GW1--00588_Well Construction - GW1_20240118

WELL CONSTRUCTION RECORD (GW-I)
For Titternal Use Only: I
I.Well Contractor Information: I, . I
RANDY OWN BEY i •
(4,WATER ZONES I
Well Contractor Name I+tu)Ni To nFs(atli'rton
3214A 229 1'I. 230 ii, -- . ._._. ._.
NC'Well Contractor Certification Number rt. rt.
IS.OUTER CASING(for rnniti-cased swells)012 LINER lit'np slicable) -_ _. 1
AIR DRILLING I N C !+RoNI To DIAMETER 'I'IIIcKNESR m..yiT.RIA1—
compiny Name p rL 80 ft. 6 In. -PVC
2.Well Construction Permit//: 65095 16,INNER CASING OR TUBING(geothermal closed-loop)
_1_RONI To _ ol_\tETER _ 'I'IIICKNESS NIATcalm.
List all applicable well constriction permits(i.e.WC.County.Stale, Variance.etc.) 'rt. ft. 'in. —
3.Well Use(check well use): --`- —
L fl. I ill.
Water Supply Well: 17.SC:REEN -- ------_..._
:\g;rirulnu;ll ruoN)_ __rO_._._____ut.yNlE7_r:R, sl.o'esl/.t•: t'in(tt\iss •�r.�ri:iiiii
. I(Municipal/Public -- -
I'I. rt. in.
1Kicotherntal(Itearing/CoolingSupply) ('(Residential Water Supply(single) -- -
fh ft. in„
I Ilndustrial/Commercial LlResidentittl Water Supply(shared) --_ --_
IS.GROUT
[Ilrrigation ClWells> 100,000 GPI) FItMNI TO "MATERIAL. EMPLACEMENT N)E•fnoi.Aaitn:;;T-I
Non-Water Supply Well: 0 f'• 20 n• GROUT POURED
1:7Moniloring I]Recovery ft. ft.
Injection Well: _
FIAquIicr Recharge I,Groundwalcr Rcmcdialion ft. II.-
1=L\tailor Storage and Recover 19.SAND/GRAVEL PACK(if applicable)
Y I::ISalinity Barrier IRONI TO _ atATET.,1t I;'at t,.1(1\1L\r an:rnou
Fl Aquifer'lesl ' 0St(nnnvalerDrainage rt. ft. - - - _-
17lixperinienutl TechnologyI_lSubsiticncc Control ft. fy `----) '----- - _ _1
It icuthcrmal(Closed Loop) I:.I'IYaccr 20,DICILLIN(.;LOG(attach udditionnl'chcevts IL necessary) --_.-- ._
LIGcolhcrnutl(Beating/Cooling Return) I�1Othcr(explain under//7.1 Remarks) rltt�t ___-rO ---. °ta(attl it° (�„in_,•,i,p,dngy,,.n uro a r;•p,, r,,l, ir,,i, a
0 11, 70 rl: DIRT
4.Date Well(s)Completed: 02-23-23 Well ID// 70 I'•_245_ IL ROCK .
Sa.Well Location: ft. - - ft. - -- "
SILVERPOINT HOMES -rt. — - IL �.•' -r - _____-- - --
Facility/Owner Name Facility IDk(il'applicable) R. II. i
6367 ROCK FALLS RD,MORGANTON,N,C, 28655 fly "" _ft. ,JAN-I.-S 2024'
Physical Address.City,and Lip ft. ft. ' � .^ -- `__.__.--•------_.__. ._
BURKE 2639677493 n'v'r'-�lien err `"x"" tie, ---_
21,REMARKS E3 .•coo=-mac
(•°only Parcel Identification No.(PIN)
5b.latitude and longitude in'degrees/minutes/seconds or decimal degrees: - -_
(il'well Held,one Lullong is sonic knit) —1 —--- -- -
35° 38.348 N 81 ° 34.315 22.Cent ion:
I° 2/23/2023
6.Is(are)the well(s): f`ll'ermanent or El'I'emparary Signature of ' rafted ell Contract( Dane
lb,signing this firm,l hereby erect/i•that the Well(s),ras(were)constructed in accordance with
7.Is this a repair to an existing well: LIYes or I?INo /54 N(•:IC(2C./1/00 or ISA NC:IC,'02(,'.0200 IVc//construction standards aid chat it copy
I/this is a repair,fill out known well construction lglbrmatioc and explain the'mare ol'the "!•this record lax been 1".""led I"doe well ascner-
repair under 02l!muds s section or an the back yl'chis„/neat.
23.Site diagram or additional well details:
You any use the back of this page to provide additional well construction tali,
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only I C1W-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages ifcleeesar\.
drilled:
- _ 24.SUBMITTAL INSTRUCTIONS •'
9.Total well depth below land surface: 245 (it,)
Pmaahip/c wells list all depths il'dilli•rcn,tramplle-.3(i/!2011'caul2(n.!IO ') Submit this GW-I within 30 days ol'well,uomplt ion per the following;
10.Static water level below top of casing:
(
50 (It') 24a, For All Wells: Original form ui Division o!' Water Resources I l)\Vlt I.
1%wain lercl ie uhurcrn.cia,L,use"i" Information Processing Unit, 1617 iMSCI•Raleigh,NC 27699-1617
II.Borehole diameter: 6 (its) 24b. For Injection Wells: Copy to D\•VR. Underground Injection Control I IIJ('!
Fragrant, 163E VISE,Raleigh,NC2769r):1636
12.Well construction method:
(i.e.auger,amity,cable,direct push.etc.) 24e.For Water Supply and Open-Loop Geothermal(return Wells:Copy tothe
county environmental health depar utent bf the county where installed
FOR WATER SUPPLY WELLS ONLY: 1'
p 24d.For Water Wells producing over I(10,000 GPI): Copy to DWR,('('I'('U,\
13a.Yield(gpm) 50 Mefhetl of test:AIR Permit Program, IGI I MSC.Raleigh,NC(27699-I6I I
1
131).Disinfection type: HTH Amount: •
I
Perm OW-I North Carolina Dcpartrnucn of Environmental Quality-Division of Water Resources . Revised l-a-"oIS