GW1--00589_Well Construction - GW1_20240118

WELL CONSTRUCTION RECORD (GW-I) For Internal Use Only:
I.Well Contractor Information:
NEILL PARDUE 1
14.\\'ATER ZONES j --_I
Well Contractor Name _FROM TO DESCRIPTION
2609A 309 it 310—r%_ I.•
I
NI.'Well Contractor Certification Number ft. ft. I
IS.OUTER CASING(for multi-eased bells)OR LINER(ifttp tlicable) ..-
AIR DRILLING I N C
ERO\I '1'O DIAMETER _I THICKNESS KNEES__ J,.�rtiRiAt. —
company Name 0 ft* 46 ft. 16 i ia' 1— PVC
61058 16.INNER CASING OR TUBING(geothermal closed-loop) -------
2.Well Construction Permit i/. _FROM _•I0 _ DIAMETER: TIIICEN SS .ttA•natt.tt_ .List all applicable well construction permits(i.e.UIC.',County.Si,,,,, Variance,etc.) ft. I'I.- in, --•--
3,Well Use(cheek well use): ft, ft. • in,
\\rater Supply\Veit: 17.SCREEN I —
L.I:\gI'icUhttrnl :Municipal/Public Raoul _To ttAJI F:rEIt' st.OI sm.: 'CitIct(NtS5 d1A'rtOt _t,\I.lJMunicipal/ _._ __...
H. ft, in..
' 'Geothermal(I lcating/Coolie);Supply) In Residential Water Supply(single) ----- --- n.-- ----iiit------
!Industrial/Commercial LiResidential Water Supply(shared) - —.- .--
IS,GROUT •
-
':Irrigation I-I Wells> 100,000 GPI) mom I TO MATERIAL EMPLACEMENT METHOD, AMITFIT -,
Nun-\viler Supply Well: 0 ft, 20 n, GRO__UT POURED
•
'Monitoringf-lRecovcry - fi. H.
. _ --
Injection Well: -- —^-- _—
- -- - -
i uil'cr Recharge ['G rt. . n.I 'Aquifer
1 ['Groundwater Remedintion
I IAquil'er Storage and Recovery ['Salinity BarrierIS.SAND/GRAVEL PACK(if applicable)
I+tiu I •t'o __ aI,\'1'F.RIAL ratt't.AC.Ea[ENT'm rltOn— -
[IAquil'cr'fest ' DStorntwater Drainage ft. n, •
0Nxperimental'1'echnology [)Subsidence Control ft. rt.
— -
I.IGeotherntal(Closed Loop) LlTracer 20.DRILLING LOG(attach additional sheets if necessary)
L.I(ieothcrntal(floating/Cooling Return) 1=101her(explain under I/?.I Remarks) FROM fro ntsCRII1°I ION(color,hardness,soil/rack tv
•Ln•, ,u„,ire,_eu,,-
------------- -f -
0 rt. 36 fL DIRT ' .
02-22-23 ---- -__ - - -4.Dale Well(s)Completed: Well IDIi 36 It 325 r1, ROCK ,
Sa.Well Location: rt. ft. �- - -
' I i
JASON ADAMS rl,-- ft. j( . - ,,,, ,c
- ' W 0 -
Facilil /Owner Name 1 ��'G Li,
y Facility ID!((il';gtplicah)e) I't. fl.
1875 OLD AMHERST RD,MORGANTON,N.C. 28655 ft. rt. f l`T j- ""2�j2
Physical Address,City,and Zip It. It.
liti,:r7f=P'tP.1 c
BURKE 21.REMARKS i Ear:.:�„_,Q2 U — =
1,a
Parcel I Identification No.(PIN))
Sit.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ---•--
tiC well field,one tat/long is sufficient) � -
22.Cc' ' bn: 7 )
•
35° 48.430 N 81° 36.817 \\ ,
. ` il 2/22/2023
6.Is(are)the well(s): I:IPermanent or D'I'mnporary Signature of Certified Well Contractor I Date --`--- -"
Ar s/ening this Arm,/hereby cerl/f i'dun the well(c)was twere)constl'acted in accordance with
7.Is this a repair to an existing well: IJ\'es or l lN° ISA,V(:•I('O2C.0/0ll or/S)1 NC:IC 0 1.'.0200 Well Construction Standards rood dun a ropy
If this.isa repair.Jill out kn well o,rn we construe/inn iq%ormalion and aylain the nature or the of this recrna(has been p,vn ided In the well nn7,elt
repair under 1121 rcwar65 section or on the hack of this Arm.
23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
You may use the bock of this page to.provide additional well construction ink)
construction.only I OW-I is needed. Indicate Taw.NUMBER of wells (adti'See Over'in Remarks Box).You may also attach additional pages il'necess:uy.
thrilled: _
• 24.SUBMITTAL INSTRUCTIONS
9.'l otitI well depth below land surface: 325 (ft.) ' •
For multiple,"ells list all depths i/'dif/i•rcvu(example-.3©U.00'and 20!00') Submit this GN'-1 within all clays at well completion per the following:
I
10.Static water level below lop of easing: 40 24a. For All Wells: Original formformjo,Division of Water Resources (I)b\!R).
ry'win,hr"r.•/ cuhoyaeas;,,4,use"+' (ft') Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
I I.Borehole diameter 6 (in.) 24b, For Injection 1\'ells: Copy lu 1)\ Control Underground Injection Coil- (Ida')
Program, (636 MSC,Raleigh.NC 27699-I636
12.Well construction method: 24c.For Witter Supply and Upon-Loop Ceoihermal Return Wells:Copy u,the
(i.e.am ter,rotary.cable,direct push.etc.) county environmental health department of the county where installed
POR WATER SUPPLY WELLS ONLV: I
2411. For Water Wells producing over 100,000 GPD: Copy to DWR.CCP('U,\
13tt.Yield(gpm) 25 Method ol'lcsl: AIR Permit Program. I61 I MSC'.Raleigh,NC 27699-I6I I
13b.Disinfection type: HTH Amount:
Form GW-I Non):Carolina Department of Environmental Quality-Division or Water Resources
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