GW1-2023-00378_Well Construction - GW1_20230103

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WELL,CONS,rRUCTION RIB CORI) (GW-1
----__ For lnlernal use Onl);
I.Well Contractor Information:
i
CHAD HARTNESS )
14,WATER ZONES y
Well Conlraclor Nnmc 1eR0�1 TO UI?SCRII';1'ION
2901A 309 ft. 310 ft. hI
NC Well Coolniclor Cc ft.Number ft. ft. P {
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A I R DRILLING I N C I5,OUTER CASING for multi-cnsod wells)OR LiNER ir n )licahlc)
(FROM TU DL\M6TEIt�' 1'111CKNESS aIATEltlr\I.
CompaaYN:smc Q it• 110 rf, 6 In. PVC
2022-6444 l6,INNER CASING OR TUBING cotherrnnl closnI.o2.Vlecll Consh action Permit/): FRO\I _ TU DI,\NLTER T1fIC \1,1TERL\l.List applicable ue•!I cnnstraction permits(i.e.UIC,Courtly,State, Variance,etc.) ft, ff. in,
3.Well Use(cllecic well use): ft. ft.F01ndustrial/Conlillercial
er Supply'Vent: I7.SCREEN
�ri , Frio�l ro ni,\�lrlt sl.orslr.RTHICKN1'SS NIATU'RIAI_
❑MunicipaUl ublio othernial(Heating/Cooling Supply) MIZesidential Water Supply(single)
ft.❑Residential Water Supply(shared)
18.GROUT
011•ri gation ❑WClis> 100,000 GPD Pit O\I TO s7ATERl,\L EMI'LACEaIBNTM4:7'IIOD Ai41OUNT
Non-Water Supply Wcll; 0 ft. 20 ft, GROUT POURED
❑Monitoring ❑Recovery ft. ft.
injection\Veil• _
t uil'cr Recharge ti
1JA . ft.
1 b ❑GroundN7tcrRcmcdialion
❑Aquifer Storage and Itecovery OSalinil Barrier 19.SAND/GRAVEL PACK if n Ilcable�_
y FROM .1.0 MA•1'ERIAI• E�1P1,nCE\IBN'I'NI•:1'lIOD
❑Aquifer Test ❑StormwalerDrainage ft. rt.
❑13xperimcutal'l'cchnology ❑Subsidence.Conlrol ft. f,. — '---
❑Goothernlal(Closed Loop) ❑Tracer• 20.DRILLING I,OG attach additional sheets If necessary)
❑Geothermal([seating/Cooling Itetuln) ❑Other(explain under 1/21 Remarks) VROM TO DESCRIPTFON(color,hardness,soillrock type,grain size,etc)
0 ft. 100 n. DIRT
4.note Well(s)Completed: 11-22-2022 Well IDI/ 100 f" 325 ft. ROCK
5a.Well Location: ft. ft.
JOEL HARDISON rt.
iscilitylOwner Ntlme Plwility iD11(if npplicnble) ft. 1'l.
244 ALEXANDER ACRES, MOORESVILLE,N.C, 28117
rf. rt.
Physical Address,City,and Zip
IREDELL 4677343931 21.REMARK19
County Parcel identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/soconds or decimal degrees: '
01'well field,une L•u/long is S111iCient)
350 35.291 t.c rtilic jon:
11/22/2022
6.Is(are)the well(s): [!]Permanent or ❑Temporary Signalure ofCcrtifiell Well Cantnscror DFsto
411s•igning this fora,!herebp cerrJi rhrrr the welf(sJ was(ivere)emtsa•ucled in acenralance with
7.Is this a repair to an existing well: ❑Yes or [!]No /Sal NCAC 02C.0100 nr/SA NCAC 02C.0200 lVe/l Construction Standards anal rhrrr a c•opr
10his•is a repair,Jlll ow known❑'ell cousn•Irclion h?,lbrutntion and eepla/n the nature of the nJ'thi,s record has been provideel to the well owner.
repair under 1121 remarks section or on the hack of dtis•forth.
23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the sank you may use the back of this page to provide additional Well Construction inlb
construction,only I GW-I is needed. Indicate TOTAL NUMBER ofwclls (add'Scc Over'in Remarks Box).You may also attach additional pages il'neecssary.
drilled:
24.SUBMITTAL IN 9.Total well depth below land surface: 325
For mluUiple wells list all depths//'dt•'(jerent(avantple-3 a200'and 2 cI 100') (f t) Submit this G W-1 within 30 bays of well completion per the following:
10.Static water level below top of casing; 70 (ft.) 24a, For All Wells: Original form .to Division of Water Resources (DWR),
U'wator level Is above easing,use"a" Information Processing Unit, 1617 MSC,•Raleigh,NC 27699-1617
11.Borehole diameter: 6 24b.For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method;(ix.auger,roulry,cubic,direct push,etc.) 24c.For Witter Su ly and Open-Loop Geothermal Return Wells'Copy to the
county environnienta hCflltln(1CPFIl'IIIICnI 01 the C011llly lVhel'L`II151F111ed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water'AelIs producing ove:r 100,000 CPU• Copy to D1VR,CCPCUA
13a.Yield(gpnl) 50 Method of test: AIR Permit Program, 1611 MSC,Raleigh,NC 27699-1 6 1 1
131).Disinfection type: HTH Amount:
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Furm U W-I
North Carolina Dep:uiment of Environmental Quality-Division of Wntcr Resources Ruviscd 6-6-2018
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