GW1--03309_Well Construction - GW1_20240603

WELL CONSTRUCTION RECORD(GW-11 For Internal Use Only:
1.Well Contractor Information:
A.C. Schultes of Carolina, Inc. 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
ft. ft.
Jeovany Bautista ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
4125 A FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 40 ft• 16 in. SCH 20 Black Steel
Company Name
p 16.INNER CASING OR TUBING(geothermal closed-loop)
W
2.Well Construction Permit : "'SOOO1074 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) ft. ft. i 1 Se` A 1 1 ('1C117 ED
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ClMunicipal/Public 116 ft• 126 ft. 8 in. .030 304 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 136 ft• 15Io ft• 8 in' .030 304 SS
❑lndustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 95 ft' 100 ft• Bentonite Tremmie
OMonitoring ❑Recovery 95 ft• 0 fc. Slurry Tremmie
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 100 ft. 160 ft. Southern#2 Tremmie
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft.
SEE ATTACHED
4.Date Well(s)Completed: 4/17/24 well ID# 1 ft, ft.
ft. ft.
5a.Well Location:
Bill Clark Homes ft. ft. -
---,
Facility/Owner Name Facility ID#(if applicable) ft. ft.
8650 Sidbury Road, Wilmington ft, ft. - iL l "
Physical Address,City,and/ih ft. ft.
New Hanover 21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:(dwell field,field,one lat/long is sufficient) 22.Certification: a 1�
N W .s: �- J-04k9 f
6.Is(are)the well(s): ItPermanent or ❑Temporary t_o`itar o,.: or Date
By signing this form,I ereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo ISA NCAC 02C.0100 or 15.4 NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the 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 construction info
construction,only 1 GW-1 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: 160 (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)
32.65 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (10 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: 21 (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 over 100,000 GPD:Copy to DWR,CCPCUA
150 24 Pump Test 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 itrZI
A.C.SC Liltes
d
of Carolina
Gerseratlona of Water&Wastewater ioluriens
16. INNER CASING OR TUBING (geothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 116 ft. 8 in. SDR17 CERTA-LOK
126 ft. 136 ft. 8 in. SCH 40 304 SS
156 ft. 160 ft. 8 in. SCH 40 304 SS
20. DRILLING LOG
FROM TO DESCRIPTION
0 ft. 10 ft. SANDY CLAY
10 ft. 20 ft. CLAY&SHELL
20 ft. 30 ft. HARD AT 26' /LIMESTONE
30 ft. 40 ft. HARD/LIMESTONE
40 ft. 50 ft. HARD/LIMESTONE,TRACE OF CLAY
50 ft. 60 ft. HARD 47'-54'/LIMESTONE,TRACE OF CLAY
60 ft. 70 ft. LIMESTONE/SOME SAND STONE,SOME SAND
70 ft. 80 ft. SOFT LAYERS/LIMESTONE&SANDY CLAY
80 ft. 90 ft. SOFT SANDY CLAY/SAND STONE HARD 99'
90 ft. 100 ft. SOFT SANDY CLAY,SAND STONE,TRACE OF SHELL
100 ft. 110 ft. FIRM CLAY,SOME SAND STONE
110 ft. 120 ft. MOSTLY LIMESTONE, SOME CLAY
120 ft. 130 ft. HARD/LIMESTONE"TOOK UP WATER"
130 ft. 140 ft. LIMESTONE"TOOK UP WATER"
140 ft. 150 ft. LIMESTONE
150 ft. 160 ft. LIMESTONE,TRACE OF WHITE CLAY
160 ft. 170 ft. HARD LIMESTONE
354 Sawdust Rd. Rocky Point, NC 28457 Office: [phone] www.acschu!tesnc.com
WATER &WASTEWATER CONSTRUCTION MAINTENANCE REPAIRS IMPROVEMENTS
INSPECTIONS SALES& INSTALLATIONS WELL DRILLING & REHABILITATION
LIFT STATIONS PUMPS& MOTORS VALVES& PIPING EMERGENCIES AND MORE!
1OVER 100 YEARS/