GW1--01672_Well Construction - GW1_20240313

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WILL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
x�G.v(1tlM_ / ibl El4mATE13'ZONEst:3t`_, :i: :•:�?,Iv .. .i,..' ,ty,:n ,si.•;.1T.- • •. ,...;,,:.
WellContr�acttorname FROM TO , DESCRIPTION
�^'/.1 ?gout ft 24-3'd ft Su " Are4 -
H -.
NC Well Contractor Certification Number ,151'.OUTER'CASINGOtr'multi=e'esed:aellilORL7NER'(it",iip livable)%, '2:'.-:.=^r
Yadkin Well Company, Inc. FROM TO DIAMETER THICKNESS MATERIAL
P Yr i
ft ft in.
Company Name
/ .i16:7NNERCASING.OR.TflBING:(geotliermal'clii edlo-op):•;± - 7,,s•
2.Well Construction Permit#: 3710 0 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) +p ft 2 ft' 6.1 in- SP R �11 p�
3.Well Use(check well use): 1j ft. N ft in.
Water Supply Well .7S:S:CREEtkt=.==-- - '.-. .: :._:2 ..»:��
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
DAgricultural OMunicipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) `qt.esidential Water Supply(single) ft, ft. in.
❑Indnshisl/Commercial ^❑Residential Water Supply(shared) .18 GROUx:;::>-' =- - ----- --. ----- --:--_.
❑Irrigation DWells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft ft gen�1,/,ap 1:8®yy itki
❑Monitoring ❑Recovery 14ft. t
p�°fn,'eolur pfu...Nred
Injection Well:
ft ft
DAquifer Recharge ❑Groundwater Remediation
ii;19:.SA1VD/GRAVF.IiPAC(ifupphnAble)r:;:_ r: =_-`-1-------.':2,
DAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTMETROD
DAquifer Test ❑StormwaterDrainage ft ft
❑Experimental Technology DSubsidence Control ' ft. ft.
0 Geothermal(Closed Loop) DTracer _'_2lli1MILLINGI:OG`(attnOtaddittonulsluetaif.necessary);.-T;=_= ='- �:
FROM TO DESCRIPTION(color,hardness,solllrock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) CI Other(explain under#21 Remarks) ��J ft• �'�a G. d� �
Date Well Started o'-/0-2+0-�d 49 ft.4.Date Well(s)Completed: I- -cc ID s9 Well #AA�4 I 9J� g3 ft 46)°ft �'
rile" d kr _ ie, Jk (,Pry
Sa Well Location: • Phone#: , i D $3 L� ft. ft It, ` i�, .�.,.'e
ft ft Lam-:, 4 - - (/ �°'
U>AI ell? /. 4rh e,s a1,:_,-. '��. '.; rT-•r.- .
Facility/Owner Name Facility ID#(if applicable) ft ft L k / •
S 7% ,3i�t.e. Pos¢ ® /le -e. gc�a'7 ft. ft ,VAR 2024
Physical City,and /�" ft. ft. ;._
Y P �/a pr 1F1V17�Y`7're'�i(f'.,1 prr,. �•
'.._�i..,--: �_
t,e�j�� 2 3B 6,s .:21.ItEIKAIIKSI..__ __ ._._ _.__ ....._ ._nttl •,,s .-„d-- r^..-___
County Val / Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 0 22.Certification:
36 g3. 0Lf3, Ns • 15w 'sot W
6.Is(are)the well(s): )(Permanent or OTemporary S�gn3fure of C. ed Well Contractor Date
)(
Permanent
By signing this forth,'hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: DYes or ro 15A NCAC 02C.0I00 or l5A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction in formation arWexplain the nature of the of this record has been provided to the well owner.
repair under#21 remark section or on the back of this form. 23.Site diagram or additional well details:
• 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
0-1
construction,only 1 GW 1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: I 24.SUBIVIITTAL INSTRUCTIONS
9.Total well depth below land surface: `T .,),° LP
(ft) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3@200'and 2 aC3100)
�" ) 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft Information Processing Unit,1617,MSC,Raleigh,NC 27699-1617
If water level is above casing,use"+"
24b.For Injection Wells:Copy to DWR,Underground Injection Control gm)11.Borehole diameter: (in.)Bit Off: aQ^ ®®� Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: /to 7/-4 r,. 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
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FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA g.)
Permit Program,1611 MSC,Raleigh;NC 27699-1611 . -
13a.Yield(gpm) 9.eA-- Method of test: e.9 Y.
o � Date Site Visited: j"1 i3 .3 93
70/o hth / ' OZ Site Visited By:
_ 13b.Disinfection type: Amount:
Form_GWd_ __ __._North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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