GW1--00059_Well Construction - GW1_20231218

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WELL CONSTRUCTION RECORD(GW-11 For Internal Use Only: '
1.Well Contractor Information:
Spencer Adams 4.i WATERZONES f ' : . ..
FROM TO DESCRIPTION
Well Contractor Name
•
145 fL 300 fL ,5 GPM
4449-A ft. ft.
NC Well Contractor Certification Number •
1$:'Utl L�R CA51fiiG(foe tniilti lased:tirelLs)OR LINER(if op lrcable) :
Rowan Well Drilling FROM TO DIAMETER; THICKNESS MATERIAL
0 ft 145 it a 1/4 !n' SDR21 Pvc
Company Name
06-2023-198352 '16.-1NNERCASINGORTUBING(Reottitrmalelosed luap):
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIG County,State,Variance,etc.)
ft. ft. 1n.
3.Well Use(check well use): ft ft. 'in.
Water Supply Well: FROM TO DIAMETER i SLOT SIZE THICKNESS MATERIAL
Agricultural onmicipallPublic ft. ft. in. ,
Geothermal(Heating/Cooling Supply) X)Residential Water Supply(single) g- ft, is '
Industrial/Commercial °Residential Water Supply(shared) -is CR0151 '._
'.Irrigation FROM TO MATERIAL - EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: o ft. 20 ft Holepluo '• Gravity 9.5
Monitoring r3Retovery ft, tt..
Injection Well: ft. ft •
Aquifer Recharge Groundwater Remediation 19:-SAND/GRAVELPACK(if applicable)
Aquifer Storage and Recovery EDSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
i'
Aquifer Test fStormwater Drainage ft R •
Experimental Technology }Subsidence Control ft. ft I:
Geothermal(Closed Loop) °Tracer '204DRJLLINGL0G(iittaetsiddittonafsb bttriicessacyl. -. .
Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,seithoek type,grain size,etc.)
Geothermal(Heating/CoolingReturn) 0 ft• 15 ft. Clay
9/14123 198352 is ff. 120 ft' Sandy Overburden
4.Date Well(s)Completed: Well ID#
,ro ft- 135 f" Weathered Rock
Si Well Location:
--- - -- -Schumacher Homes 135 ft- 145 ft Sad Rode - , ..
Facility/Owner Name FacilityIDll(if applicable) 152 iL f70 ft. Solt Pink Rock!Quartz
1824 Sayre Farm Rd, Newton is ft.
ft. ft.
Physical Address,City,and Zip ......
Catawba 21.REMARKS ' jf i „,^
4..�i' t �-s'
County Parcel Identification No.(PIN) • )
GisIg2023
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one tat/long issufficient) 22.Certification: ,'�f: _ 1t. ,
N 81 11 29.352 `kw""''It'I'
35 3813.018 w y °� ( '��'w �4 2"3
Signature (Certified Well Contractor ,, Date
6.Is(are)the wells)jX Permanent or Temporary b
By signing this form.I hereby certify that the we (s)was(were)constructed in accordance
7.Is this a repair to an existing well: °Yes or 'LI No with 15ANCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If this is a repair,fill out known well construction',formation and explain the nature of the COPY of this record has been provided to the well owner.
repair under 421 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 details. You may also'attach additional pages if necessary.
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:' SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 465 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths tfchfferent(example-3@200'and 2(5100) construction to the following: .
10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mall Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
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.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Man Service Center,Raleigh,NC 276994636
13a.Yield(gpm) 1'S Method of test:weir 24c.For Water Sunnlv&Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
Chlorine mount. 21 0z completion of well construction to the county health department of the county
13b.Disinfection type: A
where constructed.
Form GW I North Carolina Department of Environmental Quality-Division of Water Resources
Revised 2-22-2016