GW1-2021-00299_Well Construction - GW1_20210127

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
JACOB MESSICK 14.WATER ZONES
Well Contractor Name FROM I TO DESCRIPTON
fI
. ft.
A - 4252
R. a.
NC Well Contractor Certification Number
15.OUTER CASING for mold-cased wells OR LINER If t livable
GEOLOGIC EXPLORATION FROM ro DIAAIE F.R T,IICKNE55 „ATEOIAL
n. a.
Company Names
16.INNER CASING OR TUBING eothermel closed-too
2.WeR Construction Permit 0: FROM TO DIAMETER THICKNESS MATERIAL
/.ra ail appheame vrh conrrruo.an Isernder p-e-U1C,Cau.q,,smrc.Ynr.nnoe.ea'1 0.0 I'L 5.0 ft. 2.0 in. SCH 40 PVC
3.W'eil Use(check well use): ft. ft. '
n.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5.0 ft. 30.0 ft' 2.0 in. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) D. n. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑lrrl atlon ❑Wells 1100,000GPD FROM TO MATERIAL ENIPLACEMENTNIETHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 2.0 ft PORTLAND BENTONITE SLURRY
LE MonitoringWe ❑Recovery ft. n.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundvoiter Remediation
19.SAND/GRAVEL PACK iftop livable
❑Aquifer Storage and Recovery ❑Salinity Barrier TOM TO MATERIAL EM1IPL\CEM E]T METHOD
[]Aquifer Test ❑Stormwater Drainage 4.0 ft' 30.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology DSubsidence Control n. a.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG fiamach.ddidonal shuts ifnecessa
❑Geothermal(Heating/Cooling Return) DOther(explain under k21 Remarks) FROM TO DESCRIPTION rotor.hmN1.,xA AnlVmrk soon
0.0 fL 15.0 R- TAN SAND
4.Date Wee(s)Completed: 01/13/21 Well IDN MW-4 15.0 fL 30.0 D GRAY/BLACK SAND
Sa.Well Location:
t. ft.
WRIGHT CHEMICAL ft. H.
Faciliq/O..ner Name Facility l Dd(ifapplicable) ft. G.
333 NEILS EDDY ROAD RIEGELWOOD 28456 f. ft.
Plosical Address,City,and Zip ft. ft.
COLUMBUS 21.REMARKS
County parcel Identification No.(PIN) BENTONITE SEAL- 2.0-4.0 FT
Sh.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
ofwell field,one ladlong is sufficient) 22.Certification: ,,,�,/
340 19' 36.64" N 780 12' 04.70" W :'"rd" Ono"" 1/15/2021
6.Is(are)the well(s): (EPermanent or ❑Temporary, Slgnamre oWerified Well Corttmetor Date
Hpsignmg r...I..... l herehy.eats mai the im//(r)nos(u ere)runrtru,Nor n.omaM n,e i.ah
7. Is this a repair to an existing well: ❑Yes or ONo 13A A'Ci('02C 0200 or l5A NCA( 02C.0200 Wei/('......tics..stondorda and rhos a,on
1/rri,iv a repair,/ill ow knnvrr vdl couilraclion nob)rnwoon and e.rp/am the.score o/rhe ',J In..'retard Ira.been pro ul d ro the u,e l corner.
rupxrir under r21 rrmarlo section sr on.lie hock of rho jars
23.Site diagram or additional xell 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 constnmlion 11110
construction,only I GW-Iisneeded. Indicate'FOTAL NUMBER ofwelis (add'See Over in Remarks Box).You may also attach addrt.onal pages ifnecessary
drilled 24.SLBMI"I'LAL INSTRUCTIONS
9.Total well depth helow land surface: 30.0 (ft.)
I'sr.00hrple vef,li.rr aH dcprhs/rh/jerenr(.....Isle-3@200'and 2n_000) Submit this GW-I within 30 days of well completion per the following:
ns
p.use i3Original
10.Static water level below to of eosin p , (fit) IInfo Foion Processing Ou 1617 MSC,Raleigh,n of Water Resources (DWR).
15.0
P g°�-� Informal' INC 27699-1617
If u'nmr Irre/it ahnre.stir.
11.Borehole diameter: 8.0 (1 n.) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER
24c.For Water Supple and Open-Conn 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 2 7699-16 1 1
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Farm(i W-1 North Carolina Deparanent of Environmental Quality-Division of Water Resources Revised 6-6-2018