GW1--06175_Well Construction - GW1_20241014

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: '
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1.Well Contractor Information: I
Bill Magette 14.WATERZONES• :1
Well Contractor Name FROM TO DESCRIPTION - a.
2299-A 190 ft• 205 ft• med sand
ft. ft.
NC Well Contractor Certification Number ' 15.OUTER.CASING(for multi-cased wells)OR LINER.(if hp licable) `
Magette Well & Pump Company Inc FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. i ' in.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#:224 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U1C,County,State,Variance,etc.) +1 ft. 195. ft. 4,5 in. SDR 17 PVC
3.Well Use(check well use): ft. ft in.
Water Supply Well: 17.SCREEN
FROM TO
Agricultural 0Municipal/Public 195 ft. 205 ft. 4 `"' 032 SCH 40 PVC
Geothermal(Heating/Cooling Supply) ,Residential Water Supply(single) ft. in DIAMETER.
Industrial/Commercial Residential Water Supply(shared) 18.GROUT
ft. SLOT SIZE THICKNESS MATERIAL
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Irrigation • FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well:
Monitoring Well:
5 ft• 170 ft- bento"Hite pump
Recovery 0 ft 5 ft. Cement pump
Injectionft. ft.
Aquifer RechargeGroundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test
DStormwater Drainage 170 ft 205 ft• #3 SP tremie
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) ITracer 20.DRILLING LOG(attach additional sheets if necessary)'
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
__1 Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks)
0 ft. 20 ft• clay and sand
4.Date Well(s) 8/6/24
Completed: Well ID# 20' ft• 80 ft• sandi,with clay mix t'' ,, a- : a;; F-• y
5a.Well Location: 80 ft 120 ft. same OCT w 2024 5 s
Cola Vinson 120 ft. 180 ft. clay !• 4
Facility/Owner Name Facility ID#(if applicable) 180 ft. 190 ft. sand and clay speb:--Frki!c-n ThrC.,rr,- -,.t; Ar
2474 Vaughan Creek Rd Pendelton NC 27862 190 ft. 205 ft• med sand trio i• `�t';-'•'
Physical Address,City,and Zip ft. ft.
Northampton ; , 21.REMARKS.• - - ,
set 10SQ07 on 1.25" sure align
County Parcel Identification No.(PIN) g
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5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.C 'i d* on:
36.485434 -77.122011
N W
11W4-
8/28/24
6.Is(are)the well(s)1Permanent or Temporary S gnature of Ce ified Well tractor Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a.repair to.an.existing_well: Ij Yes or EINo with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If this is a'repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner.
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 may use the back of this page to provide additional well site details or well
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled:1 SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 205 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@100') construction to the following:
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10.Static water level below top of casing:60 (ft.) Division of Water Resources,Information Processing Unit,.
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8.75 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
rotary above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: , , 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 30 Method of test:air lift 24c.For Water Supply&IniectiI nl Wells: In addition to sending the form to
" the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: HTH Amount: 1 pound completion of well construction to die county health department of the county
EItit4' •
where constructed. I
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources', Revised 2-22-2016