GW1--06477_Well Construction - GW1_20241104

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information: I
Eddie Swain "14.WATER'zoNEs
FROM TO DESCRIPTION.
Well Contractor Name
ft. ft.
4632B ft ft. .
NC Well Contractor Certification Number :15.OUTER CASING`,(for tuultt cased,WeUs)OR LINER(if ap licable)
CATLIN Engineers and Scientists FROM TO DIAMETER' THICKNESS MATERIAL
ft ft. j in.
Company Name
lfi.INNER CASING OR TUBING in(Eeotherat do loop)':.::...sed
2.Well Construction Permit#: N/A FROM TO DIAMETER THICKNESS MATERIAL
List al/applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 10 ft. 0 ft• 1 ,in* 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 20 ft. 10 ft• 1 tn• Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) [Residential Water Supply(single) ft ft. in.
❑Industrial/Commercial [Residential Water Supply(shared) 18 GROU.1
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
CJMonitoring _ - _ ❑Recovery _ ft. - ft. 1 _
i
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation '
13.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 'ZU:DRILI:ING:LOG(attaehaddi6oasisheeisifnecessary)>.'t ... ' ''.;
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed: 10/07/2024 Well DO OWS42-TW ft. ft. r ,
i.;.",_2,' r'_ ,. 'in: .L.
ft. ft. e v
5a.Well Location:
MCAS Cherry Point OWS-42 ft. ft. NOV 0 4 2.024
Facility/Owner Name Facility ID#(if applicable) ft. ft. ;?-r,.y."`r ..to Pl.
t.
7th Avenue, Havelock, NC 28532 ft ft.
•
Physical Address,City,and Zip ft ft. ,
Craven 21.REMARKS !.
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: ,..
34.916353460358955N -76.90079458058264 W ' r% •' 7 .
A eo ; «.: ;;.ixqs,....; 10/15/2024
6.Is(are)the well(s): ❑Permanent or Temporary Signature of Certified Well Contractor Date
l l
By signing this form,I hereby cernfr that the Well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: DYes 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 I 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: 20.0 (ft.)
For multiple wells list al/depths if different(example-3@200'and 2 a 100') Submit this GW-1 within 30 days,of well completion per the following:
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"+"
24b.For Injection Wells: Copy to DWR,Underground Injection Control(NC)11.Borehole diameter: 1 (in.)
Program,1636 MSC,Raleigh,NC 27699-1636
CPT/DPT j •
12.Well construction method:
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: I
24d.For Water Wells producinglover 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-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018