GW1-2021-01692_Well Construction - GW1_20210329

WELL CONSTRUCTION RECORD(GW-D Far Internal Use Only:
1.Well Contractor Information:
JOHNNY BURR 14.WATER ZONES
Well Contractor Noma FROM TO Dumirr N
h fl.
A - 3098
h Is.
NC Will Contractor Cem ficsoion Number
IS.OUTER CASING Ifor wullFewad wells)OR LINED up Ikatrk
GEOLOGIC EXPLORATION FROM TO DIAMLTER TPICNNiSn MATERIAL
Corrpuny Na.. 0.0 I'. 58.0 h 6.0 1- 1 SCH 40 vVC
14 INNER CASING OR TUBING earhermaeksed-
2.Well Construction Permit D: FROM TO DIAMLTER TRIC"M I MATERIAL
W,all tyy,l,nbk cell am=vwnanpa'mnapr.Ulf.f,vavJ'.y'wr 1'(.vmnrr.err) a. h I la.
3.Well Use(check well use): D. h la.
Witter Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIEE TR KNL'u MATERIAL
OAgricultural (3Muntcipal/Publlc Is. R. im
OGeahermal(Healing/Cc ing Supply) ❑Residential Water Supply(single) h R, im
Olndmirial/Commercial ❑Residential Water Supply(shared) is.GROUT
olffigation OWells> 100,000 GPD mom TO I MATERIAL Ease" ENIMMETHOD&AMotxYf
Non-Water Supply Well: all a' 58D It, 100-1)11,00- SLURRY
CMonitoring DRecovery a. Is.
IRjectnon Well: Is. N.
❑Aquifer Recharge OGrourdwater Remedlatnn
❑ uifer Storage and Recovery OSalinl Bacier It SAND/GRAVEL PACK Ira able
A9 orage ry tY FROM I TO I MATERIAL FAIMC4Mrfff METHOD
ClAquder Tat ❑Stormwater Drainage R. h
❑Experimental Technology ElSubsldence Control R. h
OGeothermal(Cloned Loop) OTracer 20,DRILLING LOG forawls oddidaaal shaft timewsa
OGrothennel(Hea(in oolin Return) OO(her(explain miler A21 Remerks FROM TO DESCRIPTIOnw .hardrea.rdFM da she,ere.
0.0 R' 15.0 IL ORANGE/RED SANDY CLAY
4,Date Wells)Completed: 03/10/21 Well IDR BR-1 15.0 h 57.0 ft- LIGHT GRAY SANDY PWR
4.Well Location: 57.0 R' 100.0 h GRAY ROCK
GENERAL ELECTRIC fL a
W
Facility/Owner Name Facility lDs(ifap ob pikk) IL IL ti t
1223 FAIRGROVE CHURCH ROAD SE HICKORY 28602 Is. h
Plyskal Address.City.and Zip R. h 21
CATAW BA 21.REMARKS
C-ty Parcel Ideniiki on^b (PIN) OPEN HOLE Infrm.3ton ProGe sing Un0
ec I n
Sb.Latitude and longitude is degreilin emdecimals<rones or decimal degrees: p1r�
(ifwdl Dad om hukng is saRriea) 22.Certification:
350 42' 39.51" N 810 15' 32.34" W " ' 03/18/21
6.Is(Are)the well(s): 191'ermmeat or OTemponry Swewe orcemfied Well Connector Date
RY=etwag nak fwm./Asrrby ren*dwt Ae aeflp/ras hetE1 mmlrwaM,irann,vlotrrr•,a,
7.Is this a repair to to existing well: Oyes or PJNo IM M'W'OX' 0100 ar IJA M'W'O2G.02W Will Comitrararw.Tmralaerk.1 tbtou,pr
IJ An 'Ni,fill raise W,n.n rdl........in/arawlen,nrl'Vloin Ar nonvr 4 rise rfdi=rerrW b=be<n lnmi,kd to rie a moanrr.
,pM,r wnkr Q/rrnmhi Henan or,m,hr back cf dv,/rm. 23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page(o provide additional sell constna:imn tofu
construction,only I GW-I is deeded- Indicate TOTAL NUMBER c wells (add'$ee Over'in Remarks Box).You may also attach additional page if rlecessary
drilled. 24.SUBMITTAL INSTRUCTIONS
%Total well depth below land surface: 100.0 (ft.)
l'Jr mWlllllr M'rllt/I=l a/l l/rplAr✓/d Knt(e=o Wr.J@100'<mf 2@IOO) Submit this CW-1 within 30 drys of well completion per the following:
10.Slttk water level below top orcasing: 5.0 (0) 24s. For All Wells: Original focus to Division of Water Resources (DWR).
If.~lne/fit obore cnuag urn--- Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole distorter: 12.0/6.0/7.875 (in.) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Rakigk NC 2 7699-1 636
li W<II construction aRt6od: AUGER/AIR
24c.For Water SuDdv sad Ootn-Loop Geothermal Retara Wells:Copy to the
(i.e auger,lrNay,Hole,direct push.me) county tnvrronmema tat epartmen101 county r�s lerein5lr
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin 01 100 000 GPD:Copy to DWR,CCPCUA
13a.Yield Permit Program 1611 , slag .NC 27699-161 I
(gpm) Method of msL
13b.Disinflation type: Amount:
Fain GW-I uonn Cmohnn Depenrtrnl of EnvironmenulQnbly Dlvumn of Wale,Resources Revised6b-7018