Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
GW1--04995_Well Construction - GW1_20230807
1 WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can be used for single or multiple wells 1.Well Contractor Information: Dwight L. Huneycutt 14.WATER ZONES FROM TO DESCRIPTION Well Contractor Name c-' r:r; f ..,,,, 99 ft- 103 ft* 2 gpm (150'-155'=6gpm) 4070-A L'` Li 173 ft 180 ft- 67 gpm NC Well Contractor Certification Number A U G 0 7 2023 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable) FROM TO DIAMETER THICKNESS MATERIAL Derry's Well Drilling, Inc. inc,- `.,,,,, ,,r- o ft• 48 ft- 61/8 in- SDR-21 Pvc COmpany Name r, ""�''9-' Ufl 16.INNER CASING OR TUBING(geothermal closed-loop) 9 FROM TO DIAMETER THICKNESS MATERIAL 2.Well Construction Permit#: 369027 ft. ft. , in. List all applicable well permits(I.e.County,State,Variance,Injection,etc.) . ft. ft. in. 3.Well Use(check well use):. 17.SCREEN Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public ft rt. in. 0 Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. in. ❑IndustriallCommercial OResidential Water Supply(shared) 18.GROUT FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT ❑Irrigation 0 ft. 3 ft- Bent.Chips Gravity Non-Water Supply Well: ❑Monitoring ❑Recovery 3 ft. 20 ft- Bentonite Pumped Injection Well: ft. ft. ❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable) ' FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Storage and Recovery ❑Salinity Barrier rt. ft. ❑Aquifer Test ❑Stormwater Drainage • It. ft. ❑Experimental Technology ❑Subsidence Control ' 20.DRILLING LOG(attach additional sheets if necessary) 0 Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,soillrock type,grain size,etc.) ID Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 fL 8 rt. Red Clay 4/17/23 8 ft. 17 ft. Brown Dirt 4.Date Well(s)Completed: Well ID# 17 ft 23 ft Brown Rock 5a.Well Location: ZacharyChandler 23 ft- 185 fL Slate Facility/Owner Name FacilityID#(ifapplicable) ft. ft- Seams:55',68',72',81',95',99'=2gpm, ft. ft. 150'=6gpm, 169', 173'=67gpm Union Grove Church Rd, Albemarle 28001 f4 ft. Physical Address,City,and Zip 21.REMARKS Stanly 19973 County Parcel Identification No.(PIN) 5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: (if well field,one lat/long is sufficient) tt- N W � .C_. 5/5/23 Signature of Certified Well Contractor Date 6.Is(are)the well(s): ©Permanent or ❑Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a 7.Is this a repair to an existing well: ❑Yes or 0No copy of this record has been provided to the well owner. If this is a repair,fill out known well construction information and explain the nature of the repair under 1121 remarks section or on the back of this form. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well 8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary. For multiple injection or non-water supply wells ONLY with tire same construction,you can submit one form. SUBMITTAL INSTUCTIONS 9.Total well depth below land surface: 185 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths ifdifferent(example-3@200'and 2@l00) construction to the following: 10.Static water level below top of casing: 30 (ft.) Division of Water Resources,Information Processing Unit, If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter. 6 (in.) 24b.for Infection Wells ONLY: In addition to sending the form to the address in Rotary 24a above, also submit a copy of this form within 30 days of completion of well 12.Well construction method: construction to the following: (Le.auger,rotary,cable,direct push,etc.) Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELTS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) 75 Method of test: Air 24c.For Water Supply&Injection Wells: Also submit one copy of this form within 30 days of completion of 13b.Disinfection type: Granular Amount: 1/2 lb. well construction to the county health 1 department of the county where constructed. 1 Form GW-1 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013 1 ,