GW1--00641_Well Construction - GW1_20240119

WELL CONSTRUCTION RECORll GW-1
� ) For Internal Use Only:
I.Well Contractor Information: '
CHAD HARTNESS
14,WATER ZONES l i
Well Contractor Name mom To t)ESC1(I I'"PION ---
2901 A 409 IL 410 It. ---1
f.- ff. 1 4
NC'Well Contractor Certification Number
AIR DRILLING I N C IS.OUTER CASING(far multi-eased wells)OR LINER(if applicable)
fRO)st To DL\\tta•ER THICKNESS stA•rtitu o. -1
Company Name 0 51 6 IPVC
327829 16.INNER CASING OR TUBING 'eothernml closed-lot,)
2.Well Const action Permit if: paosl To t rtnNrSS �:�"rla tA
Hsi anup/diva/de,fell construction permits(Le.WC.County.State', Variance.etc.) ft. ft. —l:�s�li-f[li in,- -c.t: ---- ---a -- - t. .I
3,Well Use(check well use): — ft. '-- _rl. . ._-- tn. ----- - --'-- .- _.._..._... .
\Ve
\\'tiler Supply il: 17.SCREEN — 'I
PRosi To ttA\th:l'61IC
IA�ricultu•al ) -...-------------------•-----_.---st.orstrn rutct<xiss �tnrratlnt.!- C_IMunicipal/1 abbe ft. 17, in.
i !Geothermal(I feating/Cooling Supply) In Residential Water Supply(single) - -
I_Ilndustrial/Commercial LIResidenlial Water Supply(shared) ---------
I8,GROUT
El Irrigation ElWells> I00,000GPD pno)I To atATERtAI. EMPLAcEst ENT St tC'rttol> S AM __
Non-Water Supply Well: 0 ft, 20 ff. GROUT POURED
:!Monitoring DJRecovery ft, ft. — ---- --'
injection Well:
LLlcuilcr ft. ft. --- - -- - -
I RechargeI.:IGroundwater Remcdiation
19.SAND/GRAVEL PACK(if applicable) — -
LIAquifor Storage and Recovery I_ISalinity Barrier t+Mosl _rI MATERIAL EMPLACEMENT METHOD
IlAquiler'lest LlStormwaierDrainage ft. I't. -- -- -
'tix erimemal' echnoloby ESubsidcucc Control ft, -
ft
!-IGeolhernrtl(Closed Loop) l Trseer 20.DRILLING LOG(attach additional sheets if necessary)
! Geothermal(I fearing/Cooling Return) GOther(explain under 1i21 Remarks) PROM _ro---_DESCRIPTION(color,bareness,sun/rip:II i)e,gnus_sic.,eic•)—
0 n, 41 fL DIRT i
a
04-21-2023 — — ---- ---- —.._...Dale Well(s)Completed: Well iDl/ 41 n• 425 it ROCK
5a.Well Lurtlion: �.I----��- =
A - S. v'; 'COMPTON BUILDERS —__—_— ---. _.------- .
iLl
xc ility/(teener Name I:,ciliiy ID/'(ifapplicahlc) ft. it.
I JAN I 9 2024
215 CAL KENNEDY RD,CLEVELAND,N.C. 27013
Physical Address,City.and Zip
rt. — ft, ----,----�ilw,fief.'tzn-rz zls!n-TV-tgiN
ROWAN 277055 ,,,„ 21.REMARKS , '"c ''tom
County .
Parcel identification No.WIN)1 —.-_--- 41"�'-
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: :--- —_
(if well licld.onetat/long issl)'IicicnO ;JI ¢ �__ _ _._. •
35 43.296 N 80 43.341 \�
11 Signature of Certilted Well Contract
6.Is(are)the well(s): I°IPermanent or D"Temporary
s Date --
titlii
By signing this farm,l hereby rer•ti/i•that the,rel)(s)❑cos(,sere)consrruere•d$h+Ht•rordwrrr with
7.Is this a repair to at,existing well: DYes or I`INo /5,1,VC.'IC.02C.(1/00 or 154 N(:AC 0.2C:•.0200 Ilell Construction S'amdends and that a cup,
IONS is a repair.fill out known well construction inlnrnraifoil and egrlain the nature oldie of this record has been provided to Inv,cell onne,-.
re pai,•mulct-02l remarks section or an the bar-f.'o/'this lino,.
23.Site diagram or additional well details:
You may use the back oh'this page to provide additional well construction inli,
S.For Geoprohe/DPT or Closed-Loop Geothermal Wells having the stone
(add See Over'in Remarks Box).You may also attach additional pages ifnacrsv,:)
roustruetion,only I OW-I is needed. Indicate TOTAL..NUMBER or wells
drilled:
24.SUB -II'I'77\LINSTRUCIIONS
9.'Cotul well depth below land surface: 425 (I•t,) i
Par nra/tipie wells/ist all c/cpt/ts i/'dl//i•reat(example-.i(i 700'soul21ro100') Submit this G1\'-1 within 30 days of well completion per the following:
I.I 24a. For All Wells: Original form to Division of Water Resources (DWR I.
(U.Static water level below lop ol'casing: 30
ll timer/reel is above casing,rise",-" ( ) Inlinmation ProcessingUnit, IGI%1vISC,Raleigh,NC 27699-I G 17
I I.Borehole diameter: 6 (in.) 241). For Injection Wells: Copy id,'DWR, underground Injection Control (Il)(;I
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: I.
(i.e.auger,rotary,cable,direct push,etc.) 24c.For Water Supply nod Open-Loop Geothermal Return Wells:Copy to Ice
county environmental health tleparltiicnt of the county where installed
FOR\VA'I'[sR SUPPLY WELLS ONLY: I'
24c1,For Water Wells producing Liver 100,000 GI'D: Copy to DWR,CC'('U,\
13a.Yield(gpm) 3 Method ol'test: AIR Permit Program, 1611 MSC,Raliigh.NC 27699-I6I 1
13b.Disinfection type: HTH Amount:
Farm(lW-I North Carolina Department of Environmental Quality-Division at'Water Resources 1 I Revised 6-0-:'tlS
! I