GW1-2022-09204_Well Construction - GW1_20220930

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
i.Well Contractor information:
Frankie L.Oliver 14.WATER ZONES,
FROM TO DESCRn'TION
Well Contractor Naive
87 ft. 130 ft.
3002-A
207 ff 239 tl.
NC Well Contractor Certification Number l5 OUTER CASING(for multi-cased wells)OR LINER(if a livable)
Carolina Well Drilling FROM To DIAMETER F THICKNESS MATERIAL
Company Name 0 ft. 68 ft' 1 6114, it" I SDR21 PVC
22-247 16.INNE R CASING OR TUDING( edthermal closed-loo )
2.Well Construction Permit#• FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well constriction permits(i.e.UIC,County,State,Variance,etc.) ft. fl. in.
3.Well Use(check well use): ft. it. in.
Water Supply Well: 17,SCREEN
FROM TO DIAMETER SLOT SUP, THICKNESS MATF.RTAT,
Agricultural [3Municipal/Public fl. ft. in.
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ft in.
Industrial./Commercial Residential Water Supply(shared) ,18.GROUT'
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 tt. 20+ ft. Bentoliite Pour(19)501b Bags
Monitoring DRecovery
injection Well:
Aquifer Recharge []Groundwater Remediation
19.SAND/GRAVEL PACiC(if applicable
_ Aquifer Storage and Recovery ®Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Tact DS[ormwatea`Drainage
ft. ft.
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) Tracer 20.DRILLING LOG(attach additional sheets if necessa )_
FROM TO DFSCRTPTTON(color,hardness selltrock rain sire etc)
_l Geothermal(Hearin Coolin Return) Other(explain under#21 Remarks
0 ft. 12 ft' BrownNellow Clay
4.Date Well(s)Completed: 8-12-22 Well ID# Well#2 12 ft' 60 ft. Brown Dirt
5a.Well Location: 60 ft. 600 ft' Granite
Epcon LR2, LLC ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft. — t �
Courtyards on Lawyers Indian Trail 28079 ft. ft
Physical Address,City,and Zip
Union 08-321-367 21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one la(hong is sufficient) 22.Certification:
35.14.775 N 80.61.985 W
8-24-22
6.Is(are)the well(s)OPermanent or OTemporary Signature of Certified Well Contractor Date
B)-signing this form,I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an eAsting well: ®Yes or RNo with 15A NCAC 02C.0100 or 15A NNCAC 02C.0200 Well Constrta7ion Standards and that a
jfthis&a repair,fill out ktuixn well convruction information and explain the nature of the copy of this record has been provided to the well owner.
repair tinder#21 remarks section or an 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 site details or well
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 600 (ft-) 24a. For All Wells: Submit this form within 30 days of completion of well
Fnr multiple wells list all depths if different(example-3g200'and 24100D construction to the following:
10.Static water level below top of casing: 31 (ft.) Division of Water Resources,Information Processing Unit,
If water lcvcl is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 (in.) 24b.For Infection Wells: In addition to sending the form to the addre^"in 24a
Air Rotary above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,Direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 2 769 9-1 636
13a.Yield(gpm) 24 Method of test: Air 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: 70%HTH Amount: 36oZ completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016