GW1--04090_Well Construction - GW1_20240712

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Joseph L. Zuncich 14.WATER ZONES
FROM TO DESCRIPTION
w.:II Contractor Name ft. ft.
3324-A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER Of a bk)
Applied Resource Management. P.C. FROM TO DIAMETER THICKNESS MATERIAL
Company Name 0 ft. 8.5 ft. 2 in' SCH40 PVC
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 (17('.County.State. 6 urrance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 ft. 13.5 ft' 2 in' .010 SCH40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18 GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO , MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.1 11. 0.5 ft' Cement Poured
in Monitoring ❑Recovery 0.5 it 6 it Bentonite Poured
Injection Well: ft. R.
❑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 6 ft' 13.5 ft. Coarse Poured
❑Experimental Technology ❑Subsidence Control ft. ft.
OGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain Bar,etc.)
ft. ft.
4.Date Well(s)Completed: 5/19/2024 Well ID# REC2-TW1 ft. ft. See Attached
ft. ft.
5a.Well Location:
Williams Cleaners N/A ft. ft.
Facility,OwnerName Facility lD (if applicable) ft. ft.
808 S. 17th Street, Wilmington, NC 28401 ft. ft.
Physical Address.City,and Zip ft. ft.
New Hanover R05411-013-005-000 21.REMARKS
County Parcel Identification No (PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latilong is sufficient) 22.Certification:
34 13' 34.39" N 77 55' 36.76" w.
teitc 6/6/2024
6.Is(are)the well(s): lPermanent or ❑Temporary Signature ertifiu f ill Contractor Date
By signing this fortn,I herehE cern/r than the well(s)aa.s(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Fes or l!No /5.4 AZ..4('02('.0100 or 13.4 MA('02('.0200 Well Construction Standards and that a copy
11-this is a repair.fill out known well construction tnlitrntation and explain the nature of the of this record has been provided to the well owner.
repair under=2l remarks section or on the hack of this Jirrm.
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-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: 13'S (ft.)
bar multiple wells list all depths if different(example-3 200'and 2ik100') Submit this GW-1 within 30 days of well completion per the following:
9.85 24a. For All Wells: Original form 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 4 (in.) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(WC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Hand Auger
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 s,here installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpm) N/A Method of test: N/A
Permit Program, 1611 MSC.Raleigh,NC 27699-1611
13b.Disinfection type: N/A amount: N/A
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018