HomeMy WebLinkAboutGW1--05525_Well Construction - GW1_20240913 . .i .„.
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lirgy. , coNSTRyCnoN RECORD GW4' For Internal Use Only:
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1.Well Contractor PP:it:motion: . . ,
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FROM_ TO_ ..' 'DESCRIPTION
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NC il Contractor Ceilification Number 1-7 . • d
.,_ , 1.4.1'01121tR-HaNN-07(fOnliMeiiienirD13:10NEIVOriritesilifel
;Yadkin Well Cof.rIpany, Inc. ,.',_• , - •FROM, :TO. . DI - _ raamerass _ 'MAT ER I id*
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CompanyName . ., ie gA '
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2.Well Construction Permit li: CI(CI i&2,-- 22s2.3 .FROM ,TO . DIAMETER• THICKNESS. - BIATntrAL' . . •
...' List all applicable well construction permits(i.e.UM,Cowry State,Variance:eta) -ft. IbMit' /j6'in'. 1 W ea)V '
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•..: 3.Well Use(check well use): ft: .
Water Supply We
ll: alataitalk--:::-,722 -:;_lnl,s2711:',.7:::,=1...N.:•ir•rs.fiiii.VEtii'iiiitizr-:.......'::•f•ZIT..'
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. FROM _TO. _ ,DIAMETER:..SLOT SISIZE .,.TRICKNESS, MATERIAL -
.S. DIAgricultural DM.unicipal/Publid ': ft ft.
OGeothennal(Heating,/Cooling Supply) (113feSidenlial Water Supply(single) ' ft. I 'ft; '- - ' - - - - - . •,,.,
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Olndustrial/Commercial OResidentirdWater Supply(Shared): 'visr.mixtr.-74- :,,...--; -:- '- ----• • = -- - ---- • i•-•-r''...7.-'''..
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ClInigation OWells>100,000 GPD' _ , ,FROM TO' _ _ . DiATERIAL._ EMPLACEMENT meTiksistAMoure.
Non-Water Supply Well: .
' 0_ft' ;39,1L &6.841-VeA..9tati V _Ziats5 Cit,.: .
ElMonitoring DRecovery _ _ : ft; ; ft.
Injection Well: -1. - ft. ft. - •
CIA0er Recharge OGroundtrater Reniediation i -- - , O , .
illkSANDMIRWV313331XCICSMiailiteim '': ''-'1
C4iiifer Storage and Recovery DSlilinity Battier FROM_ 'TO . . MATERIAL . EMPLACEMENT METHOD -
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OAcinif er Test OStormwatertitaiiiage ,, ft. ft ' 1,
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:Experimental Technology OSUbsidende-COntrot '1 ft. .i ft.
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OGeotherinal(Closed Loop) . ElTricer il2013GIOG(ittlie'lilidulraliketiriffiefiiiiiniy)a7125S.,1:1T-7.111,:t::,JF.'--!• gr
FROM 'TO DFSCREPTION,Ceder,Idirdeets,sollittek tYpe, ab slze,,ete.)- 1'.
OGeothermal(Heating/Ccioling Return) D Other.(explain under#21 Retnerksi. •
Date Well Started -7.-ib- ai 1....) ' 0 ft- ! .tO ft. • ril l'-I. (.r .'z
4.Date Well(s)Completed. 747- -1tai ':,weura# ./ 14,13t 4 15,r) ft. ft*Il ‘ $...04:r,c9rphl-K., ..,
5a.Well Location: •'''',,,40.' Phone#:33C-$C41. og'S"g .. ,77 r)ft. 'Ift.I t, ic c • -- r
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i , aret yeleoi ttle-yeeiV , ft, ' _ft. -k if 14;AirtP 4 T;Yd C.; Canet/ - - - - . ''''':Th ir""9 1 ,t9 9.-.•-•-....
Facility/OwnerName k', Facility lDit(if applicable), , ft: , ft. - 17'',-+- '..,01.... 4‘i ."".i.." I
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9 / ge."-4-'Tree /dap. Yq;Elit lit v iiie , ft. ft, - --- j
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Physical Address,City,and zip '' NC: a77055 ft. ft.-
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Pared Iderdification,No.(AN), "-• 1247C.-.4.'7 _CO6 Zttr‘5._Iti 41" 'FA '- 5Raitew2, -T INA,
5b.Latitude and longitude in degrees/minutek/seconds or decitial degrees: - -- --- -
(if well field,one let/long is sufficient) .,-....1
22.Certification: . 75.
. SC o 12.2L1 .-
8.0#: cr4A 3‘1_ Vir e ---27 .--
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' 6.Is(are)the well(s): laPiermanent or OTemporary Signatireo C ' ad Well Contrail& Date'
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*signing thisfoi7n;Ihereby ad.*that the wellarwas fwere):eonstrueted in accordance with
7.1s this a repair to an existing well: IllYea Or 1 15A NCAC 02C.0100 or 15A NCAC 02C.0200 war Con:frith:1mi Windards and that a copy
. gilds is a repair,Jill out known well construction information and eipleigthenatiire afthe of this record haS been provided to the wen:on-men
repair under#21 remarks section or on the back of thisAnn: •
23:'Site diagram or additional well:details: .•,
You May use;the back Of this page to provide additionW.Well construction info P
8.For GeoprobeJDPT or Closed-Loop Geothermal WellS hiiVing the sante
(add'See°Vet'in•Remarks Bet):YOU may also attach additional pages if nec.essary. -\
, constmction,only 1 GW/1 is needed Indicate T)OTAL NUM:MIR of*ells•
----.' - drilled:
• . ..._____, / 24:simurrAL INSTRUCTIONS,
• 9.Total well deith below land surface: loCaS_ .
For multiple wells list all depths if different(example-3g20-0'- :2@.1007. (ft)' Submit this GW-1,Within 30 days of well completion per the foRowingi
24a For AR Wells: Origimil,form-to Division of Water Resoluta, (bWR),
10.Static water level below top of casing: ::. 19,6._ . , ., __
If water level is above casing,use"+" „ 0-4 Ifif-. atiodYrbeetting Unit,1617MSC,Raleigh,NC27699,1611 -
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11.Borehole diameter: ' C. oxLiElit Off: 1 ...•.1-(6.7,.. 24b.For Injection Wells:Copy to,DVM,U3 iidergrolind.Injection Controlcup
Prograni,1636 MSC,.Raleigh,Ng 276 99.166 ,
12.Well construction method:A-lie taalloray 0 au. - 24e.For Water Supply and Open-Loop Geothermal-Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county-cavil-cantle:nal health department of the'county where installed- kA
FOR WATER SUPPLY WELLS ONLY: t,- Z
i 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA 4
'Permit Prognini,1611 MSC,Raleigh;NC 276994611
13a.Yield(gpm)• t, Method of test: Allti . 7.,
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: Date Site Visited; 3...-.1k.-.2 Y .
70% hth Amount: li g,,, oZ
13b.Disinfection type: • Site Visited-By: 0 Cria.. - .2 c-•
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Form GW-1 1 I .'.';•'''''':-.. .North Carolina DemitinentofEme nmental Quality-Division of Water Resources Revised 6-6-2018,
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Price: 1- - . . • ,,-.,_ . , . "Zi----
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