HomeMy WebLinkAboutGW1--00575_Well Construction - GW1_20240118 •
WELL,CONSTRUCTION RECORD GW-I
For internal Use Only:
I.Well Contractor Information:
•
RANDY OWNBEY '
Well Coim;tctrn Name 14.WATER ZONES I -
Vitom TO DESCRIPTION
3214A 290 t•l• 291 fI• 5 - I __ ..._._
NC Well Contractor Certification Number 330 it 331 ft. 35 I i
AlR DRILLING I N C IS.OUTER CASING(for multi•cased ivells)OR LINER(if applicable)
• FROM TO -DIAMETER THICKNESS MATERIAL
Company Name 0 ft' 115 f'• I6 I I in. GALV
Z,Well Construction Permit II: 12-2022-185462 16.INNER CASING OR TUBING(I cothermul closed-loop)
FROM TO DIAMETER THICKNESS_ MATERIAL,,_
Liu allirpplie•ahlr'well construction permits(i.e.WC,County.Slate, f�ro'intrc'e,etc.) fl.- - -ft. 1 I i -
- —
n. -- - -
3.Well Use(check well use): ft. ft. in.
\1'ale'Supply Well: I. ' -
17.SCREEN I •
I_IAgrieuluu'al 1+Roll— Tu omen ro- si.o'rslr,E _THICKNESS \g;�rr:atni.
I(Municipal/Public rt. ft. in in, -- - '11Geothermal(I lcating/Cooling;Supply) I._IResicicnhal Water Supply(single) -- -----------fit
f ih,tlusu'ialiComnicrciol I'l. ,•,, i„i ----- .—..__ _ _
L1Rcsidcntial Water Supply(shared) _- — I,
fllrrig;alion I8.GROUT -- ---—...---
rl Wells> 100,000 GPD FROM TO \'L\TERIs.i, EMPLACEMENT M ETHOD&AMOUNT
Non-Water Supply Well:•
0
i:!Nlunilu,•;,,jt _it. 113 II. -rnt_MMII2 cROur PUMPED
I-1Recovery — ft. ,— ft. — — ---
Injection Well:
ft. I,.
I lAquifer Recharge L1Groundwatcr Remedialion — —
ElAquiler Storage and Recovery t=lsalinity Barrier IS.SAND/GRAVEL PACE(If applicable) —
Pawl _o _MATERIAL EM PLACE(EEDI tat HID_
LlAquifer Test f_7Storntwater Drainage 11L rt. —
❑l;xpe'intcntal Technology ❑Subsidence Control . - —
DGcothcnnal(Closed Loop) I:Tracer
IJGcothcrmol(fleeting/Cooling Return) LlOther(explain under VI Remarks) 20 DRILLING LOG(attach additional sheets if necessary) -
FR•
OaI TO DESCR,P'r1UN color,hardness,soil/roil,iv.te_gn,id s(m,e,c.
( L b._. 1
03-13-2023 ' 0 ft' 105 ft. DIRT
4.Dale Well(s)Completed: Well I Dtl 105 Il• ft. — —-- -
345ROCK `
5a.Well Location: f, l•, -- -- -- -----------._-
PRINCETON HOMES ft. ft.
facility/Owner Name ` - ATM-,._
Facility MO(il'applicnblc)
1358 ASTORIA PKWY,CATAWBA,N.C, 28609 rt. n. e. ,:,t,� ^5 it `' .,,,-�
-- `-- u"`°
fl• H • JAN 1 (�
I'hysieol Address.City,soil Zip ---- y7 •
CATAWBA II. • ft. CG 4 - —
471001265510 21.REMARKS ;-
county . Parcel Identification No.(PIN'( 42
�`*��,tJ`Zel r,
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: •
(if well nod,one Iatilong is tiiliicient) - --- —- ------ --_._....-_l
35° 40.519 22.Certi,Iea n .
N•
80° 58.707
�� •
3/13/2023
6.Is(are)the well(s): ClPermanent or I:Temporary Signature of Cenil Well Contractor Date
By signing this farm,I hereby cerli/ir that the,re11fi' was(were)constructed in accordance uric/
7.Is this a repair to an existing well: - ElYes or InNo /5,. Afc,fC 02C.0/Oil or/54 Arc,/L'02C.000 Hell Consu-octioa S7amlards and that a ram.
Ifthi.r is a rcpair,,Jill out knon•n melt conslrncliou iq/orntation and ay/on,the cloture g/7hcc gfthis record has hecv,proridel In die reel/ouwer,repair under VI remarks..recvion or on the hack alibis farm.
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 construction inli,constuction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You,nay also attach additional pages ir necessary.
drilled:
24.SUBMITTAL:INSTRUCTIONS
9.'Total well depth below land surface: 345 (ft.)
I-or•multiple well,-list all depths i/'di(/cunt((wimple-.i(iii200'and2@/00't Submit this C;\V-I within 30 days o('well completion per the('ollowing:
10.Stulic water level below top of casing: 115
(fI 24a. For All Wells; Original feral to Division of Water Resources (DWR).
/f worm Irrel is alcove rrrvinti,use"i" ) Ind cannon Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
1
11.Borehole diameter: (in.)
(in.) 24b. For Injection Wells: Copy to I)\VR, Underground Injection Control (IU('I
Program, 1636 MSC,Raleigh.NC 276'3,,9-1636
12.well construction method:
i,.e.:mgtvr,roiary cable,direct push.cic.1 24e,For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
county environmental health departmeit of the county where installed
FOR WATER SUPPLY WELLS ONLY:
24d,For Water Wells producing ove1-100,000 GPI): Copy to D\VR.CCP('U.\
13a.Yield(gpm) 40 Method of test: AIR Permit Program, I6 t t MSC.Raleigh,NC 27699-1611
13b.Disinfection type: HTH Am[t»nt:
Form OW-I North Carolina Department of linvironmental'Qmdity-Division o(*Water Resources I
Revised 6-6- (11