GW1--06399_Well Construction - GW1_20241025

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
1
Eddie Swain 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name -
ft. ft.
4632B ft. ft.
NC Well Contractor Certification Number IS.OUTER CASING(for multi-cased wells)OR LINER(if apelicable)
CATLIN Engineers and Scientists FROM TO DIAMETER THICKNESS I MATERIAL
ft. ft. in.
Company Name 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.UIC,County,State,Variance,etc.) Q ft. 4 ft. 1 in' Sch.40 PVC
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 4 ft. 14 ft. 1 in' Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in. I
❑Industrial/Commercial ❑Residential Water Supply(shared)
18.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL i EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
nMonitoring ❑Recovery ft. ft.
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 ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft. '
❑Geothermal(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,solUrack type,Brain sac,etc.)
ft. ft.
4.Date Well(s)Completed: 04/24/24 Well ID# TMW-1 ft. ft.
ft. ft.
5a.Well Location: "
MCB Camp Lejeune 511 Lift Station ft. ft. G- L:4,= L, . -. -LI
Facility/Owner Name Facility ID#(if applicable) ft. ft. i
Rhodes Pt Dr, Camp Lejeune, NC 28540 ft. ft. OCT ;. 2024
Physical Address,City,and Zip ft. ft. j Iri .7:.a^Fi` P''r::•f?:�;- ;j'i t
Onslow 21 REMARKS . ••v,"•.,'�:'s
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County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
/
34.64401 N -77.402701 W �- ad/9 6t-67-c:� 10/16/2024
6.Is(are)the well(s): ❑Permanent or llTemporary Signature of Certified Well Contractor Date
By signing this form,I hereby certi that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or InNo 15A NCAC 02C.0100 or 15A 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-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: 14 (ft.) Submit this GW-1 within 30 days of;well completion per the following:
For multiple wells list all depths!I-different(example-3@,200'and 2@100)
6 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"+" 1
11.Borehole diameter: 1 (in.) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: DPT 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
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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ENVIRONMENTAL,CIVIL
WELL LOG GEOTECHNICAL CATLIN
Wilmington.Raleigh.Washington.
Charleston,2231,i9.012Engineers and Scientists
SHEET 1 OF 1
PROJECT NO.: 223149.02 STATE: NC COUNTY: ONSLOW LOCATION: Jacksonville
PROJECT: LOGGED BY: Trevor Mizelie WELL ID:
511 Lift Station DRILLER: Eddiie'Swain
NORTHING: 3836192 EASTING: 279781 CREW: I t TMW-1
SYSTEM: NCSP NAD 83 (m) DRILL MACHINE: Power Probe T.O.C.ELEV.:
VERT.DATUM: NAVD88 (USft) METHOD: DPT 0 HOUR DTW: 6.0 TOTAL DEPTH: 14.0
START DATE: 4/24/24 END DATE: 4/24/24 24 HOUR DTW: N/A WELL DEPTH: 14.0
BLOW COUNT OVA o L SOIL AND ROCK WELL
DEPTH LAB. 1 0
0.5ft 0.5ft 0.5ft 0.5ft (PPm) s G DEPTH DESCRIPTION DETAIL
0.0 Land Surface 1 o.o
o.o
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ee
4.0 A• 4.0
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1 —
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N fn=
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' 14.0 — '
14.0 = 14.0
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