GW1--00723_Well Construction - GW1_20240119

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WEIA,CONS'FRUCI'ION RE'CORI) (GW-1). , For IntC1181 Ilse Only:
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. 1.Well Contractor Information: • •
CHAD HARTNESS - . .
. - 14.WATER ZONES I i
Well Colilrilelor Name • leR031- TO ' DESCRIPTION
2901 A ' . 410 n. I_ I
ft. ft.
NC'Well Contractor Certiliealion Number -
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IS.OUTER CASING(far multi-cased Wells)OR LINER(lisp glcable)
AlR DRILLING INC .
--mi3, TO DIAMETER1 Tinc8NEs8 MATERIAL .._
. . 0 rt. 79 n. 6 r ii„. PVC
Company Name ' ,,.
.1107fIgq . 16.INNER CASING OR TUBING(gliothermal closed-loop)
2,Well Construction Permit II; 1/414-.1 Y tj%j • . _j!,RpAr.,•_::.__._To_7.,_• _____111.:91.t.;.rAi _Titic 104,58._ ...mvyi.:121A1._ .. 1 List all°pp/noble ioil construction perinits fix.WC.County.Slow, Variance.vied l'I. ft. - 1: ,in. .
. 3.Well Use(cheek well use):. ' • • , ft. •ft, 't in. 1
Water Supply Well: - 17.SCREEN
, PROM • TIL„. DIANIFJC:It a .Sidit'SIZ.F. 'THICKNESS NIATERIAI.
LIAgrieultural . 1..1Municipal/Public " .
I iGeothermal(Heating/Cooling SuPply) L'IResidential WaterSupply(single)
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rt. rt.
. t !Industrial/Commercial LIResidential Water Supply(shared) i"Rour
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0 Irrigation ' . LIWells> 100,000 GPO. FROM TO ATATERiAL Empi.,kcEmENTAirniob
Non-Water Supply Well:
Q ft. 20 f'' GROUT POURED
nMoniloring , ft
1.3Itecovery f.
Injection Well:
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. . I' ft.
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1.1Aquifer Recharge OGround WEI tef Itemediation . I,
19.SAND/GRAVEL PACK(if applicable)
I;Aquifer Storageand Itecovery " 1:3Salinity 13arrier _PROAt ...T9_ ' mATERIAt. F.:mei...sm.:Awn sir num
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I.:Aquifer lest • IJStormwaterl)rainage . ft. • , ft. . . •
IlExperimental Technology• 171Subsiclenee Control ft, . ft. I.
:Geothermal(Closed Loop) . . EITracer 20.DRILLING LOG(attach atlditionat'shects if tweenary) . ..._
I i(it:Mlle:mai(I I eat i ng/(ool ing'Return) LI Other(explain under//21 Remarks) -01.19-1-ic---6.-a n-..-: DI I.-C-- 11'..1:,1921(1.52115111'11jIls'' ulusi ".?14r2in'1;‘..L.1-‘73.
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•4.Dole Well(s)Completed; 3-24-2023 l'Vell 11)1/ . 69 IL 425 11.v ROCK :'
• .t,.7z•7--- r.;•;•,,,-.,-. - .
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rt., --. ft. ' .
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5a.Well Location; .
WAC CONTRACTING . rt. It. 1.I; . ,---
L.
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r“,ility/Owno.Nnme ' Facility WI(ir applicable) i:' JAN-1 9 -,0
e 24
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580 PATTERSON FARM RD,MOORESVILLE,N.C. 28115 It. rt. 11. 1 iniCiric1P.5i1,1
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IREDELL • 4685102687 21.REMARKS .
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County Parcel Identification No.(P(N)
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Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
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Orwell field,one Int/(ong is sufficient)
. Rlertiliceybit:2 ......:41tcr.L....,
35° 31.580
80° 44.697 : (, i ..,'' .._,.„4.,,:_.T___....„, 3/24/2023 . .
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Sit:mat:iv of Certified Well Contractor ,,' Owe "------ .
6.ls(are)the well(s): MPermanent or 1:71Temporary
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By signilig ihisibrin,/herein,cerbli,dun thelvel/09 lists(Were;t.i.iiisinicteg ill ileellrdalIct• l'illi
7. Is this a repair to an existing well: Cl Yes or I!INo . /5,4 N'C'.4('Oa'.0/00 or/5,1 Nc.',IC 02C 11200 Well Construction Standards and dna II cops
. if thiv it 0 repair.WI out known well construction I:Ovulation and exploit,the nature tdthe of ihix n-"'""111"b""I"'"vided I"Ih''l'''''11/pi"'
repair snider(121 1131100N.11;r1i011 Or 011 lilt bela Ofilli.V.101711.
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23.Site diagram or additional well details: -
v...e a....c..t.on we..construction ink:
l'ou may use the bitek.of this page to!'pro 1,1 d li i II It
8.For GeoprobeMPT or Closed-Loop Geothermal%Veils having the sante
(add'See Ova'in Remarks Box).Von May also attach additional pages if licce‘sai),
. construction.only I (AV-1 is needed. Indicate TOTAL.NUIVIBlilt of wells
Milled:
. . 24.SUBAIITTAL INSTRUCTIONS:'..
9.Total well depth below land surface: 425 , -. ... , (ft.)- Submit this GW-1 sit thin 30 clays ol'
/ 11.1Well completion or the following:
'‘ 1111111.rit'Wells.list all depths if difii.rrat(example-31.4200''Hid Nsib'0(1)
, 24a. For All Wells: Original form to:,Division of Water Resources I I)WR I.
10.Static water level below lop of easing: 50 .
(It) Inlbrmation Processing Unit, 1617 NIse,Italeigh,NC 27699-1017
illsilwrit'IVI iv(111011!COSIIIN,11$0 ,..- •
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24b.For Injection Wells: Copy'to FMK, Underground Injection Control(MC)
I I.Borehole diameter ' (in.) .
Program, 1636 MSC;Raleigh,NC 27699-1636
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' .12.Well construction method: ., • 24e.For Water Supply and Open-Loot G p eothermal Return Wells:Copy to the
(i.e.auger.rotary.cable.direct push.etc.)
. county environmental health department or the comity where installed
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FOR wATER supPix WELLS ONLY:
24d.For Water Wells producing oveti 100.000 GPO: Copy to I)WR CCPCI.A
Permit Program, 1611 MSC.Raleigh.NC 27699-1611
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13a.Yield(mit) 1 0
Method of test: AIR ,
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HTH .
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131):Disinfection type: . ' . Amount: . „
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Form OW-I North Carolitut Depitrinicili of Environmental Quidity-Division of Willer Resources ' ' Revised 6-6-.10 IS '
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