GW1--00734_Well Construction - GW1_20240119

WELL CONSi UC'I'ION RECORD (CW-1)
For Internal Use Only: l
I.Well Contractor Information: I
RANDY OWNBEY 1 I
Well Coau'aetot Name — 14.WATER ZONES I I ---
3214A 289 rt. 290 it. I ___ .. _..
NC Well Contractor Certification Number ft. ft
AIR DRILLING INC IS,OUTER CASING Mir rnulti-easelltiells)ORLINER(ifapplicable)tl.u.--___...
�I.\rla
Company Nunn 0 rt. 136 r'• 6 I I iu. - GALV
2,Well Construction Permit 0: OSWP-2023-12962 16.INNER CASING OR TUBING(gcothcrmal closet!-looI)',
7
PROS! ___ .Tp
Lis(all applicable well construction permits(i.e.(/!C,County,State, Variance.etc,) ft. "—' UTA\•11•:1'I•:Itl PIIICK\haS \l,s'1'EItIS I.
ft. in.
3.Well Use(check well use):, ft. ft.-- ----- - —
Water Supply Well: I
17.SCRr EN --_
:Agricultural 7 Afoul_-__p —._ i)LA,,71.,1t.?tl sl.O'fstrr_ ft11C1(NI•;S5 2l, fatIAl.
I L1Munieipal/1 uhlic - - —
' :(ieulherin:d(I Italia:;/C.'uolinp Supply) I'IResidenlial\Viler Supply(single) ----.�__, 1.1. iu.'I,
'htdusu'inl,Commercial
I Ike Residential Water Supply(shared) — -----._...._._...._-._--.--- ._--,_.;,------•---_L___.._..__. ._ _ i
Is.GROUT
f Ilrrigation I'IWclls> I00,000 GPD rmpAl TOMATERIALr:Mu'1.a(I•:mn•:x'ralt:rnuu x AMOUNTI
,\uu-\\:aUcr Supply Well;
_--..---.--------.......
0 ft. 20 II. GROUT , POURED
I IMuniluring lJlt.eeovcry -
Injection Well: 17. fl
11!\railer Rechargeft. fl.
I".IGroundwater Reinediation I
I Ir\auilcr Storage and Recovery 19.SAND/GRAVEL PACK(if applicable) —`LlSalinityl3arrier FROM To MMATEtti,ci. EMI't.ACI_asii crM':ritot)LIAquiler Test OStormwater Drainage ft. ft.
rilnxperintental'l'cchnology I:Subsidence Control — ft. ft. —_ -' _.____._
l I(icothemtal(Closed Loop) iTl'racer 20.DRILLING LOG(attach additional sheets irnecessart') --_ _—
I.I(ieotherutal(I(eating/Cooling Return) 1_IOthcr(explain under i.. t------ TO Uliti(:1tIP'... color hardness,sniUrnsle lypa.train tier,c,r,)
( I !�I Remarks) —_ ------ - ---L_._(--
6-9-2023 0 rt. 126 r'• DIRT
4.Dtttc\Vcll(s)Completed: Well WI/ 126 rt• 305 fly ROCK ,.it --- i
ia.Well Location:
I}, ft. '
ANDREA JAMES ft. ft _ --- '
r• ;
Facility/Owner Name Facility I[)/I(it tpplicnblc) ft. - II. 1 ` ± r ,L(rA i, 1 v,:,��
149 ELYSIAN DR,MOORESVILLE,N.C. 28117 n. _.._._.._ ___..._-.___.__ .-,
Physical Address.Pity,:and Zip ._.----'---'i"`-----
IREDELL 4646356875 21.REMARKS
;n;:; -- --_- — -----_..._
v'
yawn, Parcel Idmrli neat ion No.(PIN) —
7 .�
_L..._.... ��e•(,:i'_y(.fir:,', iv..-
51).Latitude and longitude in degrees/tninules/sec011(IS or decimal degrees: I
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(il'well lield,one lit/long is sufficient)
---•- _.-----._... .- --- -._ ,
35° 33.891 N 80° 52.245 22.CcrtiP on:
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6/9/2023
6.Is(tire)the well(s): 171Permanent or ITI'empornry Signature of Certified Well Contractor Date
By signing this Jana,/hereby cerli(i•that lhelirel/(c)110,1(were)constructed in acrary/aucc with
7.Is this a repair to an existing well: LI Yes or I'INo IS:I N(....1(..02C.0/00 or/54 A'e::1C 022U.0200!Fell Cansu•uelioa Sliminlm'dc and rho,a rrpr
(falls is a repair,•/ill out known)we'll construction in/ormalion and explain the nature oldie of this record hn.s been prrn'ided Io the well owner.
repair minder 112I rca+orks sec•lW!l or on the hack of this from.
23.Site diagram or additional well details:
S.For Geoprohe/DPT or Closed-Loop Geothermal Wells having the Caine You may use the back (!'this page ur provide additional well construction info
eunstructi(n.only I OW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in'Ren)arks Box).You ratty also attach additional pages iI necessary.
drilled:
24.SUBMITTAL INSTRUCT I.
9.'Total well depth below land surface: 305
1•'nrnu,ltiple wells list all depths i/di/i'rent(example..3611?00'and'(ntl00') (ft.) Submit this GbV-1 within 30 days of well completion pm the I'nllowing:
ill.Static water level below lop of ruing: 30 (i(') 24a. For All Wells: Original fora) iii Division of Water Resources (UWR;,
I!'+rrrrr, ler,rl is above casing use" ) Inlbrmation Processing Unit, I617 MSCi::,Raleigh,NC 2 7609-I6I7 .
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I I.Borehole diameter: 6 (ilt.) 24b. For In'cclion Wells: Copy to D\VIZ. Underground Injection Control (IIIC)
Program, I636MSC,Raleigh.NC 27699-'.(636
12.Well construction method:
(ix.anger,unary,cable,direct push.etc.)
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copt to the
county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY:1 24d.For\\'ater Wells producing(well
0
U110.0(111 CPI): Copy to I)\VR,('(•PC't'
Da.Yield(gent) Method Method of test: AIR Permit Program, I61 I MSC.Raleigh,NC 27699-I61 I
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13b.Disinfection type: HTH Amount:
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Pam
it(1W-I North Carolina Dep:ii•tment of Environmental Quality-Division of Water Resources
Revised a-t,_;!o I