GW1--00725_Well Construction - GW1_20240119

WELL CONSTRUCTION RECORD GW-j
For Internal Use Only: ,
II.Well Contractor information: I l
RANDY OWNBEY
14.WATER ZONES I I
Well Contractor Name FROxI TO DESCRIPTION
3214A 369 ft. 370 ft 1 I ----------•------
NC Well Contractor Certification Number ff• rL I I
AIR DRILLING I N C IS,OUTER CASING(for multi-cased)wells)OR LINER(If oP)licahle)
FRO\I TO DIAMETER TIIiCKNI:ss xi,VIERtM,
Company Name 0 ft' 76 ft, 16 "t' PVC _. .-
2022-10199 16.INNER CASING OR TUBING(geothermal closed-loop)
2.'Well Construction Permit//: FRO t To DIAMETER, Tinclo Ess �NATLRtAI.
tam till applicable well construction permits(i.e.(//C,County,Steele, Variance,um.) ft. ft. j! in. _
3.Well Use(check well use): ft. fl. i; in. -'- —
Wn1er Supply Well: 17.SCREEN I , —
LlAgricuhur:tl _rtto.t To _ nlna'lt•:fito I sl.orslru_ THICKNESS .\I MATERIAL
ft. t't. in.
LlGcothermal(Heating/Cooling Supply) L•IRcsidential Water Supply(single)
fl. ft. in.
I-Ilnclustrial/Commercial ID Residential Water Supply(shared)
18.GROUT i —
CI Irrigation ❑Wells> 100,000 GPD Pltost TO SIATEttl,\I. EMPI.ACEM ENT mrrtioD&Amu0 LINT
Non-Water Supply Well: 0 fl• '20 ft• GROUT POURED
❑Monitoring DRecovery rt. ft,
Injection Well: i
lJAduifcr Recharge fJGroundwatcr Rcmediation ft. ff.
17Aquilcr Storage and Recover 19.SAND/GRAVEL PACE(if applicable)
Y OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
lJAquifcr Test CIStormwater Drainage ' ft. ft. !
Cllixperimental'technology ❑Subsidence Control ft. ft. —___
OGeothcrrnal(Closed Loop) ❑Tracer
20.DRILLING LOG(attach additional sheets If necessary)
LlGcothermal(Heating/Cooling Return) Cl Other(explain under 1/21 Remarks) FROM TO DESCRIPTION(color,hardness,call/rndc type,groin size,ele.)
p ft, 66 ' ft. DIRT
4.Date Well(s)Completed: 1-24-2023 Well IDI/ 66 ft• 385 I•t. ROCK 1
Sa.Well Location; ft. ft. - 'd -"
—_1u•_ -.X
COPPER BUILDERS — n, — n. -- =t,br. 4•
,-.^
Iacilitl'iO,vncrNamc rt. fl. j Jr�j --- -""'� .Facility IDII(ifapplfcable) A
109 RYLEIGH DAN PLACE, MOORESVILLE,N.C. 28117 fl. It. j. N�_ Z4_.--`--
•
Physical Address,City,and Zip ft, (1. tU` 's°''.'�i1 ��C —
IREDELL 4654687138 ' 21.REMARKS '- , Or; V
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: 6' I: -- _ J
(if well field,one tut/lent!is sufficient) 22.Cel'1i15C. --
35° 31 .047 N 80° 49.498 N, '
• 1/24/2023
(I.Is(are)the well(s): ❑Permanent or OTemporary Signatue of Certif t Well Contractor i Date
Byxigning/hisfbon,I hereby cerli/i•that t/te•tvell(x)was(here)constructed in uccordunce with
7.Is this a repair to an existing well: DYes or l Net 154 NC-IC 02C.0/00 or/5;1 NCAC:02C•0200 IVe/1 Construction Standards and that a copy
!phis is a repair.fill out known well construction iq%rma(ion and explain the nature of the (Obis record has beer,provided to the well r',yn•,••
repair under 1121 remarks section or on the bock of this foray.
23.Site diagram or additional well details:
S.For Geuprohe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to'provide additional well oonsuuctinn in lb
construction,only I OW-I is needed. Indicate TOTAL NUMBER of wells (add'Sec Over'in Remarks Box).Youtray also attach additional pages il'neceosnn•.
drilled:
`T- 24.SUBMITTAL INSTRUCTIONS
9.'1'otal well depth below land surfa1Ce: 385 (no
Pm.multiple wells list all depths ii'/'di/Jcren!(example-.3 a?On'and?�t110(l') Submit this G\•V-I within 30 days of well completion per the following:
Ill,Static water level below cup ofcasing; 50 (, , 24a. For All Wells: Original form to Division of Water Resources (DWRi,
?fewer is,dtorertx•ine ux•e .• Information Processing Unit, I617 MSC,Raleigh,NC 27GJ9-I(il7
I I.Borehole diameter: 6 (in,) 24b.ForInjection Wells: Copy to DWR, Underground Injection Control (WC)
Program, 1636 MSC,Raleigh,NC 27699.11636
12.Well construction method: 24c.For Witter Supply and Open-Loop Geothermal Return Wells:Co to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed PY
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing ove': 100,000 GPD: Copy to DWR,CCPC'UA
13a.Yield r m, 25 AIR Permit Program, 1611 MSC,Raleigh,NC 27699-1 6 1 1
(6I ) Method of test:
i3b.Disinfection type: HTH Amount:
Perm GW-I - Nord,Carolina Department of Environmental Quality-Division of\\'tiler Resources Revised 6-(1--2(118