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Home My WebLink AboutGW1--06410_Well Construction - GW1_20241025 WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1.Well Contractor Information: Justin Marlowe 14:WATER ZONES '_ - I • We1lContrectorName FROM TO DESCRIPTION ft. ft. 1 4452-A - ft. ft. 1 NC Well Contractor Certification Number 15.,OUTER CASING(for-multi cased wells)OR LINER(if Op licable) S&MEr Inc. FROM TO DIAMETER THICKNESS 1 MATERIAL ft. ft. 1 1 in. Company Name 16.INNER CASING OR TUBING(geothermal closed-loop) _ - 2.Well Construction Permit#: WM0301 376 FROM TO DIAMETER THICKNESS MATERIAL List all applicable well construction permits(i.e.UK'.County,State,Variance,etc.) 0 ft. 2.9 ft. 2 I; in. sched 40 PVC 3.Well Use(check well use): ft. ft. I' ;in. Water Supply Well: FROMREE TO DIAMETER` i SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public 2.9 ft 12.9 ft 2 1D' 1.01 sched 40 PVC ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in ❑Industrial/Commercial ❑Residential Water Supply(shared) 18.'GROUT,.: . 4---11! -, . - - - ❑Irrigation ❑Wells>100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 0.9 ft• 1.9 ft. bentonite poured nMonitoring ❑Recovery 0 ft. 1.9 ft cement poured Injection Well: ft. ft. ❑Aquifer Recharge ❑Groundwater Remediation 19.-SAND/GRAVEL PACK(if applicable) - - . ❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑Stormwater Drainage 1.9 ft. 13.2 ft #2 sand poured ❑Experimental Technology ❑Subsidence Control ft. ft. ❑Geothermal(Closed Loop) ❑Tracer :20.DRILLING LOG(attach additional sheets if neceisary) •.- -. . ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness soiUrock type,grain size,etc.) 0 ft 10 ft. Residual soil 4.Date Well(s)Completed: 9/20/24 Well ID# PZ-2 10 ft• 13.2 ft PWRI _ _ . 5a.Well Location: --> , '-'.•. ft. ft. 4 St. John Properties ft ft. OCTFacility/Owner Name Facility 1D#(if applicable) ft. ft. �1 t'I v c 2024 213 Fairview Road ft. ft. Info.:,., ,l.F- ?-,r. r„o-1.y �7 Physical Address,City,and Zip ft. ft. [;: 4u'' ter Union K7081011 2L REMARKS County Parcel Identification No.(PIN) See attached Well Construction Diagram 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lat/long is sufficient) 22.Cer• cation: 35.087672 N -80.657650 W !, ; 9/26/2024 6.Is(are)the well(s): dPermanent or ❑Temporary Si cure of Certified Well Contractor 1' Date By signing this form,I hereby cert that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or lNo 15A NCAC 02C.0100 or 1SA NCAC 02C.0200 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#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 construction info construction,only 1 GW-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: 13.2 (ft.) For multiple wells list all depths ifd�erent(example-3@200'and 2@100') Submit this GW-1 within 30 da Is of well completion per the following: 24a. For All Wells: Original form to Division of Water Resources (DWR), 10.Static water level below top of casing: 8.9 (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 If water level is above casing,use"+" 24b.For Injection Wells: Copy ito:DWR,Underground Injection Control(IUC) 11.Borehole diameter: 9 (in.) Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: 4 1/4" Auger 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (i.e.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 Permit Program,1611 MSC,Raleigh,NC 27699-1611 13a.Yield(gpm) Method of test: 13b.Disinfection type: Amount: Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018 • • • : is c"':Lutck,v- Itvel'- d'•-•.- • .•..• : _ • - .. .-. 'T o-4C I uo l�e- Vie :. ...1•.. . •WELL �ID�. -�= • •• • PROTECTIVE-CASING.-TYPE • . • -• _ •Z e3. . : : . ••.: : ' •STICKUP':' .'Q ;DIAMETER :- : .• - •-: . .+,; MANHOLE DIAMETER`: $ : .. : CONCRETE PAD DIAMETER - - _�:,j 11 l r. A .• 1 . '� ; �. : I I J1 ; I I _I1-1 I 1=11 ir- 11 F-I I Iti-1 I ..•` • ,i • �LI--I•11-1 1' i- 1I I -1�11 . 1:11=1.1. 1:1 1 f 4 111 .1:1:• :::: :• .. 1_I:1111-1:1. .I .... _I 1-:: • • • • ' . .WELL CASINGr_ . �i .. • GROUT EPTH_: U . TO' :.:: _ FT: 'BLS• :' . DIAMETER:: '2-. .: :. INCH-:.-• •• ' •••.:::- •% :/ • :. .. •• : : .. OFi`CEMEN... :US - - . BAG ED._ " MAT•ERIAL:: . BENTONIIE SEAL, :' •• ' . : .. . BENTONITE•DEPTH TO i'9 FT BLS CASING LENGTH FT ' ,,, •ti s . ' " • . . ••BAGS 0 BENTONTIC:USED .- •.DEPTH :1): • 'TO. ZiQ. FT•-BLS:: • : : , 3r. t 1•..4 • • • • _ • ..• • • L ...,- .7`: .i . :' • .• •.. :• • •• : s• ey 3i dea•ni,:•e;ti :- •.• :• •• Y;' �,' SAND FILTER PACK .. . . - .�.t.. ti :'FILTER PACK ' /�:2 '. . • • ' WELL SCREEN . - •;•' .' ' ' : DEPTH I. .TO. .a FT. 'BLS •. .. . ..--- - - :•" • DIAMETER• ;g.i..- • • • • ?y` 'SAND SIZE I.1Z ; .. •• �.j 't��I L�. �S�.� • • • • .' :• • MATERIAL'_ , .•. • • • • • . . . '.�.:.._..� �,; . . . ... . . BAGS OF.;SAND USED• ' _ SLOT.SIZE'. • • •4 .•• 1 ';•5 i . •..• . .� S Ste` � • .. .. . :. • SCREEN LENGTH _ 10 ET. . ' . . .1 — . I : . : .' ' . . • : . DEP:T �y• .• 70 1'2� FT BLS• ..' : � • • .. . ' .. .. • . - TOTAL DEPTHI _12;d .... • SCAUr ' - . . .. . • .. .NTS: l. ' - '' - " . FlGURE.NO. _DATE, . D AGRAM �WE LL� �• UCTION� . DRAWN.BY: . n . PROJECT'N0::• . .' '. :-°.O1iAOR8`a.COM. '