction - GW1_20240301

`'WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
A.C. Schultes of Carolina, Inc. 14.WATERZONEs
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
lrvinn Gutierrez-Bautista ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi=cased wells)OR LINER(if ap licable)
4504-A FROM TO DIAMETER THICKNESS MATERIAL
0 ft• 40 ft. 16 ' in' SCH 40 PVC
Company Name
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. 95 ft. 6.9 , in' SCH 80 Certa-Lok
3.Well Use(check well use): 95 ft• 180 ft• 4 in' SCH 40 304 SS
Water Supply Well: •-17..SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 100 ft 175 ft. 4 in'' .050 304 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 1 ft. ft. int
❑Industrial/Commercial ❑Residential Water Supply(shared) „18.GROUT .
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 90 ft. Cement Slurry 5 CY
I1Monitoring ❑Recovery ft. ft.
Injection Well: -- -
ft. ft.
❑Aquifer Recharge ❑Groundwater Retnediation
•19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 90 ft• 183 ft• Southern#3 Tremmie
❑Experimental Technology ❑Subsidence Control ft. ft. .
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary) I .
❑Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
ft. ft. SEE ATTACHED
4.Date Well(s)Completed: 10/18/2023 Well ID# DT1 2 ft. ft.
5a.Well Location: ft. ft.
ONWASA ft. ft. t~ Ns..
Facility/Owner Name Facility ID#(if applicable) ft. ft. 8 rw 3if 1
228 Georgetown Road, Jacksonville, NC 28540 ft. ft. MAC
Physical Address,City,and Zip ft. ft. I 1 �(�(�(�
Onslow `21:REMARKS' rtr(tii`i'l" rem pe....
. ,-1 .
County Parcel Identification No.(PIN) Dtoicy3-00
• 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) . 22.Cer rcation:
N W . l"ahee S
• lure of i ed ke Date
6.Is(are)the well(s): l lPermanent or ❑Temporary i '
.y signing thi, arm,I ereby cert&that the well(s)was(were)constricted in accordance with
7.Is this a repair to an existing well: ❑Yes or 8No 15A NCAC 0 .01 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well constriction information and explain the nature of the of this record een provided to the well owner.
repair under#21 remarks section or on the back of this fonn. - -
23.Site diagram or additional well.details:
You may use the back of this page to provide additional well construction info
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 180 (ft.) 4
For multiple wells list all depths if different(example-3@200'and 2@I00') Submit this GW-1 within 30 days of well completion per the following:
34 24a. For All Wells: Original folnn1 to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing,use"+"
11.Borehole diameter: 6'9 (in.) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC I'27699-1636
12.Well construction method: Rotary 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
I '
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh;NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount: '
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

Est.1021
ANC Sc ultes
r
1�.s
H of Carolina
Qe;norations of Water&%Vastewator Solutions
I
ONWASA
WELL: DT12
Formation Description: Depth from Ground
Soft/Fine Sand/ Sandy Clay 0 10
Brown Sandy Clay/Trace of Grey Clay 10 20
Soft Grey Clay/ Sand 20 30
Firm Clay 30 40
Soft Grey Clay/Fine Sand 40 50
Coarse Sand/Shale/Trace of Clay - 50 60
Mostly Shell/Sand/Trace of Clay 60 90
Limestone/ Shell /Trace of Clay Hard 90 100
Limestone/Trace of Shell 100 110
Limestone, Very Hard 110 120
Limestone, Hard& Soft Layers 120 130
Limestone,Hard 130 160
Limestone, Soft 1 160 170
Limestone, Hard& Soft Layers j
170 180
354 Sawdust Rd.Rocky Point, NC 28457 Office: [phone] www.acschu!tesnc.com
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