GW1-2021-01691_Well Construction - GW1_20210329

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
JOHNNY BURR IL WATERZONES
Well Cemrcla No. FROM lfl DLSCIVrgN
n. R
A - 3098
tL n.
NC Well Contrctw Cenificalion Number 14001'ERCASINC far mala<med weR OR LINER Kkkd
GEOLOGIC EXPLORATION TO DIAMETER TNICKNL54
CwPor Name 0.0 n• 35.0 n• 6.0 I" SCH 40
16.INNER CASING OR TUV IMremlclaed-loa
2.Well Construction Permit t: PROM TO DUMErLR 7MIrlfnt1
/isr Wl ryplimD/e er/l rumrrurrion prrm+u(r.!lH'.(twig .Garr Vwranre rrr+ R R In
3.Well Use(check well raty n. n• I1>
Water Supply Wen: 47.SCREEN
/ROM TO I DIAMETER I SLOTSIEE I TRICKNESS AfATEAIAL
OAgricultunl OMuniclpab'Publlc
OGeollsemlu(Healing/Cooling Supply) OResndenual Water Supply lsmgle) n n Id
❑Industrial/Commercial OResldenual Water Supply(shared) tL CROUT
Olicitrattion OWells>100000 GPD wwm TO MATERIAL ERIPLf(:FAtE 1111M DRAMOUNP
Non-Water Supply Well: 00 m 35.0 fL scift w0offf SLURRY
09Moniloring ❑Recovery A. rt
Injection Well: R n.
DAquifer Recharge OGroundweter Reenecluxion
❑A ruler Storage Recovery OSalina Barrier If.SANdCRAVEL PACK Ile lkabie
9 ag ry Y TROM TO MATC0.IAL ENPURMFM Mkll10D
DAquifer Test OStormwaler Drainage ft n.
❑Experimental Technology OSubsidence Control ft I R
013cwhermal(Closed Loop) OTracer 211.1111111111.1.1 LOO ~b addldeaM aheeb lfRMeau
OGeolhermal(Heating/Cooling Return) OO(her(exlain under 421 Remarks) noMTO DESCRU'PI0Nralsr,brdsr sodi..h gm soosmer,ne.
0.0 R• 9.0 R ORANGEIRED SANDY CLAY
a.Due Well(s)Completed: 03/11/21 Well IDN BR-3 9.0 R• 33.0 h' GRAY PWR
Sm.Well Location: 33.0 R. 1000 R• GRAY ROCK
GENERAL ELECTRIC R h.
FcdaylOw.Name Fudo,Iris(ifappllcabk) a' IL t .--
1223 FAIRGROVE CHURCH ROAD SE HICKORY 28602 fl. R
Physi i Address,City.and Zip n. R
CATAWBA 21.REMARKS map
CoaMy Parer`idrnri5cwon N. (PIN) OPEN HOLE Unit
sb.Wti and d longitude in degrea/mfautn/fecondf or decimalInionr,j=
degrees: - - •�
(if.ell field,one Itow,if satficknt) 2L Certification: ,�.,,r ^
35a 42' 39.51" N 810 15' 32.34" W dp" U -64" 03/18/21
6.ls(are)the well(s): OPereatment or OTemporary, SVouwe ofCeroRed Well Contractor Dare
BjA M'N IOisl+ral.I b 15 V' tlrw rbr wrl/(1 woe here)o+rerrxxJm orrwrbrur n rA+
7.If this repair f0 an emitting well: ❑Yes Or MNo /SA,w'M dX 0/M)w/SA,W'AC OX'l11(VI WrH Pwurruvnrxr.VrvalaM ant dw+u rv/n
I/Ihv v a rt/wn,lill and bnx.r.rll nma..... a Jnnrarirm mW rslAarn rhr nvwrc u/rhr 4A,rrr✓rdhar hrrn pwW l m He xrfl nwmr.
rcryv uwlrr 21 rrmrkr ttrrin+w.m Ihv bark Jlhrr frvnr.
23.Site diagram or additional well details:
S.For Geuprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well cronslrucuon info
construction,only I GW-I Is needed. Indicate TOTAL NUMBER of wells (add Sm Over`in Remarks Bos) You may also arch additional pages nfrecessar)
drilled 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 100.0 (R,)
fir wu/n/a�r nr/b bn✓fhk/xA+I/dBienn/am/tlr-3L/a20o aw/2 1tart Submit thisGW-1 within 30 days of well completion per the following:
10.Static water level below top ofrasiog: 5.0 (n) 24m. For All Wells: Original form to Division of Water Resources (DWR),
I/'cwcr krrl Ir above rmlrq:,xrr .. Information Praessing Unit,1617 MSC,Raleigh,NC 27699-W7
11.Borehok diameter: 12.0/6.0/7,875 (in.) 24h. For Infection Wellf:Copy to DWR,Underground injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
IL Well construction tfMthod: AUGER/AIR
(i e.uEer,ro 24c.For Waters and Opev-Loop Geothermal Reluro Wells:Copy to the
county envnronmenta Ih cpanmenlo t cpmty noualled
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin over 100000 CPD:Copy to DWR.CCPCUA
13a.Yield( Pennll Program,111 M a .N 276 -16H
gpm) Method of lest:
13L Disinfection type: Amou.I:
Form GW-1 Nonh Cwolixe Deperinrerrn of Ennronlmmal Quality-Orvnios of WMcr Rraources Re scd6fi-2019