HomeMy WebLinkAboutGW1--00519_Well Construction - GW1_20240118 • ' r •
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• WELL CONSTRUCTION RECORI) (GW-1) Fol.Infernal-Use Only: -
1.Well Contractor Information: I
. CHAD HARTNESS • -
IVeii Contractor Nnmc 14.WATER ZONES 1 ' ---�
IrRO\7 _I'0 UI?SG211t'PIO\
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2901 A 429 430 — —_ —'
• NC'Well Contractor Certification Number•
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15,OUTERCASING(curmulti-cased wells)OR LINER(tra11tticablo)
AIR-DRILLING INC
FRO\'� To_— •' DIA\11•'r t.. isS Tnicicsl \L\T'tim,I.
• ('on,p;rn) N;nne - ' 0 1'1• 79 ft 6 � I in. — _....--PVC
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2.1\'en(;D,1511'll l'110 r1 PCI'lllil i(;
11385B#13099 16.INNER CASING ORTUn1NG(aent;tel'mal closed-loop)
FItO\I •TO DIA:N.1:I•Elj' TIIIC!C\I:SS MAT RLA1_-
List all applit ohle well construction permits(i.e.WC,County,Stole, Variance,vie.) -.-__-fl. rt.--'-
in.
3.Well.'Use(cheek well use): ---__. -- __--
rt. rt. in.
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Water Supply Well:. 17.SCREEN •
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lJAgricultura) ,ublic •
FRoMI TOI)I,UIi•:rr-it' si.OI SIZi•_ 'rl.iictcvp_ss 'rpatln i
❑Municiipal/1 ft. • f1. in:• _ _-- -\in -
t.
I_IGeolhermal(Pleating/Cooling Supply) In Residential Water Supply(single) - -----••--
I_Ilnduslrial/Conuncrcial rt. ft. (n;' -
C1Residential Water Supply(shared)
L.Ilrrigalion 18.GROUT -�__.
1_IWells> 100,000 GPD FROM TO MATERIAL EMI't•ACEMENTMI'frnUD._,MOt NT+
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Non-Water Supply Well: 0 r' . 20 r'' GROUT, POURED
'Li Monitoring - !_lRecovery - —fl• rt. ---- --�--
Injection Well: "
LlAguifcr Recharge ' ' 11Groundwater Remediation ft
• ,'t. _------- __- „-
f lAguil'cr Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACE(if applicable) J •
FROM ._'1'0 _ 'IA'1'V.RIA1. 'E61t'LAC:IC\iENT NIET•ItOD •fl/\gttirer'lest . ❑StormwaterDrainage' ft. ft,
CiExperimental Technology ' 17Subsidcncc Control -�-""- --- -
• CiGcothermal(Closed Loop) ra'l'ruecr - - 20.DRILLING LOG(attach additionid sheets if necessary)
I.1(icothci 11 11(11eating/Cooling Realm) I:IDther(explain under I121 Renturks) FROM TO DESCRIPTION anm,.Mirthless,snnnnca teLc,l,r,ap situ,cit..)' DESCRI
0 fir 9 ut T
04-03-23 69 DIRT
•I. Dale Well(s)Completed: Well ID/P ' ' 69 f'' 445 it ROCK �`-- -_...__..___ _-- _-- • -
,a. Location: rt. ;r --
It. t/ sr
. . DYLAN BAUGU•ESS ., . . . • D. rt.
.„,,..,..,0_, nr+ 'Inw
I u dily/Owner\'an t
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facilily9D1;(il;;y,plicable) ft• ft.
20201. SHEARES RD,DAVIDSON,N.C. 28036 - --
ft.
ft. ---! JAN 1 S_LG24_�_`_
Physical AdchLss,City,and Zip -- t --- -- •
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rt. in s,
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MECKLENBURG 00337126 21,REMAKES —{
County Pam el Identification No..(PIN)
Sb.Latitude and longitude in(Icgreeshniniiles/secon(Is or decinu,l degrees; ,� I ---
Of well field,one iaVlnntf is sufficient) 1 "y i f --- -------..__---_-----.- ,
35° 28.957 -• 80° 47N .308 •
t zz• tc;�rtu; �uan:
`` `'°4/3/2023
6.labsre)the itcll(s): I'IPern,lu)eot or `,�..: -•--
Cl'1'Cn,porary Signature of Certified Well Contractor I Dale
By signing thisfbrin,I hereby cerri/i'that the,re'll(s)was(were)constructed in arnn•dww,'with
7,Is this a repair to an existing well: LlYes •or I°INo /5.4 NC'AC'(1.2C:.01f0 or/54,\'C 4C://2(.'.6200 It'rll Cmsullerla,Slwnlarrts rail dwt o cope If this is a repoir,•/ill old known well eonso'iwi/a,in/brnnaion and explain•tIn.nature o/7he 'Phis record lies lice„/n•ovidcrl to nc‘.,Set"'ler.
repair under 1121 rc•n,arkc section or on the hack of'this;%arnr.
23.Site diagram br additional well details: •
S,For Ceoprobe/OPT or Closed-Loop(geothermal Wells having the same You may use the back ol'this page u, provide additional well construction inli,
• construction,only I (iW-I is needed. indicate TOTAL NUMBER of wells. .(add'See Over'in Remarks Box).You may also attach additional page,if'ncccssar)
drilled:
24.SUllt\IIT'I:\L,INS'I'RLJCI'IONS.
9.'lout well dent!,below land surface: 44.5. • i
Ern nin/npie ur//,II,/all depths ijdl//i'rent tiwannide-.i'tii:'nn'and 2.(irc/tin') (!h) Subunit this G1\'-1 within 30 days of well completion per the Iollawing:
70 (fl. 24a. !'Dr All Wells: Original liirni to Division' of Water Resources II)\VR,.
10,Static water level below top of easing:
l/'irrrrcr level i.r above rrarinq,use ''i- ). Information Processing Unit, (617),MSC,Raleigh,NC 27699-1617
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i I.Borehole diameter: 6 (in,) • 24b.For Injection Wells: Copy to 1)WR, Underground Injection Control (Il1C)
Program, 1636 MSC,Raleigh,NC627699-1636
12.Well construction method:
(i.e.auger,rotary,cable,direct push,etc.) 24c.Fa'Water Supply and Open-Loop Geothermal Return Wells:Copy to the_
county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY:• - I
24t1.For Water Wells producing over 100,000 GPO: Copy to DWR,CC'PC'U:\
Pia.Yield(gpm) 2 Method of lest:AIR Permit Program, 1611 MSC,Raleit;h/NC 27699-I6 I I
13b.Disinfection type: HTH Amount: •
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Form UI•in-I I •
Noah Carolina Department of Environmental Quality-Division of Walcr Resources I
IRevisdd n_i,:'u l ti
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