GW1-2022-08229_Well Construction - GW1_20220418

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WELL ONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
GARRETT J. PADGETT ;44:WATER=ZONES
FROM TO DESCRIPTION
Well Contractor Name
ft. ft. �
4545-A
NC Well Contractor Certification Number
15�OUTER�CASING for.'.multl-casedsweUf BUR=LINER:'if's llcable z� '�.lr.r,
CAMP'S WELL AND PUMP CO. FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 55 it- 6.125 In' SDR21 PVC
Company Name
P y ^16'raINNERiC&SING=OR.�TUBINGs 'euthermel¢losed=ioo t,.t.r'.s �^z'` �+.^s'�'..r�a �'
2.Well Construction Permit#: SW20-0085 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well consu7iction permits(i.e.UIC,County,State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft ft in
Water Supply Well: :1T.-:$GREEN ., Yrl t �. Y ohs>.r .fia:•>4 s ,
PP Y FROM TO I DIAMETER SLOT SIZE THICKNESS I MATERIAL
Agricultural [:)Municipal/Public ft. tt. I in.
Geothermal(Heating/Cooling Supply) %Residential Water Supply(single) tt. ft. in.
industrial/Commercial QResidential Water Supply shared
PP Y(shared)
hTi ation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 20 ft, BENTENITE POURED 14 BAGS
Monitoring Recovery
Injection Well:
Aquifer Recharge Groundwater Remediation
,19SANDlGRAVEI PACK if.e`"liable . e:x•'
Aquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
Aquifer Test [3Stomtwater Drainage ft. R.
Experimental Technology Subsidence Control R. ft.
Geothermal(Closed Loop) Tracer �20,DRILILING LIOG_a`ttach'a'ddINonel:e-h&ts4f necesie': 3
FROM TO DESCRIPTION color,hardness solitrock a rain size etc
Geothermal Heatin Coolin Return) Other(explain under#21 Remarks) 0 ft- 55 ft CLAY
4.Date Well(s)Completed: Well ID# 56 ft• 345 tt• GRANITEL-1111
`
5a.Well Location:
DAVID FOY APR -
Facility/Owner Name Facility ID#(if applicable)
338 LAKEVIEW TRAILtsr .a.aaui.w
-
Physical Address,City,and Zip
MCDOWELL �—
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
35.561609 N -81.898883 Wi
6.Is(are)the well(s)�x Permanent or Temporary Signature of Certified Well Con or! Date
By signing this form,1 hereby certify that the well($)was(were)constructed in accordance
7.Is this a repair to an existing well: [3Yes or 0No with 15A NCAC 01C.0100 or 15A NCAC 02C.0100 Well Construction Standards and that a
If this Is a repair,fill out known well construction information and erplain the nature of the copy of this record has been provided to the well owner.
repair tinder#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: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 345 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3Q200'and 2@1001 construction to the following:
10.Static water level below top of casing: 160 (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: 6 (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) 50 Method of test: AIR 24c.For Water Supply&Iniection 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: CHLORINE Amount: 2 CUPS completion of well construction to the county health department of the county
where constructed.
Feint GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016