GW1-2022-03341_Well Construction - GW1_20220314

G
WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
CARL CARPENTER 14.WATER ZONES I1
Well Contractor Name FROM TO DESCRIPTION
ft. ft. 4
A - 4475
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. I in.
Company Name "
16.INNER CASING OR TUBING eothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.111C,County,Slate,Variance,etc) 0.0 ft. 3.0 It. 2.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
-
Water Supply Well: 17.SCREENFROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 3.0 ft- 13.0 ft' 2.0 in.I
010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl atlon ❑Wells>100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 2.0 ft' PORTLAND BENTONITE SLURRY
OMonitoring ❑Recovery ft. ft.
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 2.5 ft. 13.0 ft• 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO. DESCRIPTION color,hardness,soilhnck type,grain size,etc.
0.0 ft• 1.0 It. ASPHALT/GRAVEL
4.Date Well(s)Completed: 02/17/22 Well ID# MW-1 1.0 ft. 5.0 B. PEA GRAVEL
5a.Well Location: 5.0 ft' 10.0 ft' GREENJTAN SILTY CLAY
WAKE COUNTY PUBLIC SCHOOL 10.0 ft• 13.0 ft• BROWN SILTY SAND
Facility/Owner Name Facility ID#(if applicable) ft. ft. f
1551 ROCK QUARRY ROAD RALEIGH 27610
Physical Address,City,and Zip ft. ft.
WAKE 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-2.0-2.5 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
350 45' 37.40" N 780 36' 38.26" W �-� MAR 1 22
6.Is(are)the well(s)• (EPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing this form,I hereby certify that the well(s)-was,(tvere)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or [END 15A NCAC 02C.0100 or 15A NCAC 02C.0200•Well Construction Standards and-dun a copy
ffihis is a repair,fill out known ivell construction information and explain the nature ofthe ofthis record has been provided to the well owner.
repair under 121 remarks section or on the back of this form.
23.Site diagram or additional well details:
8.For G¢oprobe/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: 13.0 (ft.)
For multiple we//s list all depths ifdii ferent(example-3@200'and 2@100') Submit this GW-1 within 30 days of well completion per the following:
1
2.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
lfwaier level is above casing,use"+" i .
11.Borehole diameter: 8.0 (in.) 24b. For Injection Wells: Copy toDWR,Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: 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
I
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test:
Permit Program,1611 MSC,Raleigh i,NC 27699-1611
t
13b.Disinfection type: Amount: I
I
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018