GW1--07835_Well Construction - GW1_20231208

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information: ,
Frankie L.Oliver r3.:14.WATER ZONES., ',. ,':'s'
FROM TO DESCRiP,TION
Well Contractor Name $6,97 ft" 110 ft
3002-A 119 ft' 135 fL 145,1581187
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased.wells)OR LINER(if applicable)
Carolina Well Drilling FROM TO DLIMETERI THICKNESS MATERIAL
Company Name 0 ft' 80 ft' 6 5/8 in. .188 Galv.Steel
'16.INNER CASING`OR TUBING(geothermal closed-loop)'
23-240
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U1C,County,Stare,Variance,etc.) ft ft in.
•
3.Well Use(check well use): ft ft in
Water Supply Well: •" OM REE TO, DIAMETER SLOT SIZE THICKNESS MATERIAL
AgriculhtralIMunicipal/Public ft. ft. in.
in.Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ft R,
Industrial/Commercial OResidenual Water Supply(shared)
'Di.GROUT_ ' .,'' .'Irrigation FROM TO MATERIAL EMPLACEMENT METHOD St AMOUNT
Non-Water Supply Well: 0 ft 20+ ft• Bentonite Pour(42)501b Bags
Monitoring
Injection Well:
I�IRecovery rt. et
ft. rt.
Aquifer Recharge IQIGroundwater Remediation 19.SAND/GRAVEL PACK or applicable)
Aquifer Storage and Recovery
Aquifer Test
QlSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHODDStornrwater Drainage rt ft
Experimental Technology Di Subsidence Control ft. ft.
Geothermal(Closed Loop) Tracer ,20.DRILLING-LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,suil/rock type,grain size,etc.)
Geothermal(Heating/Cooling Return) nO[her(explain under#21 Remarks)
0 ft. 3 ft. Brown Clay
4.Date Well(s)Completed: 9-20-23 WellID# 3 ft' 47 it. Brown Sandclav
5a.Well Location: 47 et. 72 ft. Brown/Blue Rock
The Meadows @ Weddington Well#2 72 ft. 200 ft' Granite
Facility/Owner Name Facility ILA(if applicable) rt it -. `^'j- c
Santolina Ct. Weddington 28104 et. et_ ! ' ;�(,,,,',,a.-r i` 'l i ,•r--)
rt. rt. �
Physical Address,City,and Zip DF� tI 8 ,) )
Union 06-153-282 21.REMARKS- , , . 2.0 3:'
Infra :: ;-, .
County Parcel Identification No.(PIN) '^='% `ram L'-_
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
34.59.544 N 80.46.118 W
- 10-10-23
6.Is(are)the well(s)EIPerinanent or 0I Temporary Signature of Certified Well Contractor{ Date
By signing this form, 1 hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: IJYes or ZINo with 15ANCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If this is a repair,fill out known well construction information and etplain the nature of the copy of this record has been provided to the well owner.
repair under#21 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 site details or well
construction,only 1 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: 200 (ft-) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@•200'and 2Q100') construction to the following: 1
10.Static water level below top of casing: 26 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail ServiceICenter,Raleigh,NC 27 699-1 61 7
11.Borehole diameter: - 6 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
Air Rotary above, also submit one copy of this fot•m 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 ServicejCenter,Raleigh,NC 27699-1636
13a.Yield(gpm) 38 Method of test: Air 24c.For Water Supply&Inle{tion Wells: Tn addition to sending the form to
the address(es) above, also submit one copy of this fonn within 30 days of
13b.Disinfection type: 70% HTH Amount: 18oz completion of well constructionito;the county health department of the county
- - - - - where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016