GW1--01463_Well Construction - GW1_20240301

;WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
A.C. Schultes of Carolina, Inc. .14.WATER ZONES - l:. , ..
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
lrvinn Gutierrez-Bautista ft. ft.
NC Well Contractor Certification Number •15.OUTER"CASING,(for multi-cased wells)OR LINER(Willi Lcable):
4504-A FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 40 ft• 16 in* SCH 40 PVC
Company Name 16:INNER CASING OR-TUBING'(geothernial'-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. 93 ft. 6.9 i in' SCH 80 Certa-Lok
3.Well Use(check well use): 93 ft. 178 it 4 1 ]in' SCH 40 304 SS
Water Supply Well: 17:SCREEN
FROM TO DIAMETER' SLOT SIZE _ THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 98 ft. 173 ft. 4 in. .050 304 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. iR'•
❑Industrial/Commercial ❑Residential Water Supply(shared) 1 . . . ,
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft• 83 ft. Cement Slurry 5 CY
ltMonitoring ❑Recovery ft. • ft.
Injection Well: . -
ft. ft. '
❑Aquifer Recharge ❑Groundwater Remediation •19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 88 ft• 180 it. Southern#3 Tremmie
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional'sheets if necessary) - '
OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
ft. it SEE ATTACHED
4.Date Well(s)Completed: 11/7/2023 Well m# DT4R ft. ft.
5a.Well Location: ft. ft.
ONWASA ft. ft. CC
Facility/Owner Name Facility ID#(if applicable) ft. ft. ;•'R:~• .'"•'7 1 t",E
Li
228 Georgetown Road, Jacksonville, NC 28540 ft. ft. MAN Address,City,and Zip ft. ft. I�Iktt 0 1 20Z4
Onslow 21.REMARKS'--
Ilitoin-4- ;tit,
County Parcel Identification No.(PIN) DiOilOj •0,�j
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.CeF�ftc{ttion:
N W 1 J_ 7_207,3
6.Is(are)the well(s): L!lPermanent or ❑Temporary mature of C elf ontractor ate
By signing thi 1 hereb cert({y tha to well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or l No ISA NCAC 02-.0100 or 15 NCAC C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known welt construction information and explain the nature of the of this record has been provi 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 I 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 INSTRUCTIONS
9.Total well depth below land surface: 178 (ft) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3@200'and 2@100')
30.45 24a. For All Wells: Original forin to Division of Water Resources (DWR),
10.Static water level below top of casing: (A") Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing,use•'+"
24b. For Injection Wells: Copy to,DWR,Underground Injection Control(IUC)
11.Borehole diameter: 6'9 (in.)
Program,1636 MSC,Raleigh,NC 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
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing I 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

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OEto aUons of Water_&Wastewater Solutions
ONWASA
WELL: DT4R
Formation Description: Depth from Ground
Fine Sand, Sandy Clay ! 0 10
Firm Gray Clay j 10 40
Clay ; 40 50
Mostly Sand, Trace of Shell and Light Clay ; 50 60
Mostly Shell with Some Clay Trace I 60 70
Mostly Sand and Shell " 70 80
Clay and Shell/ Slow 80 90
Limestone/Trace of Clay/Hard 90 100
Limestone/Hard 100 110
Limestone, Trace of Some Clay 110 120
Limestone/Hard Layers 120 140
Limestone Hard Layers/Trace White Clay I 140 160
Limestone Hard Layers 160 180
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354 Sawdust Rd. Rocky Point, NC 28457 Office: [phone] ww,w.acschu!tesnc.com
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