GW1--07832_Well Construction - GW1_20231208

i
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Frankie L.Oliver 14..WATER ZONES f"'::-'` '
WellFROM TO DESCRIPTION
Contractor Name
3002-A 244(7)f` 358 ft. I
356 ft' ft.
NC Well Contractor Certification Number -15.OUTER CASING(for multi-cased".wells).OR LINER(if applicable)
Carolina Well Drilling FROM TO DIAMETER THICKNESS MATERIAL
8** ft. 58 ft. 6 5/8 i in' 188 Galv.Steel
Company Name
16.INNER CASING`OR TUBING(geothermal closed-loop)
23-201
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U1C,County,State,Variance,etc.) f[ ft. in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: FROMREE TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural DMunicipal/Public ft. ft. , in.
Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. it. in.
Industrial/Commercial OResidential Water Supply(shared) 18.GROUT ' .. . ' " •. '
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
Monitoring DiRecovery ft. ft. ••
Injection Well:
ft. ft.
Aquifer Recharge IDIGroundwater Remediation
_ ; 19:SAND/GRAVEL'PACK(if applicable). '
Aquifer Storage and Recovety DISalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test DIStoimwater Drainage et. ft.
Experimental Technology E3Subsidence Control ft. ft.
Geothermal(Closed Loop) OTracer 20.DRILLING•LOG(attach additional sheets if necessary), "
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size etc)
285 ft. 600 ft. Granite
4.Date Well(s)Completed: 9-6-23 Well ID# ft ft.
5a.Well Location: ft.
Beechwood Weddington LLC ft. ft. ;:.,;: L..,i ': .,y , .,,
Facility/Owner Name Facility ID#(if applicable) ft- i'u �-.rt j
Weddington Glen Matthews 28104 et. ft. DEC U 8 2OL 3
Physical Address,City,and Zip fG f[. In, ,C ;_C r R_
21:REMARKS- ' E3"t. .,,� ",J'..eta.
Union 06-120-373 __•
.,
County Parcel Identification No.(PIN) **Replaced damaged casing with 6 1/4"SDR21_PVC from 0-8'
and grouted with bentonite,Drilled well deeper from 285'to 600'
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,.one lat/long is sufficient) 22.Certification: '
35.03.400 N 80.74.224 �, 1
• 10-3-23
6.Is(are)the well(s)EiPertnanent or oTetnporary ignature of Certified Well Contractor; Date
By signing this form, 1 hereby certfy'that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: BYes or ONo with 15A NCAC 02C.0100 or ISA 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 ouster.
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 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
9.Total well depth below land surface:• 600 (ft.) 24a. For All Wells: Submit tliis form within 30 days of completion of well
For multiple wells list all depths if different(arample-3(2200'and 2@100') construction to the following: i
10.Static water level below top of casing: 32 (ft.) Division of Water Resources,Information Processing Unit,
If water level i.e above casing,use"+" 1617 Mail Service,Center,Raleigh,NC 2 7699-1 61 7
11.Borehole diameter: 6 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
Air Rotary 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) 10 Method of test: Air 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: 70oa HTH Amount: 36oz 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 1 Revised 2-22-2016