GW1--00520_Well Construction - GW1_20240118

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WELL CONSTRUCTION`RECORI) (GW-1) •
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For Internal Use Only: f '
• I.Well Contractor information: • I
. CHAD HARTNESS , . _ 1
ia.w,�1'ERI.ONES I I •
Well Contractor Nnmc • I+ItO�I TODESCRIPTION
2901A 320 rt. 321 fL- -- • _ - -----
NC Well Coiitr eloi Certification Number IL n. •i H ---"
IS.OUTER CASING(for multi-cnsed!wclls)OR LINER or
AIR DRILLING INC - —
FROM "r0 DIAN7 tam THICKNESS _ MATERIAL
('„nq„n;y Name rl, 88 rt. 6. in: PVC
SW22-10098 • 16.INNER CASING ORTUBiNG_E1)01crnmlclosed-loop)
2.Well Construction Permit//; - RRO\I_ •rO __ ET:(s Tnlr.•tc\'I•;Ss \t\_rt•, t 0 ---
I,i all„pplicable well construction partials((.e•• WC,Coinijt Suite,Variance,iance,etc•.) rt. _ '!M- n.
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3.Well Use(check well use): ft. ILin. ._
\\':her Supply\\'ell: • 17.SCREEN — — -- -----•--------i
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=:;\l11'Ii'tlllnl';tl IItO•tt '10.. tuA)ll•:I'I•:lt i St.O'[St71, 'I'uiciex••: r ).,'iERI,A1
ipMlinieipal/Public -,__...__.._.____.. _...._. . -
(icuthernttt!(limning/Cooling Supply) ' I•IResi(le,lial Water Supply(single) - -I-'- It. in,
:Indusu'ial/('ommcrcial I'L . f. M.
I�IResiclential Water Supply(shared)
(�irrigaliott IS.GROUT
Dwells> 100,000GPD FROM TO ' MATERIAL EMPLACEMENT M MUM x^AMOUNT_I
Non-Water Supply Well: 0 -rt. 20 f1'_ GROUT POURED
I!,Monitoring L:!Recovery --- . ---__....
injection!Nell: fl• -flu
VI/Igniter Recharge I�Groundwalcr Remedint)on n,' ' rL -- - --
!Aquifer Storage and RecoveryI:ISulinily Barrier 19.SAND/GRAVEL PACK(If applicable)
FROM TO MATERIAL I•:MVLA(:P..MENTMn•`tROD --j
GI;\cluifprTest DStormwater Drainage ft. • D. _- —
❑fixperintelnal'I'echnology IlSubsideteeConhel ft. , -- _-_
I!(icothi:rtnal(Closed Loop) O racer 20.DRILLING LOG Mundt additional sheets if necessary)
I.:1Cietlherntal(I leafing/Cooling Return) DOther(explain under//2I Remarks) !'ItOI TO DESORIP'1'IUN(color,luurinese,snivrocic�)•L,grain eirc,nr.) `�
03-07-2023 0 ft' 78 • ft. DIRT
4. Well(s)OttleCompleted: -- - - --------..-...-_.._..
P Well lDll ' 78 rt. 1005 1. ROCK '
—-- —- .'-Sa,Well!mention: -.. - •. ...
rt. 1't.
ANGELA PARKER n_ fit, •:_--------^. --_ ,_
Par dilri hv!,r:r Naps. -----------_.------'--- -+"$s-.--,n "., t y-,r+-= ..
Facility Mit tifnpplicnblc) It• - rt.
�• p�� e i y 9--
10933 US 64 W, MORGANTON,N,C, 28655
ft. rt.
I'h ..._!_JAN-1 2G
pzicnl',\elder>s,City.and Zip rt. - rt. I
MCDOWELL 16580063583821.REMARKS - •r- -,'.g ^.�.�(.Fi;i • • .I
, Parcel Identification No.(PIN) ` 'Dc�
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5b.Lalitude and longitude in degrees/minutes/seconds or decimal degrees: — ---- - - . . •
. (if well field.me lat/long is sufficient) -- — ---
35° 35.881N 81 ° 49,967 ( crJ urt t ;tt: ..----'•
3/7/2023
fi.Is(are)the well(s): GlPermalienI or ❑Teinporltry•
Signature ofCertified Well Conu'auter '' (t;tte
17r signing this tofu,l hereby cord/i•that'dre•h'ell(e)was(were)constructed it rrrconio rr.-e with
_ 7. Is this a repair to an existing well: CIYes' or 1!INo • /5.1 N(.•AC 02(;.0100 or/Sd;VC:IC 1l.k.4100 Weld Co,sirorlioc S'tandurdx and that it r nln
/I7hl,is a tomtit.fill nut known well construction iq/brulaliun and cal,lirin the nature a/the y/'this rccnrd has been prnrirled to the uti•lI earner.
' repair ander rl.?/remarks section ar OH the back of this limn.
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23.Site diagram or additional well details; •
S.For Geiprobe/DPT or Closed-Loop Geothermal Wells'having the same You may use the back of'this page to'provide addilionttI well construction inlit
construction.only I C)W-L'is needed, Indieate"TOTAL.NUMBER of wells .(add'Sec Over'in Remarks Box).You flay-also attach additional pages if ncecss;u'V.
drilled:_
_ — 1005 24,SUBMITTAL INSTRUCTIONS
9.'1'olttl)yell depth belowland surfaces - (ft.)
Fu•,ntliipl, teethlistOilrde/ph.ci/'di/lirvni/era,nplc.dti(•UUti+•w,r/';rrfl00') Submit this G\V-1 within 3l1 clays ul'lvell complclion perthe following:
r10.Static wafer level below rep ul'casing: 80 (fL) 24a. For All Wells: Original limn to Division of Miler-Resources IDIVR).
I.,ua,;•rh•rrl i.cabate er,ain•¢,a.1e '• ' (nforminion I tocesSinp.Unit, 1617 MSC:'•Raleigh,NC 27699-1 6 1 7
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11.Borehole diameter: 6 241). For Injection Wells: Copy tu!' \\'DR. Underground Injection Control MR'1
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Program, 1636 MSC,Raleigh.NC 27699-1636
12.Well construction method: !
(Le.nutter.tines•.cable,direct push.etc.) 24e.For Water Supply and Open-1'.oiup'Cetlhernutl Return Wells:Copy to the
• county environmental health depunniedt of the county where installed
FOR WATER SUPPLY WELLS ONL : •
24d.For Water Wells producing()Iva 100,000 CPD: Copy to D\VR.CCI'('U/\ -
13a.Yield(gpm) 2 Method of test: AIR
Permit Program, l61 1 MSC,Raleigh.NC 27699-161 1
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13h.Disinfection type: HTH . Amount:
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Perm OW..I - 'Noah Cm'uliuu Dupca•Irnenl of linvirunmentnl Quality-Division 01Water Resources ' :
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Revised 6-6-.:'.I11
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