GW1-2023-02844_Well Construction - GW1_20230420

i
WELL CONSTRUCTION RECORD (OW-1) For Internal UsePnly:
1.Well Contractor Information:
Frankie L.OliverF.
WellContracWrNwma FROM TO I DESCRD'TION
496 ft. 506
3002-A
Ne well ntractor Certification Number � R;,OTITFR� .CASING 6c.'unitii etrsed-velIs-Itl>iNF
Co M"lf!" illcablc)'% .. .
Carolina-Well.Drilling- FaOMt• Tti D1AMtETER` TMCKNESS MATERIAL
0 «' 46 I n' 6 1/4 I" SDR21 PVC
Company Name lb.;mlriER CASINr,:ox`;TUIiIN6'('coihlrtnal=cigsed loa <, ;,
2.Well Construction Permit#: 23-19 FROM TO 1 DIAMETER I THICKNESS I MATERIAL
List all ypplicabie sve11 cumntation permits(i.e.UhC,Cowity,State,Variance,etc_.) rt. ! ft. in.
3.Well Use(check well use): ft. ft. In.
Water Supply Well: FROM I TO I I DTAMF.7 F.R . Sl OT ST7M I THTCKNFSS I MATF.RTAT
Agricultural [3Municipal/Public it. 'ft. in.
Geothermal(Heating/Cooling Supply) [3Residential Water Supply(single) il, in.
IndustriaUCotmnercial E3Retiidential Water Supply(shared) A Ci GROUTt
Irrigation FROM TO I I MATERIAL EMPi.ACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 «' 20+ rt' Bentonite Pour(15)501b Bags
Monitoring Recovery ft. r ft.
TnJection Well: ft. ft.
Aquifer Recharge Groundwater Retnediation
,`,19:'SADb/GRAVFi::PACK[Of, lrcii4le z ,,.'.`'tx$�,� + . ';
Aquifer Storage and Recovery ®Salinity Barrier FRom TO I MATERIAL :' ET EMFLkVMMENT METHOD
OD
Test []Stormwatel•Drainage ft'. rt.
Experimental Technology LjSubsidenceC.ontroi
Geothermal(Closed Loop) .Tracer 20 iDRiLLING-VOG'i'attacli eddlHat?al_AIeets ifnecrssaii h,7 . ..<;a
Geothermal(Hearin /Coolie Return Other(explain
ex lain under#11 Remarks) FROM TO DFSCRTI'TTON koior,hardness sonhock grain site,etc
0 ft. 6 n. Yellow Dirt
4.Date Well(s)Completed: 3-15-23 Well ID#_ 6 ff 31 n' Gray Clay
5a.Well Location: 31 rt. 760 n' G ahi e
ft.
Epcon LR2 LLC Well 03
Facility/Owner Name :Facility Ib#(if applicable)
ft. ft. APR 2 0 2023
Courtyards @ Lawyers Rd. 1362 Millview Ln, Indian Trail 28079
physical Address,City,and Zip ft ft
Union 09-321-370
County Parcel Ideotifimtiou No.(FIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certificatiotl:
35,14,929 N 80.61.974 W 4-3-23
6.Is(are)the wells) Permanent or [ Temporary Signature of Certified Well onlrnctoY Date
By signing this jorm•I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing Well: OYes or Wo with 15A NC1C OTC.0100 a;-15A NCAC 0.2C.0200 Well Construction Standank and that a
Ijihis is a repair,fill out known ireV construction itforntatinn and eaplann the nature of the copy ojthis record,has been provided to the well rimer.
repair under 1l21 rernaris section or on the back ojthis form. 23.Site diagiain 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-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9•Total wen depth below nand snriace: 700 it•i 24a. For All Wells: Submit this farm within 30 days of completion of well
Fm•multiple ive&lift all depths if different(example-3 tt 200'and 2@100) 'construction to the following:
10-Static water level below top of casing: 33 (ft.) Division of Water Resources,Information Processing Unit,
If nvater level is above casing,use"+" 1617 Mail Service tenter,Raleigh,NC 27699.1617
11.Borehole diameter: 6 (in.) 24b.For fi ection Wells: In addition to sending the form to the address in 24a
Air Rotary above,also sat snit one copy of this form within 30 days of completion of well
12.Wen construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.) I
Division ofiWater Resources,Underground Injection Control Program,
FG�I?p(1sTrg CT]PPI�!WELL ONLY: �5351::ai:3ars9cs�^a:.�,^.ale:gh,Pi.^2769p;1&;S
13a.Yield(gpin) 4 Method of test: Air 24c.For Water Sumily St Injection 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: 70%.HTH Amount 42oZ completion of well construction ito l the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environtoental Quality-Divi ion of Water Resources Revised 2-22-2016