WI0100680_Geothermal Well Construction Record_20230707

wwi„L CONSTRUCTION RECORDCOORD (GW-1) For Internal Use Only:
I.Well Contractor Information:
14.WATER ZONES
Well Contractor Name
FROMTO DESCRIPTION
3 A6,y- ft. 6 7 ft.,,..,,
3 4 4 - 2J .- 7a
1{'
ft. ft.
NC Weil Contractor Certification Number
15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
YADKIN WELL COMPANY,INC. FROM To DIAMETER THICKNESS MATERIAL
Company Name '
in. . ve_L -,.-3
16.INNER CASING OR TUBING(geothermal dose - op)
2.Well Construction Permit#: Y Z.0 ®4.4.
1 C 30 FROM TO DIAM1.1LR THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) ft. ft. in.TM
3.Well Use(check well use):
ft, ft. in.
Water.Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural Municipal/Public ft. ft. in. Z-1
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ft. ft. in.
Industrial/Commercial . , Residential Water Supply(shared)
18.GROUT
hTigation i `\CktiTire lii jI00,000 GPD FROM TO MATERIAL LA ,MENT METHOD&AMOUNT
Non-Water Supply Wel•,C.Li L.s L.LI 0 it,
e,
1 ,11L"
ft.
tIDnt v et4- 5 e..J
Monitoring
1 n
1 I3.ecovery ft. ft. 1
In(ection Well: O [[ j/
41 3'1l c''
ft. fr.
Aquifer Recharge
in
inter Remediation
nr - ij.fl t7iL`G 19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and very DwojitogSalinityBan-ier FROM TO MATERIAL E11EPLACEMENTMETHOD
Aquifer Test 05tormwater Drainage ft.
EE'cperimenta]Technology subsidence Control
ft
f1 r -
1G/eothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary) ._ •
Geothermal(Heating/Cooling Return)' Other(explain under#21 Remarks)
1-ROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
7 6111 o ft, lir ft. Sul,• .plp vvlcid S 1,2
4.Date Well(s)Completed: 7/7/a Well Mt/ A 1® C L
y
O
p
ki ft. `3 J ft. iect vj. 1 alrlrk ki Z't, ft. .tt. zSa.Well Location: Phone # 281- 7os.O2.G(
t3 ilk) Nt. Q (r ,,,,114a. 41
e Init: te(I C-5rniM Ai 44...3'z3
ft.
iiii
Factlity/OwnerName fL Facility ID#((if applicable)
1`
ft. fLe i Lid ro uir 41) ,.-
4 l E.
s
ci6'dl'hiy
tJt
d"t+f/69ejva.`4 .Mv ft• fr•
fit Lid
CA)1,,,,. P
Physical Address,City,and Zip / Ae?665 ft. ft. Q, l
Pf,4 c )
L4(i4 P-'
21.REMARKS
rr
County Parcel Identification No.(PIN)BORES (I ) DEPTH (StL 1 C c ' W e l 4 Z.
fi LOOPS PER BORE5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: DIA OF LOOPS((C
iflvell field,one lat/langis sufficient) 22.Certification: SDR OF LOOPS ( l2 ) 2.,0
79',303o N 0/, 6 -1276, ' W
7 7 •
1'57 g.
6.Is(are)the well(s): ermanent or Temporary
Signature of Ce d Well reactor atep
By signing this form,I hereby certi)51 that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: Yes or InNo 15A NCAC 02C.0100 or ISA NCAC 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. . .. li
repair,umder1121 remarks section or on the back of this form.
23.Site diagram or additional well details: •-
8.For Geoprobe/DPT of Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info Cl
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
add'See Over in RemarksBox).You may also attach additional pages if necessary. 9:
drilled: i
gg
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: V ° ft.) C
For multiple wells list all depths if different(example-3©200•and 2©100 Submit this GW-1 within 30 days of well completion per the following:
0 ft.
24a. For All Wells: Original form to Division of Water Resources (DWR),
Ifwater
Static10. water level below top of casing:Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
water level is above casing,use•44^"
gel p1
11.Borehole diameter: in.) Bit Off: P 90 24b.For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
AIR ROTARY
12.Well construction method:24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to thei.e.auger,rotary,cable,direct push,etc.)
county environmental health department of the county where installed
FOR IWATER SUPPLY WELLS ONLY:
24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
y' Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a•Yield(gpm) 7 -/1(. Method of test: ,fifer mile'
play e
13b.Disinfection type:
70% HTH
Amount: 3'X OZ DATE SITE VISITED; -/j- 2 3 Ay.,- 1-D 4,-.
Psi re:
VISITED BY: 0' 1,,)0(.
Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources -r,,,,,lbt /Awe.121 - 6-6-2018