GW1--00582_Well Construction - GW1_20240118

WELL CONSTRUCTION RECORD CW-1
� ) For Internal Use Only: i
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I,Well Contractor information:
i
RANDY OWNBEY
14.WATER ZONES (. - 1
Well Contractor Name _mom_i TO DESCRIPTION
3214A 149 fL-150 IL - -- -
--ft.--- ft. ----
NC Well Contractor Certification Number i
AIR DRILLING I N C I .OUTER CASING(for multi-cased Wells)OR LiNER(trap)licable) I
r•Roat •r(7 otAmt:rrt T THICKNESS MATERIAL 1
Com Pt v,n Name 0 rt. 76 - rl, 6 In. PVC
1036 16.INNER CASING OR TUBING(geothermal closed-loop) ........\
2.Well Construction Permit ll: FROM TO __ DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.WC,County,State, Variance,stet) ft. ft. in. ..
3.Well Use(check well use): . ft. R. in.
Water Supply Well: 17.SCREEN
C1A'riculu,rtal , ttRUaI- TO nhM-iWil•:R SLO'rSIZE THICKNESS _t•iA'rlctiIAI.
b 1:Municipal/ ublic It. ft. in! — _
I IGeotherntal(Ileating/Cooling Supply) I_•IResidential Water Supply(single) --- — --- —•--- -- .--. ._-- _.
ft. 1'L iu.
! !Industrial/Commercial' Cl Residential Water Supply(shared) ___. ...._
IN,GROUT
I;Irrigation [Wells> 100,000 GPD ttaoal TO aiKfEItIAI. i•:aMPL.ACraw•:N-ratErittti,,7.�.icirS-i'_
Non-Water Supply Well: 0 R• 20 rt. GROUT POURED
! iMunitoring 11Recovery - - ft. ft. -- — - - ----
ln•ieclion Well: ---- --- -----
I!Aquifer Recharge L1Groundwatcr Remediation ft. ft. ---" - -,
I IAquihcr Storage and Recovery I_lSalinit Barrier •
19.SAND/GRAVEL PACE(if applicable) -I
Y t:Roal •1'o al,crtillAL EMPLACEMENT_auCrt!Un
1-IAquiref Test DStormwater Drainage ft. ft.
Ellixperimenlal Technology — --------...-....
l hY 17Subsidcncc Control fa ft.
llGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
L.IC�eothcmat(lheating/CoolingReturn) I':IOlher(explain:under117.1 Remarks) hltoal -•ro -.-___oEsCaBi'_t_iON(cotor,hardness,soil/rock type,grainsize•etc.)
0 ft. 66 ft• DIRT '
4.Date Well(s)Completed: 04-13-2023 well iD9 • 66 II. 165 II. ROCK,
Sn.Well Location: -ft ft. I -- - - -
RICHARD CERCHIARA rt. ft. - I.
- - .
i.
Facility/Owner Name Facility IDIt(if applicable) ft. ft. i1)cr— • c—a', ri"-'" 1
___ '.',- tom. , " 1
1305 AUTON RD, LENIOR,N.C. 28645 --._--.- ----1-- ��, aw �� •
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Physical Address..City.and Zip ft. fL
JAN rS Z02-4 -
CALDWELL 2880820377 21.REMARKS
('uontyt Parcel Identification No.(PIN) Itllrii? I�'1 •Al' V.
51).Latitude and1ongi(tide in degrees/minutes/seconds or decimal degrees:
-
tic'o'elI field,one la/long is sufficient) 22.Cu a. n: -- — —
35° 55.783 N 81 ° 24.167 WI
I 4/13/2023
G. Is(are)the well(s): I'.II'ermanent or i'rcmporar,' Signature or Certified Well Contractor pate
lll'signing this farm,/herein'ccr(i/i'that the well(r)tins(were)constructed in accordance n hit
7.Is this a repair to an existing well: I_lNes of 1'INo IS')NC:IC 02.C.'.0/00 or/5.I NC:-1C.'0.?C10'00 Well Construction Standards and chat a copy
if this is a repair.Jill ant known well construction in/brtmtlion and explain the nature al the n/'thi,rcrard has heen praridcd In the"'el(❑suei,
repair under Il.?/remarks secvior,ar on the bask q/'thicibrn,. i
23.Site diagram or 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 inli,
construction,only I GW-i is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
— '— 24.SUBMITTAL INSTRUCTIONS
165 I
9.'rota►well depth below land surface:
(ft.)
For multiple,cells list all depths i/'diQcre,a(aviauple-.?a200'and 2a l 00) Submit this GW-I within 311 days or well completion per the following:
(fh) 24a. For All Wells: Original form to Division of Water Resources (MR).!0.Static water level below top of casing: 60
Iltrmii/et'e/is above rasing,ass"t.' Information Processing Unit, 1617 MI f C.Raleigh,NC 27699-I G 17
II.Borehole diameter: 6 (in.) 24b. For Injection Wells: Copy to 1)\VR, Underground Injection Control (IU(')
Program,_I636 MSC,Raleigh.NC 27G99-IG3G
12,Well construction method: I
(i.e.Writ.rotary,cable,dirccl_pus :etc.) 24e.For Water Supply and Open-Limp Geothermal Return Wells:Copy to the
county environmental health departmom of the county where installed
FOR\\LATER SUPPLY WELLS ONLY:
24d.For Water Wells producing over400,000 GPI): Copy to t)WR.C(•PCV:\
13a,Yield(gpm) 25 Method of lest:AIR Permit Program, 1611 MSC.Raleigh,NC 27699-I6I I
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13h.Disinfection type: HTH Amount:
Perm(lW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2tl S