GW1--06725_Well Construction - GW1_20231024

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
i
Mike Tynan . :':14.WATER ZONES. 1
Well Contractor Name FROM TO DESCRIPTION
2725-A 30 ft• 39 ft• silty sand
ft. ft.
NC Well Contractor Certification Number '''-IS.OUTER-CASING-got mdlti-cased'wells)OR LINER(if ap licable) .
IET FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name
Wi►A030 I 320 T16.-INNERCASING'ORTUBING(geothermalclosed-loop)z` '-
2.WQiI Construction Permit#: IVI J FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U!C,County,State,Variance,etc.) 0 ft• 24 ft• 2 in. Sch40 PVC
3.Well Use(check well use):Meck SIP 70003164 ft. ft. , in.
Water Supply Well:
;':17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural DMunicipal/Public 24 ft. 39 ft. 2 in' 0.010 Sch40 PVC
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ft. ft. in.
Industrial/Comtnercial DResidential Water Supply(shared) .-
IS.GROUT
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
x Monitoring DRecovery ft. ft.
-Injection-Well: - -- • - - - -- - -- -- -- . - . - - __---_-
ft. ft.
Aquifer Recharge OGroundwater Remediation
'19.SAND/GRAVEL PACK(ifapplicable)
Aquifer Storage and Recovery DSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test DStormwater Drainage 22 ft• 39 ft• #2 silica sand pour through augers
'Experimental Technology OSubsidence Control ft. ft.
Geothermal(Closed Loop) OITracer 20.DRILLING.LOG(attach`additional sheets ifnecessaiy)' :: ,.
Geothermal(Heating/Cooling Return) Other(explain under 1/21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
ft. ft. See consultant's log
4.Date Well(s)Completed:10/12/2023 well ID#TMW-2 ft. ft. _-F.7., 7r;_1
5a.Well Location: ft. ft.
'' ° .E i:
�.„ ?t 'R-r �
'�'
Residential/Agri Property ft. ft. OCT 2 r_. 202.3_
Facility/Owner Name Facility ID#(if applicable) ft. ft.
•
14720 Brown Mill Rd, Huntersville 28078 }' ''" '`'
ft. ft. fntch�� s:
::-'
Physical Address,City,and Zip ft. ft.
Mecklenburg 21.REMARKS '' `-
1
County Parcel Identification No.(PIN) TMW-2 permanently abandoned 10/13/2023.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
35 25 31.141 N -80 55 03.835 W 7/1,e4 /przf� 10/17/2023
6.Is(are)the well(s)01Permanent or Ix:Temporary Signature of Ce ed Well Contractor Date
By signing this form,I hereby certifj'that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: DYes or ONo with%SA NCAC 02C.0/00 or I5A NCAC 02C.0200 Well Construction Standards and that a
If this is a repair fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under 82I 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 Use same You may use the back of this page to provide additional well site details or well
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS 1
9.Total well depth below land surface: 39 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 1@i00') construction to the following:
10.Static water level below top of casing:34.5 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
1
11.Borehole diameter: 8.5 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
auger above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following: i
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) - -- Method of test: 24c.For Water Supply&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: • Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016