GW1-2023-01759_Well Construction - GW1_20230223

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WELL CONSTRUCTION RECORD (GW-1) For internal Use Only: I
I.Well Contractor Information:
Phillip D. Ricker 14.WATER ZONES
Well Contractor Nmnc
FROM 10 DESCRIPTION
Ft. ft. N
NCWC 4280-A
NC Well Contractor Ccnrtication Number 15.OUTER CASING(fur multi-cased wells)OR LINER(if up Ilcablc
Geolab Drilling Faonl To Dik%IETERI THICKNESS MATFRLU.
Cumpany Name
WM0301243 16.INNER CASING OR TUBING(geothermal closed-loon)
2.Well Construction Permit#: FROM To I DUJIETER I THICKNESS I NMTERIM.
Lin aft applicable sell ronsrrurtion permits Ox. UIC.C'000rv,Store,Variance.err.) .2 ft, 70 fl. 2 in, sehao
3.Well Use(check)Welluse): ft. ft. in.
7.
Water Supply Well: 1ROSCREEN
IO It IA}tFThu s1.o'rslr'.E 'I'llICKNI:Ss NI-VI'ERIAL
Agricultural Municipal/Public 10 ft. 20 ft. , 2 in' ,.010 sch40 pvc
Geothermal(I leatingiCuoling Supply) FIResidential Water Suppiv(single) fL ft. in.
industrial/Conunercial [3Residential Water Supply(shared) 18i GROUT
Irrigation FROM TO MAfER1A1. EdIPL.\CEJIESf\IF.TIIfID& UIO NI
Non-Water Supply Well: o ft. 6 ft. PortiSent poured from surface
X Monitoring DRecovery 6 ft. 8 ft. Bent Chips poured through augers
.Injection Well:
ft. ft.
Nquifci Recharge Groundwater Remcdiation - I• t — - - -- - --
19.SANDIGRAVEL PACK(if o ifcablc) _
Aquifer Storage and Recovery QlSalinity Barrier FROM TO MATERIAL I EMPLACEMENT aIET11oD
Aquifer Test aD ft 20 ft• 1AgraveGack poured through augers
Experimental Technology Subsidence Control rL rc.
Geothermal(Closed Loop) Tracer 20.DRILLING LOG attach additional sheets if necessary
FROM 1'0 DIisCRIP PION Iralar,harJnes,.Sul Utvck r,oe.xruin dn•.rle_,
Geothermal(Ileatin Cooling Return) Other(explain under#21 Remarks)1/23/23 ft'
rt —
03 gravel with red clay,firm,moist
ft. ft. —1—
4.ante 1Ye11(s)Completed: Well ID#MW-7R 3 5 tan silt with clay,firm,moist to wet
5:t.Well Location: 5 10 f`• red/tan silt with clay, hard, moist to dry l
BIN-Atando, LLC 10 `t- 16 ft• green/gray clay, mottled,soft,moist �
Facifity;o%ner Name F•acilhv ID-7(ifapplicable) 16 n- 20 ft red/brown silty clay, moist
NA-Property is a former Railroad Easement
Physical Address.City,and Zip ft. ft. e, „�, o rt
Mecklenburg 07720213 21.RENIARKS " �•" ` ' -.` '`-•P t-afir'
County Parcel Identification No.(PIN)
FEU Z ice.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwcll field.one lavlons is sufficient) 22.Certification-
Umti
Not Available N Not Available W 7 '613
i ,
6.Is(are)the well(s)oPermanent or OTemporary Si^ arc 0rCertifted Wc ll ntmca' l; Date
Br xignurg rhi,,Dorn u, ! rebc rr,•Ii1•i•dal r the wel/0)tvae•(1'wv)roavmrwd in sec"l-kn,rr
7.is this a repair to an existing well: ©Yes or E)No frith I JA NCAC 02C.0100 or 15A lJCAC 0,1C.0,00 11 c/!Cbncnxrrinn Shurdurd,on/rhor r,
lfthix ix a repair,fill our known,cell concrrucriorr iit orunrtian and 4rplain the nature nflhe enpv ojthis record has been provided m the well owner.
repair under till remarks section or on the back of this form.
23.Site diagram or additional well details:
8,For C.coprobe/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-I 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: 20 (ft.) 24a, For All Wells: 'Submit this i tonn within 30 days of completion of well
For mulriph,wells Am all depths iJ'di,Jferrnt(example-30200'and 2C100') construction to the following:
I'
10.Static water level below top of casing:•10
n (ft.) Division of Water Resources,Information Processing Unit,
If,,ater leri•l is alnn•e cr,.dng.are" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8.25 (in.) 24h. For Injection Wells: in additlion to sending the tort to the address, in 24a
Auger above,also submit one copy of this fpmi within 30 days of completion of well
12.Well construction method: construction to the following:
(ix.auger,rotary,cable.direct push,etc.) I, I
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpnt) :Method of test: 24c. For Water Supply& Injectio,n Wells: In addition to sending the form to
the address(es) above, also submit oiie copy of this form within 30 days of
I3b:Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Font GW-I North Carolina Department of Environmental Quality-Division of Watcr Resources Re,iced 2-2-1-20 It,
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