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Home My WebLink AboutGW1--06960_Well Construction - GW1_20241119 ,r WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1 ' / 1.Well Contra:tor Information: I Q j LIA C ii 1 CO WATEgc2ANE5 1:=:`::c: t •....2 • FROM TO DESCRIPTION , Well Contractor Name °�; 'fig/ ( �'/�_ J � ft �ft �tm i rt,gl `�Fe�� 4 '�� ,�i9/11, Cl)J ( _ 9 , `� 1 S ft e ft. , �,o,m I NC Well Contractor Certification Number l°OUTE41;:�AS�G`(fo%miillicasiliene`)`. RT;IlVE12;(ifa'"tiaalilef(c': ':5::'•_ • Q Yadkin Well Company, Inc. FROM TO DIAMETER;, THICKNESS 7 MATIMIAL - f .� Company Name c.( Il!6 NEICOAS 'Oxiw3M;(geutIieTmal adigniii n ,_. ... .,,.• • 2.Well Construction Permit*: I O -I '7 O FROM TO . DIAMETER THICKNESS MATERIAL List all applicable well construction permits(i.e.UIC,County,State,Variance,etc) 4, 4 ft. I OC C.ft &7 (Ct t`1,Cm• c�DA I p i c 3.Well Use(check well use): ft. ft in •] Water Supply Well: FROM ro„TO_,_ _ DIAMETER SLOT SIZE THICKNESS__,,MATERTAI;"- — •- . ❑Agricultural ❑Municipal/Public ft. ft.^"�,ln ��"'" • ❑Geothermal(Heating/Cooling Supply) >tkesidential Water Supply(single) ft --"- ----- -- ❑Indushial/Commercial ❑Residential Water Supply(shared) ;187GItOUT t°_. t`'".. -.. ... ' ',' .Y, f•;'_.t Mitigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMO Non-Water Supply Well: CD ft "�4 9 a Qft 0"tret lara r 1.t C . • cups OMonitoring ❑Recovery ft ft (� T Injection Well: lr- 64D-S ft, ft • ['Aquifer Recharge ❑Groundwater Remediation T__ DAquifer Storage OS i 19::SAND/GR: T.A.Ci (it<appiina'b7e)r '":- u.;Z.= ,r-�.��'e" q g ry ity Barrier FROM TO MATERIAL t EMPLACEMENT METHOD ❑Aquifer Test ❑Stormwater Drainage ft ft.a ❑Experimental Technology ❑Subsidence Control ftf�. ❑Geothermal(CIosed Loop) .❑Tracer ei20 DRI MIGI:OG(ittiie s'7ditii"nsIilieeffiffieceuarp) `•i:7 .. =-.,:;-Q FROM❑Geothermal(Heating/Coolin Return). ❑Other(explain under#21 Remarks) TO DESCRIPTION(color,hardness,sallhack type,grain size,etc.) Date Well Started _ 0 ft Ci ft Sa,c if • 4.Date Well(s)Completed: !O_ d ' Well]D# 6 _ 37 3 q ft •�pi it 1 t id. Cli t 1i P;--1 f1. S`�'+•( Phone#:70 y. a 4 7-0011 ft. ty ft J 1 . • 5a.WellLocation: q IP �•�d. oy,t-eaq 5Uzi,7 5,�,rr•1,'/� ft, ft S C-A,l Ye-A ( • ' < . Facility/OwnerName r . • Facility Lao (if applicable ft. �.. , • G r."4rei v; {l e Dr E,%. 1�aoA 3 gkS(n:07 ft. ft e. x . „ Physical Address,City,and Zip t ft. , ft. «O V 1 G 14 r-e W ..lp i:7.l. RF141"A'1.75: :. ,,,,,...•. ..:. . ... _ >..a:+ ,ri->e- I�'Q (1U O.5, tr:-:... -.y' _.. .. �` County .ParcelldrntificationNo.(PIN) - - - ` L� g . 5b.Latitude and Iongitnde in degrees/minutes/seconds or decimal degrees: (if well field,one 1st/long is sufficient) 22.Certification: Ca • 6 J 1 4 g 17 - N g I e. 6. 0 ; ek w c)jyLotfi: 10- ? -At/kr-- . 6.Is(are)the well(s): ermanent ,or.- ❑Temporary. Sioaturc of Certified Well Contractor Date/ By signing this form,'hereby certify that the well(s)war(were)constructed in accordance with •cive 7.Is this a repair to an existing well: ❑Yes or *o 15ANCAC 02C.0100 or 15A 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 remark section or on the back of this form. 23.Site diagram or additional well details: 8.For GeoprobelDPT 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 serene(: �a` (ft') Submit this GW-1 within 30 da s of well completionper the following' �` 24a. For All Wells: Original form to Division of Water Resources (DWR), 10.Static water level below tap of casing: �� (fti) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 If water level is above casing,use"+" 11.Borehole diameter: 6 m, Bit Off:.�i 7-) 24b.For Injection'Wells:Copy to DWR,Underground Injection Control(IUC) ( ) Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: iQ.J I. re,44 7 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.Pot Water Wells producing�over 100,000 GPD: Copy to DWR,CCPCUA Permit Program,1611 MSC,Raleigh,NC 27699-1611 0 13a.Yield(gpm)_ I / Method of test 1 70% hth • Date Site Visited: 3 s ' rU , 13b.Disinfection type: Amount: Oz Site Visited By: ,/y,� u.- g An Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources f Revised 6-6-2018 Price: