GW1-2023-00982_Well Construction - GW1_20230118

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
JOHNNY BURR 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 3098 RECEIVE ft. ft.
ft. ft.
NC Well Contractor Certification Number J A N g 2023 15.OUTER CASING for multi-cased wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
^^"''2f3 Urr�fL ft. ft. in.
Company Name I
'VeQl d
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable trell construction permits(i.e.UIC,County,Stale,Variance,etc.) 0.0 ft. 38.0 ft' 2.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
17.
Water Supply Well: FROMREE TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑AgricLlltural ❑Municipal/Public 38.0 ft' 48.0 ft' 2.0 in- .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) El Residential Water Supply(single) ft. ft. in.
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑irrl ation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 It- 34.0 ft' PORTLANDBENTONITE SLURRY
[IflMonitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENTMETHOD
❑Aquifer Test ❑StonnwaterDrainage 36.0 ft• 48.0 ft• 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION color,hardness,soil/rock e, rain size,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 921 Remarks)
0.0 ft• 28.0 ft. BROWN PWR
4.Date Well(s)Completed: 10/26/22 Well ID# MW-6 28.0 ft. 30.0 ft- BROWN ROCK
5a.Well Location: 30.0 fr• 48.0 fr' GRAY ROCK
GRAHAM COUNTY LANDFILL
Facility/Owner Name Facility ID#(ifapplicable) ft. f[.
400 SNOWBIRD ROAD ROBBINSVILLE 28771 ft. rt.
Physical Address,City,and Zip
ft. ft.
GRAHAM 21.REMARKS
County Parcel identification No.(PIN) BENTONITE SEAL-34.0-36.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(it'well field,one lat/long is sufficient) 22.Certification:
3SO 18' 53.39" N 830 48' 53.12" W d" & �g 11/07/22
6.Is(are)the well(s): [EPerm:lnent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,1 hereby certify that the lrell(s)ivas(ivere)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or [ENo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Consiruclion Standards and that a copy
//'this is a repair,Jill out knolrn bell construction i?1brination and explain the nature of the of this record has been provided to the bell owner.
repair under#21 reinarkv section or oil 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 I 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: 48.0 (ft.)
For multiple hells fist all depths ifrlierew(example-3@200'aid 2@100') Submit this GW-I within 30 days of well completion per the following:
10. 20.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
fwater level is above casing,use"+"Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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11.Borehole diameter: 1 0.0/6.0 (in) 24b. For Injection Wells: Copy to DWR,Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/AIR
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
13a.Yield(gpm) Method of test: Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018