8603_Surry_Elkin_MSWLF_CDLF_MP7_FID1323588_20190702

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LANDFILL GAS MIGRATION
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Iuformation:
Jon Pfohl
Well Contractor Name
3301-A
NC Well Contractor Certification Number
Municipal Engineering Services Co. PA
Company Name
2. Well Construcfion Permit #:
List all applicable well construction permits (i.e. UIC, County, Siate, Narrative, etc.)
3. Well Use (check well use):
'ater Supply We1L•
Agricultural MunicipaUPublic
Geothermal (Heating/Cooling Supply) Residential Water Supply (single)
IndustriaUCommercial Residential Water Supply (shared)
Non -Water Supply Well:
''xl Monitoring LFG (NOT
Recharge
Storage and Recovery
Test
rental Technology
mal (Closed Loop)
4. Date Wel1(s) Completed: 6�19�19
Sa. Well Location:
Surry Co Closed LF-Elkin
Groundwater Remediation
Salinity Barrier
Stormwater Drainage
Subsidence Control
Tracer
Other (explain under #21 F
well >D# M P-7
Facility/Owner Name Facility ID# (if applicable)
355 Elkin Landfill Rd., Elkin NC 28621
Physical Address, City, and Zip
Surry
County Parcel Identification No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
80 769299
M P-7
For Internal Use
sl 14. WATER ZONES �-
FROM TO DESCRIPTION
O ft 20 ft• DRY -ABOVE WATER TABLE
ft ft
': 15. OUTER CASING (for multi -cased wells OR LINER if a livable
FROM TO DIAMETER THICKNESS MATERIAL
ft ft. in.
' 16. INNER CASING OR TUBING eothermal closed-Ioo
FROM TO DIAMETER THICENESS MATERIAL
ft ft in•
ft ft in.
17. scREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
4 ft• 20 ft• 2 i°• 0.01 Sch 40 PVC
ft. ft. in•
18. GROYIT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOiJNT
p ft 2 ft. concrete gravity slurry 160 lbs.
2 ft 3 ft. bentonite chips gravity hydrated 30 lbs.
ft ft.
'': 19. SANDlGRAYELPACK ifa livable
FROM TO MATERIAL EMPLACEMENT METHOD
3 ft 20 ft• #3 filter sand gravity
ft ft.
20. DRILLING LOG attach additional sheets if necessa
FROM TO DESCRIPTION color, hardness, soiVrock ,gain size, etc.
0 ft 3 ft. Residuum -Reddish Brown, Silt, dry
3 ft 20 ft. Sa rolite-Silt Sand, Lt. Brown, d
ft ft. Borin erformed b Sur & J. Pfohl
ft ft. Above ground metal locking case
ft ft. Ball valve affixed
ft ft. '
ft ft.
21. REMARKS
LFG migration monitoring well along NE property line.
lion:
36.296901 N - � w r� � C3��
6. Is(are) the well(s)Permanent or �ITemporary a e of rtified Well Contractor Date
� � By si ing this form, I here�y certt�y t/aat the wells) was (were) constaucted in accardmzce
7. Is this a repair to an exisfing well: Yes ort�PNo wrt 0 Well Cozzsnvction Standards mzd that a
If tlzis is a repair, fill out known well construction information cuzd e plaraz the nature of the copy of this record has been provided to z yell owner.
repair under #21 remarks section or an 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: SUBMITTAL INSTRUCTIONS
9. Total well depth below land surface: 20 (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@L00') Construction to the following:
10. Static water level below to of casin dry >23� btOC ft.
p g: ( ) Division of Water Resources, Information Processing Unit,
If water level is above casiraA use "+" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 6• � (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
auger 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, duect 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) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
13b. Disinfecfion type: Amount: completion of well construction to the county health department of the county
.zrhrra rnn etn,rtPA
Form GW-1 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016