GW1--06476_Well Construction - GW1_20241104

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: j,
1.Well Contractor Information:
Eddie Swain 14.WATl RZON S :.
FROM TO DESCRIPTION'
Well Contractor Name
ft. ft.
' 4632B
ft. ft. I
NC Well Contractor Certification Number ;'IS.OUTER CASING(for moth-cased wells)OR LINER(ifap liea -_;<ble) .
CATLIN Engineers and Scientists FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. i in.
Company Name 16.INNER CASING OR TUBING(geothermal elosed-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.) 5 ft• U ft• 1 't"' Sch.40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: FROM TO _ DIAMETER SLOT SIZE THICKNESS -_ MATERIAL
❑Agricultural ❑Municipal/Public 15 ft• 5 ft. 1 in' Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 1 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: ft. . ft. I
19Monitoring ❑Recovery ft. ft. I
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 2i1.DRILLING'LOG(attaehadditionahsheetsifriecessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil rock type,grain size,etc.)
ft. ft
4.Date Well(s)Completed: 10/07/2024 Well ID# OWS36-TW ft. fts,i `"f: '�C` h'i;{_�--
' ft. ft
5a.Well Location: NOVMCAS Cherry Point OWS-36 ft. ft. N 0 LL 20Z4
Facility/Owner Name Facility ID#(if applicable) ft. ft.
7th Avenue, Havelock, NC 28532 ft. ft. ' J
Physical Address,City,and Zip ft. ft.
Craven z1:REMARIzs
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: ,;.
34.910516096591635 -76.8983859569103 '- % ,-"' �� '-
10/15/2024
6.Is(are)the well(s): ❑Permanent or l!lTemporary Signature of Certified Well Contractor Date
By signing this form,(hereby certifi,that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 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-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
15.0
9.Total well depth below land surface: (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3 tt 00'and 2@.100')
I
24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: 1 1 (ft•) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing,use"+"
11.Borehole diameter 1 (in.) 24b. For Injection Wells:Copy Ito DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: CPT/DPT i'
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: i
13b.Disinfection type:_ Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018