GW1-2023-02024_Well Construction - GW1_20230303

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
JOHNNY BURR 14.WATER ZONES
Well Contractor Name - ��..�� .JF a -- FROM TO DESCRIPTION
rt. rt. �
A - 3098 MAR +� � 20Z3 ft. ft.
NC Well Contractor Certification Number
l+ 15.OUTER CASING for multi-cased avells OR LINER ira licable
GEOLOGIC EXPLORATION irt±ti+"" ''_'� ' J' FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name
16.INNER CASING OR TUBING eothermal closed-too
2.Well Construction Permit#• FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction pernttls(i.e.U1C,County,Slate,Variance,etc.) 0.0 f`• 35.0 f`• 2.0 '"' SCH 40 PVC
3.Well Use(check well use): f`' ft. In.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 35.0 ft' 50.0 'ft' 2.0 m. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. rt. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑lrrl ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENTMETHODRAMOUNT
Non-Water Supply Well: 0.0 l" 27.0 rt' PORTLANDBENTONITE SLURRY
INMonitoring ❑Recovery
Injection Well:
rt. ft.
❑Aquifer Recharge ❑Groundwater Relmediation
19.SAND/GRAVEL PACK(if-applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTMETHOD
❑Aquifer Test ❑Stormwater Drainage 33.0 f` 50.0 f`' 20-40 FINE SILICA SAND
El Experimental Technology ❑Subsidence Control
❑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,soil/rock type,ginin size,etc.
0.0 rt. 80 rr. RED/ORANGE CLAY
4.Date Well(s)Completed: 01/23/23 Well ID# MW-9R 8.0 rr. 270 f` BROWN SILTY CLAY
5a.Well Location: 27.0 f`' 27.5 ft' WHITE PWR
PITT_STOP 27.5 f` 45.0 f` TAN SILTY CLAY
Facility/Owner Name Facility ID#(ifapplicable) 45.0 f` 50.0 f` BROWN/GRAY PWR
2946 US - 70 MORGANTON 28655 rt. ft.
Physical Address,City,and Zip
ft. ft.
BURKE 2L REMARKS
Comity Parcel Identification No.(PIN) BENTONITE SEAL-27.0-33.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification: Q
350 44' 39.49" N 81° 36' 42.81" W �' `� 02/10/23
6.Is(are)the well(s): 11flPermanent or ❑Temporary Signature of Certified Well Contractor Date
Hy signing this form,I hereby certify that the wells)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under 421 remarks section or or the back oJ'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 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: 50.0 (ft.)
Far multiple wells list all depths ifdierent(example-3 a 200'and 2@100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 40.0 (ft) Information
For All Wells: Original form to Division of Water Resources (DWR),
Ifmater level is above casing,use..+' Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 8.0 (in.) 24b.For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER
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
]3a.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