The URL can be used to link to this page

Home My WebLink AboutGW1--00135_Well Construction - GW1_20231228 Print Form WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: 1.Well Contractor Information: Fishburne Drilling Inc. 14.WATER ZONES FROM TO DESCRIPTION Well Contractor Name ft. ft. Mike Young ft. ft. NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap Iicable) 2370A FROM 'f0 DIAMETER THICKNESS M A I I:RI ST ft. ft. in. Company Name 16.INNER CASING OR TUBING(geothermal closed-loop) 2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL List all applicable well construction permits(i.e.(JIC,County,State,Variance,etc.) ft. ft. in. r 3.Well Use(check well use): ft. ft. in. Water Supply Well: 17.SCREEN pp y FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL DAgricultural 0Municipal/Public 15 ft. 5 ft 2 in. 010 sch.40 PVC Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ft. ft. in. DIndustrial/Commercial Residential Water Supply(shared) 18.GROUT Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 3 ft. 1 ft. chip bentonite treme Monitoring [Recovery 1 ft. 0.5 ft• concrete hand placed Injection Well: ft. ft. °Aquifer Recharge iGroundwater Remediation 19.SAND/GRAVEL PACK(if applicable) ]Aquifer Storage and Recovery D Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD Aquifer Test 0 Stormwater Drainage 15 ft. 3 ft* #2 silica sand tremied Experimental Technology 0 Subsidence Control ft. ft. Geothermal(Closed Loop) DTracer 20.DRILLING LOG(attach additional sheets if necessary) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.) Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks) 0 ft. 15 ft• tan sand 4.Date Well(s)Completed: 11-29-2023 Well m##3 ft. ft. a. rt. 5a.Well Location: ' Dowdy Park/Town of Nags Head ft. ft. , Facility/Owner Name Facility ID#(if applicable) ft. ft �r Z^ 3005 S. Croatan Hwy. ft. " ft. i 7 & �O Physical Address,City,and Zip ft. ft. otf �� Dare Co. 21.REMARKS __ County Parcel Identification No.(PIN) Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lat/long is sufficient) 22.Certificad 35.976731 • N -75.640067 Vh 12-04-2023 6.Is(are)the well(s)0Permanent or °Temporary Si lure of Certified Well Conttacto Date By signing this form,I hereby certify the well(s)was(were)constructed in accordance 7.Is this a repair to an existing well: °Yes or @No with 1SA NCAC 02C.0100 or 1SA 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#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 I GW-I 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: 15 (I') 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 2@100') 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 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 8 _(in.) 24b.For Infection Wells: In addition to sending the form to the address in 24a Hollow stem 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.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 _ - .lr ..': ,:.'<X:dL '_.// !" ..wee '..___:\III Untitled Map 'nc Doo?OBX Boutique : . 1 Legend Write a description for your map. . V`'` a"' >'• 80 , "` R I \ �� S. '' ' r . r. �' ' -.1 to ,, dOro 'jiff@ ago , _ . _,.._ C7 *.' .; . 1 i �s �oowdyt� l-rtz \ fir, \ • . 'tr, t` .',A � �� a, � 1 0. r 1\ : r P♦ �jg��"��. , •a e* � i A. - � .4�`'tY}yip {i" 33 'V' oaf ed • •Y, ' 4.s ;1 . ,r at�,,,� •' s r� ,, `a. a 't --_.` a't ^�li ,A�a.`Y �i�. .f �sx a`'� �i 1 y :.,, "'.�— ,s C .SIT+*._ • _ r ....4 '` '� J + + � {_,., 'j _` ._r. 3 J .'s' I ti. �, \ �'. a ).. t 1 a 4 � • J .�\ ` Y .� -r. W. F ` • \e - § a E } ' -: eli,:**‘:•,.'''',..,,,v;!- ':;:'' " . , 0,_ ate 4ik,* , 0. . �.eestai'se- oo I, L .�--« \ . - Y % . ,F . „t N * x gam, - y