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Home My WebLink AboutGW1--05531_Well Construction - GW1_20240913 • �_.`VE'LL CONSTRUCTION RECORD(GPV-I) For Internal Use Only: d 1.Well Contr9a�ctorit5 �ormation: I 0 Y. /VE. ir14.WATERtZONES' :.':'... t...'.: ' . Well Contractor Name FROM TO '\f I DESCRIPTION q-® _962 ft 5 - 3G Rvi Uri _____________kick ft - ft - - NC Well Contractor Certifi cation Number 1$'rO17TER:CASING`(foz�ulti easeifwelEIDRITPIF °(iL's"lira ilef;i.n.:':,.. � Yadkin Well Company, Inc. FROM TO DIAMETER THICKNESS 1 MATERIAL P ft ft in. Company Name t r .- .6_1N4NER:GASThG'OR;ru$ING(khrtthermaldosealo' �.:5 'it.%;�.. • 2.Well Construction Permit#: iJ' FROM TO . D THICKNESS MATERIAL List all applicable well construction permits(i.e.UIC Comity,State Variance,etc) "r'I v c . 3.Well Use(check well use): ft. ft in :--' Water Supply Well: FROM A 1.:JAQ: :->`:% '�:'t' 4::. .r:>: .. ..:,',: FROM TO DIAMETER SLOT SIZE 'THICKNESS MATERIAI. Agricultural OMunicipal/Public ft ft in. ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) , ft ft in. I ❑Industrial/Commercial [Residential Water Supply(shared) Togratb-tm.:::..ni.;2,,,:.:gs::.:-.;,24::::._-..3y:-...-1,,.-.7, • - ❑Irrigation ❑Wells>100,000 GPD FROM TO NATERIAL EMPLACEMENTMETaOD&AMOUNT Non-Water Supply Well: ( 6 ft ft ✓ '0)1 rp �,�.1 A(, dagc J j [Monitoring ❑Recovery ft. ft. Injection Well: ft ft :aquifer Recharge ❑Groundwater Remediation OAquiferStorageaadRecovery OSalinityBatrier `19:"SAND/GBAVR1 PACK ( ca"b7e)c „ _ ,-;:1... _= `*` _-. FROM TO MATERIAL EMPLACEMENTMETHOD ❑Aquifer Test ❑StormwaterDrainage ft. ft [Experimental Technology ❑Subsidence Control ft ft. .r' ❑Geothermal(Closed.Loop) OTracer �20:DRI>; INCY'EOG.(itfi eriidi itiFialsfiefiti idneceiilify-Vi i Z:'i :=:':': • ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,sall/rock type,grain sire,etc.) Date Well Started 7--ga 919 0 ft 60 ft 5c'1 I 4.Date Well(s)Completed: 6 -ak Well ID# Ur" ei- 0 I tiO ft • ®�f. 00t( j ki Sa.Well Location: Phone#:�� rt.�-y-�'ic i ft. ft �J Mo.. i.4.1e. Odot''tt ft. ft , 006, Facility/OwnerName Facility DU(if applicable) R ft dt '. '�-§e f ft ft l C'3 /ez.,. / & ..5 go SEf' 1 b Z024 Physical Adiiress,City,and Zip ft ft 1,0 .I '•:Z1sgiT�.l seirS ..:..:. n._ L iKi i, :2.rs•y :a a �` �r ...: 03 County Parcel Identification No.(PIN) Caw t k Da,„c•2,�i Sb.Latitude and Iongitude in degrees/minutes/seconds or decimal degrees: (if well field,one lat/long is sufficient) 22.Certification: fff . ' .3C„.32s-cr‘ N gat 70602 6.Is(are)the well(s): &Peermanent or ❑Temporary Signature ed W (t ctor Date By signing this form,Thereby certify that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: [Yes or ®1Vo 154I NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy If this is a repair,fill out brown well construction information and explaiirthe nature of the of this record has been provided to the well owner. repair under421 remark section or on the back ofthis 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 construction,only 1 GW-1 is needed. Indicatt TOTAL NUMBER of wells (add'See Over'in Remarks Box).Youmay also attach additional pages if necessary. drilled: 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: -O A. (it) Submit this GW-1 within 30 days of well completion per the followingi For multiple wells list all depths if different(example-3Q200'and 2Q100) 10.Static water level below top of casing: 75 ( ) 24a. For All Wells: Original form to Division of Water Resources (DWR), .if water level is above casing,use"+ ) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 11.Borehole diameter: C (in.)Bif Off:5.6?-2 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC) Program,1636 MSC,Raleigh,NC 27699-1636 Weil construction method:/4i. �o 411 �sa„ 12.We (i:e.auger,rotary,cable,direct push,etc.) �� 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the � county environmental health department of the county where installed FOR WATER SUPPLY WELLS ONLY: • 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA t Permit Program,.611 MSC,Raleigh,NC 27 699-1 61 1 13a.Yield(gpm) Z Method of test: ;it o //er�gg Date Site Visited: -1.T• :Z y- 13b.Disinfection type: 70�o hth Amount: ay OZ Site Visited By: p aE I Form OW-I North Carolina.Department ofEnvironmental Quality-Division of Water Resources Revised 6-6-2018 { , Price: l3 7..7 gz, 70,:, -