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Home My WebLink AboutGW1--05550_Well Construction - GW1_20240913 CONSTRUCTION RECORD (GW-1' di For Internal Use Only: 1. ell Conti?,ctor Information: t` �, 1ys T 9 �'( - `' IC I) ,J' •"�` er _iii WATER:°ZONESItr;;y;:•:• ;•• .,.. - .. . •. . �° • FROM TO DESCRIPTION Well Contractor Nreine/i — 6 i ft. 5'.0 ft ci V �R A . 6.1 A ft. � it NC Well Contractor Certification Number 1I5:oUJ'EIt:CASING`.(fuiliiilfi;c`""esei{ve4.s':OR°L•INEX(iap"licaliler:::::'- Yadkin Well Company, Inc. FROM TO .DIAMETER TrnclCRESS MATERIAL . t ft. I. C ft. 6./Z C in* c0/2'2..i I". — CompanyName b�i6'llibl 1t:CASING:ORTUBING:(keottieimal`clo4edioop]::. ?';c:::<:,::r:':'.,... - / 2.Well Construction Permit#: 0 ' & -A '`P D l `FROM TO . Norma THICKNESS MATERIAL ( ' ft. ft. in. List all applicable well construction permits(i.e.UlC Cowo(y,State,Variance,efc) ft ft in. ' 3.We11 Use(check welluse): . Water Supply Well: PROM •TO DI►MIcT R SLOT Si7.P THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public ft. ft, in. LA ❑Geothemial(Heating/Cooling Supply) ['Residential Water Supply(single) ft ft in.❑lndustrial/Commercial ta esidential Water Supply(shared) _ - ,:.•; ;;:'.;.:'.: -._ . .' - ,13.GROUT. _..: ❑�gation ❑Wells>100,000 GPD .FROM TO , MATERIAI. Ehir/ACEMENT METHOD&AMouNT Non-Water Supply Well: oft. F. ft' ,,q7/3 al, i iq/ . [Monitoring ❑Recovery ft ft. Injection Well: ft. ft. DAquifer Recharge ❑Groundwater Remediation i`19:SAND%int9I%PiAGLC(irmPp1i'c'aTe ;:: ==•.:;:;r':;c' ::`';i:;. ❑AquiferStorage and Recovery DSalinityBarrier FROM TO MATERIAL EMPI:ACEIMSPITMTTHOD ❑Aquifer Test ❑Stonnwater Drainage ft. ft. F. ❑Experimental Technology OSubsidence Control ft., ft. ❑Geothermal(Closed Loop) ❑Tracer `20DR GI:OG(attachaailitioniriliafii`itnee iliry)__.::..:- _ --' :`' FROM TO DESCRIPTION(color,hardness,soli/rook type,grain size,etc.) ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ;itt ft a t„ �. Date Well Started 7-111 -Z 1 L0 4.Date Well(s)Completed: 7''Q 2-4 Well ID#4/31 Z- .qg 19 ft. 7-S ft `ra,;;lit. Sa Well Location Oa ei •.1•c Phone#: 703-�92•.Ste'2 Snow& . ( ft. 6 0 7 ft ✓_e,,e,n•: i e. . s 'a3 4�//.-9YAJV ft. ft 5 E.. :"_ . ;- arc cr Da...A 8.Fy0" r ., = - Facilit OwnerNatne Facility ID#(if applicable) ft. ft. `' '��..e; .a yq L.) aA,4 sr v i lCc� ft. ft. S t r 1 2024 Physical ddress,City, - tP and Zip , 01/0 l ft. ft if,: :-).-__ -t. 1 1'4 .Ns CountY Parcel Identification No.(PIN) 5b.Latitude and longitude in degrees/min-ntes/seconds or decimal degrees: ./ (if well field,one latilong is sufficient) 22 Ce ' cation: J N �o, `Z 4f G w /l� 2/ o 2 ii, . . QC., -3 ice` ,' IA -t J S boa c of Ce Well Contractor .' Date 6.Is(are)the well(s): Permanent or OTemporary By s,, ing th•form,I hereby certify that the well(s)wa(('were)constructed in accordance with 7.Is this a repair to an existing well: DYes or lido 15A NCAC 02C.0100 or 154 NCAC 02C.0200 fW yf Construction Standards and that a copy If this is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owne, repair under#21 remarks 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 y use the back of this page to provide additional well construction info construction,only 1 G7-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary. drilled: 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: u (ft) Submit this GW-1 within 30 days of well completion per the following: For multiple wells list all depths if different(example-3Qa 2 0'and 2®100) tt • 24a. For All Wells: Original form to Division of Water Resources (DWR), 10.Static water level below top of casing: �''� at.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 If water level is above casing use"+" r 11.BorehoIe diameter: 6 ( 24b.For Injection'Wells:Copy to DWR,Underground Injection Control(TUC).)$It Off: (( a Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method:AO, no JQr7 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the t (i.e:auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed Als'g FOR WATER SUPPLY'WELLS ONLY: • 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA '7Method of test: �i t r Permit Program,1611 MSC,Raleigh,NC 27699-1611 ^^ 00, 13a.Yield(gpm) y . $ f-Y (,r c.'"V Pin 9 Pe4 al,/ f o .1 Date Site Visited: 7" 13b.Disinfection type: 70�c hth Amount: I® Oz Site Visited By: IN a-aci Oct r ® r1 � tv Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources _® �9 Revised 6 fi-20I8 Price: 1 - r y