GW1--04450_Well Construction - GW1_20230710

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WELL CONSTRUCTION RECORD (GW-1) Forinternal;Use Only:
1.Well Contractor information: II
Frankie L. Oliver :3"4:;WATER.ZONES".� , :t,l- -. f N.,.,N' =t,:'� I �4iA; t ; ,
Well Contractor Name FROM TO i'I DESCRIPTION I
48 ft. 291 ft. I j
3002-A 523 ft' ft.
NC Well Contractor Certification Number ,15i;OljTER°'CASING`(for mutt!cased wells)`.OR LINi ll(If an((cable)' `;'.`z.'„
Carolina Well Drilling FROM TO !i:, DIAMETER THICKNESS MATERIAL •
Company Name 0 ft' 44, ft' 6 I1/4 in' S6R21 PVC
22-385 ;16.•INNER CASING OR TUDING.(geotheriaal closed-loop)'<_
2.Well Construction Permit ii: FROM TO !" DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) ft. i ft. I in.
3.Well Use(check well use): ft. ft. I In.
Water Supply Well: g17,'SCREEN 1 7- I , ,7 :'.-.r, , ;:it: ,., . ,
FROM TOE DIAMETER SLOT SiZF I THICKNESS MATERIAL
Agricultural DMunicipal/Public ft. ft. fn.
Geothermal(Heating/Cooling Supply) EaResidential Water Supply(single) f6 ' i It. I fn.
Industrial/Cornrnercial DResidential Water Supply(shared) :18.GROUT. ) ,: .. ( -., l
Irrigation FROM TO .i MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft' I20+ n- Beltonite Poiir(17)501b Bags
Monitoring ORecovery ft. ' , ft.
injection Well: ft. rt.
Aquifer Recharge Ej Groundwater Remediation
f-19.SAND/GRAVFI.:PACK lit'ap{nllcabte) . - ( ? " 'a _
Aquifer Storage and Recovery ®Salinity Barrier FROM TO :!' MATERIAL I EMPLACEMENT METHIID
Aquifer Test 0Stormwater Drainage ft. ft.
Experimental Technology OSubsidence Control ft. ft. 1
Geothermal(Closed Loop) DTracer 4'20;.DRILLING`I,OG.funnel'iild(tlonal sh1eefs finecessary.)=a :i4', ,t_ , iz<'
Geothermal(Heating/Cooling Return) Other(explain under 421 Remarks) FROMTO.' DESCRIPTION(color,hardness,solt/roek type,grain size,etc)
0 ft* 4 ft' Reid Clay
4.Date Well(s) 5-11-23 ft. ft.Completed: Well IDtr 4 9 GrIay Rock
5a.Well Location: 9 ft' 12 ft' Orange Sand._,_.
12 ft. 16 ft' BrfpwnDirt :. + .( .ea_zi ''. �„ f
Chris Whilden
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Facility/Owner Name Facility ID/1(if applicable) 16 ft' 600 ft' Granite
2020 New Salem Rd.Marshville 28103 ft. ft. I JULv 2013
Physical Address,City,and Zip ft ft
lRi^t itvi' t ' j' t t!I--
Union 09-037-001A `2t REMARKS :,it .:„,:';:f x r a;.`hw V�s: ,, , .,�7x
County Panel Identification No.(PIN)
5b.Latitude and longitude In degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22,Certification: '
35.20.533 N :80.28.236 .yin 6-5-23
6.Is(are)the well(s)MPermanent or Temporary Signature of Certified Well Counaapr Date
By signing Ibis fans,I hereby cent,that the well(s)w (were)constructed in accordance
7.Is this a repair to an existing well: *Yes or IONo with 15A NCAC 02C.0100 or ISA lik1CAC 02C.0200 Well Construction Standards and that a
if this Lea repair,fill nta known well construction ir{jornwtirnr and explain the nature of the cagy of this record has been provided to the well owner.
repair under#21 remarks section or on the back of this fonn. 23.Site diagram or additional well details:
You may use the back of this age to provide additional well site details or well
8.For Geon,only I O or Closed-Loop rmal Wells having the same construction details. You may Iso attach additional pages if necessary.
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 600 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For•inrdtiplr wells list all depths if different(example-3(gJ2(J0'and 2@a 104' construction to;the following:
10.Static water level below top of casing: 33 (ft.) Division of Water R sources,Inform don Processing Unit,
If water level is above casing.use"+" 1617 Mail Servi4e Center,Raleigll,NC 27699.1617
11.Borehole diameter: 6 (in.) 24b.For Injection Wells: In Addition to sending the form to the address in 24a
Air Rotary above, also sulllnit one copy of this form within)30 days of completion of well
12.WeD construction method: construction tn the following: II
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resourc ,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Servi a Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 2 Method of test: Air 24c.For Water Supply&In ection'Wells: In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
13b.Disinfection type: 70%HTH Amount: 300Z completion of,well construction to the county ealth department of the county
where constructed.'
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Form GW-I North Carolina Department of Environmental Quality-Division of Water Re.SoiArces Revised 2-22-2016