GW1-2023-01760_Well Construction - GW1_20230223

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WELL CONSTRUCTION RECORD(GW-1) For internal Use Only:
I.Well Contractor Information:
Phillip D. Ricker_ 14.WATER ZONES i f
FROM r0 DFSCRI191ON
Well Contractor Name ft. ft. i I •
NCWC 4280-A
NC'Well Contractor Certification Number 15.OUTER CASING-(fur multi-cased wells)OR LINER(Ira licable
Geolab Drilling FROM ro DIAMET@Rf I TIIICKNESS
- - - ft. I ft. Hn.
Company dame !i .
WM0301243 16•►NNER CASING ORTUBING(eathermalclosed-Imo
2,Well Construction Permit#: FROM I To DIAMETER T1n(:RNESs asTERi.\L
List all applirahle yell ranstrnrrinn permits(i.e.U1C,Cbnnn.Stare.Variance.ete) .2 ft. d0 ft. 2 in. seh40 k
3.Well Use(check well use): ft. ft, I , in.
Water Supply\3'011: 17.SCREEN
FROM '176 DIAMF.'I'F:R SLO"I'SI""/.F: I'lIIC6NF_CS \I;\1'I{Ith\I
r\gricultural Municipal/Public 40 ft. 45" ft' 2 in•1i .010 sc140 pvc
Geothermal(HeatingiCooling Supply) [iR ft,Water Supply(single) ft. in.,
Industrial/Commercial OResidential Water Supply(shared) IS.-GROUT
Ifriadtion FROM TO DL\iE:R1.1L EMPtACEdIENr\IETIIOI)9 AMOI•Nl
Non-Water Supply Well: 0 ft• 36 ft• Pottr'Bent poured from surface
Monitoring [DRecovery 36 ft. 28 rt. Bent chips poured through augers
injection Well:
ft. ft.
—Aquifcr Recharge­- - - -[DGroundwater Rcmediation - ft
19.SAND;GRAVEL PACK(tia Ilcable
Aquifer Storage and Recovery Salinity Barrier FROM I TO MATERIAL I EMPLACEMENT\1ETIlon
Aquifer Test DStomiwater Drainage 38 ft. 45 ft. 1A gravei,oack poured through augers
Experimental Technology DSubsidcnce Control ft. ft.
Geothermal(Closed Loop) Tracer 20.DRILLING LOG aitaeb additional sheets.if necessa
( e ) ( 21 Remarks) FROM ro UF:SCNIPrtonrsmmr.hnnlm...a. ,aurwr� a ,t...
Geothermal Flcatin lCwling Return �Od1er(explain under m_ f1. ft.
0 20 see description for MW-7R
4.Date Well(s)Completed: 1/23/23 Well IN MW-7D 20 ft. 25 rl. brown silty clay, mottled,firm,moist —f
53.Well Location: 25 r`' 33 f`' red/brown sandv clav,soft, moist/wet
BIN-Atando LLC 33 ft• 40 ft- tan/brown sandy clay,soft, moist/wet
F'acilityiOwner Name Facility IDa(if applicable) 40 ff• 45 ft• tan/born saprolitic clay w/lenses of
rt. rt. weat ere roc
I'hvsical Address,City.and Zip
Mecklenburg 07720213 21.REMARKS
County Parcel Identification No.(PIN) n
51).Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field.one Iat/long is sufficient) 22.Certiftcatio In t ln:i
Not Available N Not Available v# °
�` 1/26123
6.[s(are)the wcll(s)X Pertnaoent or ❑ITemporury
f Si lure of Certified
w Contactor Date
v xignimg this jorm. herehe ter+fi that fire ne//(.q tr uc l tverrl c un.crrrrrreJ rn ar rnrdwn r
7.Is this a repair to an existing well: ' Q Yes or MX No mth 1 id NCAC 02C 0101)or 15A AVAC:02C.000 Well Cbnsrrurriun S'ru+ulurdc and Thai a
lfthis is a repuir.Jill our knatcn welt construction information and explain the nature of the copy aj this record has been provider/to tire well oa nc r•.
repair under r:2l remarks section or on the hack ojthis jorm.
23.Site diagram or additional well details:
S.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 I GW-I is needed. Indicate TOTAL\UNIBER of wells construction details. You may also attach additional pages if necessary.
drilled: 'SUBMITTAL INSTRUCTIONS '
9.Total well depth below land surface: 45 (ft-) 24a, For All Wells: Submit this form within 30 days of completion of well
For mohiple u•e//.c 1Lst ale depritr r1 dffl�rent leavanple-30',200'and?. 100') construction to the following:
10.Static water level below top of casing: 10 (ft.) Division of Water Resources,Information Processing Unit,
lfwarerlevel is above,aslmg.use 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8.25 (in.) 24b. For Infection Wells: In addition to sending the tam to the address in 24a
Auger above,also submit one copy of this form within 30 clays of completion of well
I2.Well construction method: construction to the following:
(i.e.auger.rotary,cable•direct push.etc.) �l
Division of Water Resources.Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Cc"mer.Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c. For Water Sunmly&Injection Wells: In addition to sending the Ibnn to
the address(es) above, also submid one copy of this Ibrin within 30 days of
13b.Disinfection type: Amount; completion of well construction to lth county health department of the county
where constructed.
Form G\l'-I North Carolina Department of Environmental Quality-Division of Water Resources R.•t ised 2-21-20I0
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