The URL can be used to link to this page

Home My WebLink AboutGW1--06059_Well Construction - GW1_20241011 1 W�i ,CONSTRUCTION RECORD (GW-11 • For Internal Use Only: CA 1.Well Contractor Information: I 0 e rr wai-krnS i14 WATERZONES•V_ ," .y t'`r;e-4n::... . :. ._ 1 L -u a t,_..... .:::4 . ) � • �� FROM • Well Contractor Name ft TO It, .ft DESCRIPTION T'6'P 3liSP f• IhoSDft 2 '/Y, G NC Well Contractor Certification Number .T15r.01: :iCCASING(far'multi=caied;welislORL1NER'(ifip liclble). 12-1..:.•213: Yadkin Well Company, Inc. FROM TO DIAMETER THICKNESS MATERIAL L ft. ft. in. eat Company Name � �� .7 �r 2 a r a i1165IIVNER_CASING:I>ItTQBINC°(geotHecmal:clased=lobp)i'-,f��_•.a;::5,::"::; 2.Well Construction Permit II:: 62. +�. 2-2. y FROM TO DIAMETER THICKNESS MATERIAL. List all applicable well construction permits(ie.UIC,County,State,Variance,etc.) 41 ft J„9 ft II'/C1 m' ,'t a I ev 3.Wel Use(check well use): ft V ft � in. I' Water Supply Well: yFROM TO DIAMETER SLOT SIZE THICIINESS MATERIAL v ' :Agricultural ❑Municipal/Public ft ft in ❑Geothermal(Heating/Cooling Supply) !?liesidential Water Supply(single) ft. ft. in. ar DIndtlstriai/Coinmercial l7Residential Water Su• pply(shared) 1g:;GR:ODT .-�_::�.,,.�:�` - _-'_ .- ` r OImgation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: ,0 ft. 12 I ' 1. 14 le P(v, Nu red I I s3 OMonitoring ❑Recovery ft. ft. Injection Well: ft. ft ❑Aquifer Recharge .0 Groundwater Remediation I:191SANDicarSoLPACK(irappli6b1e):-; w_ -:--;:: �� , ❑Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL E PLACEMENT METHOD ❑Aquifer Test ❑StormwaterDrainage it ft 'S ❑Experimental Technology ❑S Subsidence Control f. ft. �' ❑Geothermal(Closed Loop) ❑Tracer ,'20:DRIL*:SIVG1:OG'(('ttaeli additiunalshe"eiiifBecessary)�.. ___: ._ ....__:_•� , FROM TO_ 1 DESCRIPTION(color,hardness,sail/rock typ size,etc ❑Geothermal(Heating/Cooling Return)• ID Other(explain under#21 Remarks) Date Well Started 8(3OJ �� i� Q too rt• poi I 4.Date Welts)Completed:9 3y Well ID# L O ft I3763 ft C rani ,- K, ____ Sa Well Location: Phone#: T.2. .9(° JZ 3'' ft. it .� . '," : 'i d�la" /Lesiv' 411c. ft. ft. �.,_, &.. 5", - .;3 • . AGif°h ,S.. 3'oyv� &r(ae0 OCT 1 • 20 .. Facility/OwnerNam/e� �+ Facility ID#(if applicc/able) ! ft. ft - //e t7 4 vV1C(h C?0,CMC �j / .ti f x-ite• ft. ft Info: :.£i:T:'. ?"•':^ %^:G a•-i I.:c3:'% Physic(all Address,City,and Zip ✓ 14C eg� ft - ft. L'r'c ;� County Parcel Identification No.(PIN) • 3 a I vvl. ,, be 4 re .Tea co.. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: L( G r ��r`C" (if well field,one lat/long is sufficient) .22.Certification: yZ} 6.Is(are)the well(s): permanent or OTemporary Signatux ofC ' ed Well Contractor Date signing this form,I hereby certifythat the wells was(were)constructed in accordance with 7.Is this a repair to an existing well: [Wes or do ISA NCAC 02C.0100 or 15A NCAC 02C.0100 Well-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 owner. repair under#2I remarry 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 construction,only 1 GW 1•is needed. Indicate TOTAL NUMBER ofwe_lls (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: if Sb 3 (ft.) Submit this GW 1 within 30 days of well completion per the following: For multiple wells list all depths tfdifferent(example-3(a3200'and 2Q100) 30 (R•) 24a. For All Wells: Original form to Division of Water Resources (DWR), 10.Static water level below top of casing: 7+ Information Processing Unit,.1.617 MSC,Raleigh,NC 27699-1617 If water level is above casing use"+" - 11.Borehole diameter • •& (in.)Bit Off: (f 1°4 d 24b.For Injection Wells:Copy to DWR,Underground Injection Control(TUC) p Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: Air' RV i i t.eii 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (ie.auger,rotary,cable,direct push,etc.) 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 I Permit Program,1611 MSC,Raleigh;NC 27699-1611 6 13a.Yield(gpm) 1`f Method of test: .a� ,. AI bay o Date Site Visited: 3-so--2.3 ,1""&' . 13b.Disinfection type:_ iiy 7B�o filth Amount: ID 2 OZ Site Visited By: O i I 92-V. .3S IC Aiii 74,- • Farm GW-1 North Carolina Department of Environmental Quality-Division of Water Resources i ;Revised 6-6-2018• Price-- - _.___-__ -_ - --