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Home My WebLink AboutGW1--06205_Well Construction - GW1_20230925 1 "WELL CONSTRUCTION RECORD (GW-11 For Internal Use Only: 1'.Well Contractor Information: ' ' Cam'1"4 ��p9 ` )1 n14 WATER`ZONFS i-�:..,.•::,'i: (I;yf'' .P.'.. .`n:,"-.': 5::1?i ..,.:_.. .., . ,:41>:.1"`ii - , FROM TO ~DESCRIPTION - . Well ContractorN<i.e P.�ft. 2-700ft' �49 X®.E� w�u � ft= . ft �` 3 + NC WellntracCertifi onNumber „15:OUTER'CASING..(far'Iniilti'csse l:lolls)ORI INRR(if ap linable)C ..'-'..•:%a' Yadkin Well Company, Inc. FROM TO DIAMETER THICKNESS 1 MATERIAL p � '13 9 y/..1 ft. ft. I in. Company Name Focirii- 3 16iIlVN1R.CASING:Olt:TIIBING;(Reotliermalclosed=loop)=: - wf• yr 2.Well Construction Permit#: 9_. 02.- 0 Vis FROM TO DIAMETER THICKNESS MATERIAL List all applicable well construction permits(i.e.UIC,Comity,State,Variance,etc.) ! ft. /3;" ft. 1�,.a in• 1:02 a F". �' 3.Well Use(check well use): t 77S.CR,ft. ( in. +� 7IN.•�,e....�. .�^-v.. :� r a r_. - •1 1 Water Supply Well: FROM TO DIAMETER -SLOT SIZE THICKNESS MATERIAL r 1 ❑Agricultural ❑Municipal/Public ft ft in. {� OGeothermal(Heating/Cooling Supply) Afesidential Water Supply(single) ft. ft. in. • • ❑lndustriallCommercial ❑Residential Water Supply(shared) .18.?GROUT,! : ;r_ _---Y�.'.:L___-_�. _-_- ' l' ❑lnrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENTMETROD&AMOUNT Non-Water Supply Well: 0 ft. 3. ft. Ottikelligio /®u,fed, OMonitoring ❑Recovery 3 ft. � ' ft A Injection Well: it af7 Ps.'t ❑Aquifer Recharge .❑Groundwater Remediation v`: _, , 1J:SAND/t AVEEPACK'(ifspplicable)'4 :�._�._-_._.f.a7= ' ..�::a-:.�: : ❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑StormwaterDrainage ft. ft ❑Experimental Technology 0 Subsidence Control ft. ft ❑Geothermal(Closed Loop) OTracer G203DRI>t3NGT:OG:(a"ttach additiiinil ahe"ete if.necessary)=-= .:_"a' = H ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soilirack type grain size eta) Date Well Started 'f-SI• )-' ® ft. ®y,/t't. Se.°L. f,eS Z. 4.Date Well(s)Completed: g-I I';i-? Well ID#4A P-"lC C Ipie ft ‘02,°ft O'da sskg, 4,gpy� e .4 Phone#:3, m trC ' ( ' L, ft. ft Sa.Well Location: ` I, # • • ft. ft t Y 'i +,..,q 1.7?_%(-4- g �� - r Facility/Owner Name Facility ID#(if applicable) -g ft. ft. Y•-• i'''r ' r :- C i 141vehOi G1 � 00 it it SFP 2 5 2023 -Q Physical Address,City,and Zip ft. ft � f / L21'RF.M:ARICES."f.. .`n-fr.,...:.ii.'i{t1 Y.12+t�J yi l-17.1'..'L40ekV4 J:Ur. 7:::Li`-:V... �arJy w I.-,WW.;L7 County Parcel identification No.(PIN) Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one 1at/long is sufficient) 22.Certification: 3 ®cig i/964' N 2�i � �' itifii � °4 6.Is(are)the well(s): Ckermanent or OTemporary Si lure of ed Well Contractor ,, Date By signing thisfonn,I hereby certify that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or 0 15A NCAC 02C.0100 or I5ANCAC 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#21 remarks section or on the back of 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: s/ 24.SUBMTTTAL INSTRUCTIONS � 9.Total well depth below land surface: ) e (ft') Submit this GW-1 within 30 days of well completion per the following: For multiple wells list all depths if different(example-3( 200'and 2@1000 • 24a. For All Wells: Original form to Division of Water Resources (DWR), 10.Static water level below top of casing: 60 (ft) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 If water level is above casing,use•'+' 11.Borehole diameter: 6 (in,)Bit Off, 5--q q]- 24b.For Injection'Wells:Copy to DWR,Underground Injection Control(IUC) Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (Le.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 13a.Yield(gpm) 3 Permit Program,1611 MSC,Raleigh,NC 27699-1611 Method of test: �'r�� ``� 70% hth oZ Date Site Visited:`7'- ! 2..� 13b.Disinfection type: Amount: /5% Site Visited By: Din! ! Form GW_1 North Carolina Department of Environmental Quality-Division of Water Resources, Revised 6-6-2018 Price: