GW1--04035_Well Construction - GW1_20240708

• WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
14.WATER ZONES
Eddie Swain FROM TO I/I`,(RIPHON
Well Contractor Name ft ft.
4632B ft. rt.
NC Well Contractor Certification Number 15.INNER CASING':1*MB NG(y tOthermal dosed-loop)
I Romt 1O DIAML IER I 1ICkNESS NI TERIAL
CATLIN Engineers and Scientists 0 ft. 5 rt. 2 in. Sch. 40 PVC
Company Name 16,OUTER CASING(for mntti-cased v.cik)OR LINER(if appticabte)
1-ROAt 10 1)1 U11 I I R I III5 I,AI„ AI 1II RI NI
2.Well Construction Permit#: N/A ft. ft. Is
List all applicable well permits(i.e.County,Slate, Variance,Injection,etc.)
-
ft. ft. In.
3.Well Use(check well use): -
17.SCREEN
Water Supply Well: I'ROA1 10 DI AVII.IIR ,Lt1I,IL1- IIII!CVI vV V1.AI I-RLAI.
❑Agricultural ❑Municipal/Public 5 rt. 15 ft. 2 in. Slot.010 SCh.40 PVC
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ft. It in.
❑Industrial/Commercial 0 Residential Water Supply(shared) 1skt"3Y': i'
FROM i10 I NI:AIIIIIAI 1 A11'I.\(t\IIAI All 11101)6.. VA 101A1
0 Irrigation Oft. 1 ft. Portland cement Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 1 a. 4 rt. Bent. Pellets Surface Pour
Injection Well: ft. It.
❑Aquifer Recharge DGroundwater Remediation I3 hi*(Ifs
❑Aquifer Storage and Recovery D Salinity Barnet FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 4 it. 15 it. #2 Medium Sand Surface Pour
❑Experimental Technology 0 Subsidence Control a. It.
ttiO lii tine .ii iiii
0 Geothermal(Closed Loop) 0 Tracer FROM TO DESCRIPTION(color.hardness,soil/rock type gram sae,etc)
0 Geothermal(Heating/Cooling Return) 0 Other(explain under#21 Remarks) ft. rt.
4.Date Well(s)Completed: 05/29/24 Well ID#: MW-03 e. R. ii t1. ft. S ktot)
r
5a.Well Location: DEQ SLP -Wananish pg,
t.
NCDEQ Store rt.
ft. 11 • IED
Facility/Owner Name Facility iD#(if applicable) P.:
1,.��, 4 t
ft.
1306 Sam Potts Hwy,Lake Waccamaw,North Carolina 28450
Physical Address..City,and Zip rt r -
21.REMARKS
COLUMBUS
County Parcel Identification No.(PIN) D'h 14 3`
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: '!
(if well field,one la/long is sufficient)
34.32210656 N -78.50005482 w ,'1 2 4`, u: �.= ,e 7/02/2024
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or 0 Temporary By signing this.form,I hereby certify that the well(s)was(were)constructed in accordance with
i SA NCAC 02C.0100 or 1 SA NCAC 02C.0200 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: D 1'es or No this record has been provided to the we!!owmer.
If this is a repair,fill out known well construction information and explain the nature of
the repair under#21 remarks section or on the back of this form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple infection or non-water supply wells ONLY with the same construction,you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 15.0 (ft.) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths in different(example-3@200'and 2@1002 construction to the following:
10.Static water level below top of casing: 7.6 (ft,) Division of Water Resources,information Processing Unit,
If wafer level is above casrng, use" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 4.25 (in.) 24b.For Injection Wells ONLY: In addition to sending the form to the
address in 24a above,also submit a copy of this form within 30 days of
12.Well construction method: HSA completion of well construction to the following:
(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
13a. "field(gum) Method of test: 24c.For Water Supply&Injection Wells:
Also submit one copy of this form within 30 days of completion of well
13b.Disinfection type: Amount: construction to the county health department of the county where constructed.
Adapted from Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

ENVIRONMENTAL,CIVIL CATLIN
' WELL I_OG GEOTECHNICTL
Wlmington,Raleigh.Washington.
Charleston Engineers and Scientists
221070.04 SHEET 1 OF 1
PROJECT NO.: 221070.04 STATE:NC COUNTY: COLUMBUS LOCATION: Lake Waccamaw
PROJECT: DEQ SLP - Wananish Store LOGGED BY: Ashley Jessen WELL ID:
DRILLER: Eddie Swain MW-O3
NORTHING: 34 EASTING: -79 CREW: Andrew Dunivan
SYSTEM: NCSP NAD 83 (ft) DRILL MACHINE: CAT1303 CME-550 93% 03/05/2024 T.O.C.ELEV.:
VERT.DATUM: NAVD88 (USft) METHOD: HSA 0 HOUR DTW: 8.4 TOTAL DEPTH: 15.0
START DATE: 5/29/24 END DATE: 5/29/24 24 HOUR DTW: 7.6 WELL DEPTH: 15.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) S G DEPTH DESCRIPTION DETAIL
0.0 Land Surface o.o
0.0 IiNh (SM)-Orange-brown to light gray,Silty,medium to 0.0 'A•
- x
1 2 .,, :' fine SAND. : 0
•
- 2 0.0 D ••r..� -
_ - o
- .(•S. - to
'.' iv +
- sr.•... - ;,;,
' 4.0
5.0 _ 5.0
— 1 32.4 D ' —
>: _ ,;
— ;ti — -;.
- im:.:
err — oV
10.0 — ' �' r o
�,.. !n
WOH ;•':V . iv rn
- ' 2 161. •2 M ;:N�4'
_
V0'i. —
:r.r 12.5
113.0 - (ML)-Orange-brown,medium to fine Sandy SILT. -
WOH
_ WOH WOH 98.1 W —
WOH
15.0 15.0 - 15.0 15.0
BORING TERMINATED AT DEPTH 15.0 ft
w -
-
a — —
x - -
; ii
-
F
a
t_
q:• Concrete ;•;•;Bentonite Pellets El#2 Medium Sand