HomeMy WebLinkAboutGW1--00574_Well Construction - GW1_20240118 ,
\'I+;LL CONSTRUCTION RECORD CV►'_1 t
)tor internal Use Only: I
I.Well Contractor Information:
. RANDY OWNBEY , 1
Well Contractor Name 14,WATER ZONES
FROM 'ID . DESCRIPTION
3214A 189 ft. 200 n. -
NC Well Contractor Certification Numb f•
t. ft. i I•
—
AIR p R I I N G I N C 15.OUTER CASING(for multi-cnsdd*ells)OR LiNER(if applicable)
FROM To DIAMETER _ THICKNESS
0•
ft. 88 ft. in. —_MATERIAL_..._..Comptuty Name6 PVC
2.Well Construction Pcrinit fh 02-2023-189321 16.INNER CASING OR TUBING( eothcrmal closed-loop)
FROM To DIAMETER THICKNESS SIAruielnl.
LA-,all applicable u•elLconsnvclion permits-(i.e.(IIC.',Count,',Slate, )'ti-/u,ce.etc.) ft. ft. in. -.--
3.Well Use(check well use): ft. — _._
fl. in, -
Water Supply Well: - 17.SCREEN •
!;Agricultural Irtto\I To ntAML:1'RRi' si.o•r sizs Tn tct(NRss MATERIAL '
[-Municipal/Public ft. rt. in, ---
I K'ieotltcrn,,d(I Icahn);lCobhnit Supply) lFResidenlin)Water Supply(single) -- —_-- -
—
!Ilndusu'iallCotmncrci;,1 ft• n: in� -- ----_._--
I`JResidential Water Supply(shared)
! ilrri)!aliolt IS,GROUT —
El Wells> 100,000 GM FROM TO MAT1•:RI.u. EMPLACEMENT METHOD.5 AMOUNT I
Non-Water Supply Well: 0 fL 20 IL' GROUT • POURED
•fln'Ionitoring i IRccovery ---- — ------ --
injection Well: ft•
--~ --
ClAquifer Recharge t_IC3roundwalcr Rcmcdietion It. • ft. —"—
1.7Aquil'cr Storage and Recovery I_1Salinity Barrier - 19.SAND/GRAVEL PACE(if applicable) —
FROM To' MATERIAL Rnu'[.nca:nu.NT:wo-riu,o
❑Aquifer Test OStorntwaler Drainage' ft. IL ,
❑lixperimental Technology •DSubsidcnce Control ft. rt, , ---—
--
❑Gcolhemutl(Closed Loop) fa'fracct I,
20.DRILLING LOG(attach additional attests if necessary)
•
1:1Geothermal(Beating/Cooling Reim) 1::1Othcr(explain tinder 1121 Remarks) FROM TO DESCRIPTION(color,hardness,soil/reek type.grain sire,etc.) T
- p ft.. 78 I't. DIRT
4.nalo-Weu(s)Completed; 03-16-2023 -Well IDl/ 78-- -- —--- ---- --nc 205 ._——_..—It ROCK
5a.Well Location: - ft, ft. —' —..
ROBERT HIGHLAND ft.• • ft.
_Pac;lity;'('l,snar Name ;7'f. �'(
Facility Mil(fiapplieable) ft. I'l. —i, ? -L.� �E.,'r L "
4715 10TH S ft. rt. JA lei T NE,HICKORY,N.C. 28601
•-—— —— 1 8 .�SL^f2`1•
n.I'hy,ir,,)Address.r.t .and Zip ----•—
n.•
CATAWBA . . 372513137171 21.REMARKS il+L.Y,- :.,•l �.._ti,;,1:.r2-(,jCi —
('uultly Parcel Identification No.(PiN) 6> `v{.J'!`5L7
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: "— `
(iI well field,one tat/long is sufficient) — — ----"_-_..:_...__
35° 47.902 • N 81 ° 17.263 22.Cetti" I
w .. 3/17/2023
6.ls(are)the well(s): IJPermaneul or OTemporary Signature of Certified Well Contractor Date
By.signing this fbr,n,I hereby milli.dial the ireil(s)win(elan')constructed in accordance with "
-7.Is this a repair to an existing well: .I:IYes or 1!JNo /S:I NCAC 02C.0100 or/54,VC i1C 02C.0200 Well Conxa•ucvion Standards and that n cop,•
If this is a rcpu,,',fill out known Isv/I construction hilbrtnation and explain die nature of the 'Obis record has hcen provirind to the um!!grvncr.
repair under ti.?I remarks section or an the hack o/'this,/hrn,. -
23.Site diagram nor additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same ' You may use the back of this page to provide additional well Construction inlh
construction,only I OW-I is needed. Indicate TOTAI..NUMBER or wells (add'See Over'in Remarks Box).You May also attach additional pages if ncet:ss:u•y.
drilled:_ :.---___—_- _
24.SUBMITTAL INSTRUCTIONS
9..Total well depth below land surface: 205 (ft.) ''
Poi multiple,cells list all depths if(Wiwnr(crumple-3@200'and 2(irll00') Sttbmil this GVY-1 within 30 days of well completion per the Iutlln,ving:
lll.Static water level below lop ol'casing: 50 (it• 24a. For All Wells: Original !brm (o;Division of Water Resources (I)WR).
it:r:urr 7r, •t ts,d.o,e eosins.rsc• ' ) Inlbrmtttion 1 recessing Unit, 1617 MSC,Raleigh,NC 27699-1617
I I.Borehole diameter: (in.) 24b• . For Injection Wells: Copy to IWR. Underground litjeelion Control (ILK')
Program, 1636,MSC;.Raleigh.NC 27699-1636
l2.Well construction method:
(i.e.:taper,rutty,cable,direct push,etc.) • — .24e.For Water Supply and Open-Loup Geothermal Return\yells:Copy to the
county environmental health department ol'the county where installed
FOR WATER SUPPLY WELLS ONLY: I
p 24t1.For Water Wells producing over',100,000 CPI): Copy to DR,CCPC'UA
13tt.Yield(gent) 30 HTH
test: AIR Permit Program, 1611 MSC,Raleigh,NC:'27699-161I.
•
13b.Disinfection type: HTH Amount: t
' Form CiW=I North Carolina Departincnt of Environmental Quality-Division ol'Water Resources
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