GW1-2021-02741_Well Construction - GW1_20210527

WELL CONSTRUCTION RECORD(GW 1) For Internal Use Only:
1.WeH Contractor Information:
Edward Wyllys Taylor, Jr. 14.WATER ZONES
Well Contractor Name FROM TO DFSOUPMIN
2440-A fL
NC Well Contractor Certification Number IL
IS OUFER CASING for multi cased wells OR LINER if a 'cable
Geonetics Corporation WOK TO fL I DUMXTK'RiFL THCKNESS MaTt$uAL
fL
Company Name
WM 0401291 16.INNER CASING OR Tul1ING thermal closed-lonnI
2.Well Construction Permit#: FROM To DUMETER T1110ENEss MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0 tl. 5 fI. in.
3.Well Use(check well use): H. R is
Water Supply Well: 17.SCREEN
❑Agricultural ❑Municipal/Public FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
5 ` 15 ft- 2 h` .010 sched 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. 5 ft.❑Industrial/Commercial ❑Residential Water Supply(shared) 18 GROUT hL
OIrrigation ❑Wells>100,000 GPD FROM To MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 3 M 4 IL bentonite gravity
OMonitoring ❑Recovery ft 3
Injection well: cement gravity
❑Aquifer Recharge ❑Groundwater Remediation ft. ft
CK a 'cable
❑Aquifer Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PA FROM To MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 4 IL 15 It #2 sand gravity
❑Experimental Technology []Subsidence Control ft. fL
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM To DESCRIMON color,hardness,soivro& in sae,etr-
1 ft. 5 fL alluvium, brown, silty CLAY
4.Date Well(s)Completed: 4/27/21 Well ID# MW 1 6 fL 10 n alluvium, brown/tan, silty f-c SAND
Sa.WellLocation: 13.5 ft. 15 fL residual, gray/green,f. sandy SILT
Appalachian State Univ. NA ff. ft.
Facility/Owner Name Facility ID#(if applicable) >l ft.
Hunting Hills Ln, Boone, NC 28607
Physical Address,City,and Zip fl. ft.
Watauga 2910746484000 21.REMARKS
Cody Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lattlong is sufficient)
22.Certification:
36.20671 N —81.65199 W
1 d w"&W. Taylor,Jr 4/30/2021
6.Is(are)the well(s): InPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing this form,l hereby certify day dhe wells)was(were)constructed n accardamv Willi
7.Is this a repair to an existing well: ❑Yes or 8No 15A NCAC OK.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 ofthe of this record has been prroi ikW io the well owner.
repair under 921 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
9.Total well depth below land surface: 15 (D-)
For multiple wells list all depths ifdifferenr(example-31@200'and 2@I001) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 6.7 ft 24a. For All Wells: Original form to Division of Water Resouuces (DWR),
lfwarer level is above casing,use-+' ( ) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6•5 (in,) 24b. For Injection Wells: Copy to DWR Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Auger
(i.e.auger, ,cable,direct push, . 24c.For Water Su and O n-Loo Geothermal Return Wells:Copy to the
au rotary, etc) 1 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 ,
13a.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699-1 6 1 1
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018