GW1--00590_Well Construction - GW1_20240118

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
I.Well Contractor information: I !I
NEILL PARDUE I.
14,WATER ZONES I
Well Contractor Name UROSt •1'0 DI{SCltll'irION
2609A 289 ft. 290 IL _ I --_ -
rt. fL I -------- - -
NC'\NulI Contractor Certification Number •
AIR DRILLING i N C IS,OUTER CASING(for multi-casedhveils)OR LINER(If up Ilicable)
mum' To DIAMETER T_IIICI(NESfi a \T'liltlnl.
Company Name 0 IL 67 1't 6 ill. PVC .... .... .
.16.INNER CASING OR TUBING(geothermal dosed-loop)
2.Well Construction Permit II: _FROM _ TO _DIAMETER THICKNESS \i:1'I'ha(L\L
List all applicable tin'!!construction permits(i.e.WC,County,State, Variance.ow) ft. ft. in.
3.Well Use(check well use): ft. It. ! in. -- — "-"-
Water Supply Well; 17.SCREEN
C!A•rlt dltnral -FROM _ To DIAMttTEtt ,_surf sizv. _r1IlCENI�SS .\I,T:RIAL
b DMunicipal/Public ft. ft. in.
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l-.I(ieothcrmal(Heating/Cooling Supply) I°1Residcnlial Water Supply(single) - ----------_.... _
I•L fl, lit, i
I lindust•ial/Commercial C1Rcsidential Water Supply(shared)
IS,GROUT
LLlIrrigation f_IWells> 100,000GPO FROM TO MATERIAI. EMPLACEMENT NIE.rutro&AMOUNT_
Non-Water Supply Well: 0 f'• 20 ft. GROUT POURED
1:1Monitoring LlRecovery ft. ft. —Injection wen:
Well:
LIAc niter Recharge rt. rt.
1 DGroundwater Remedintion
L7/\quil'cr Storage and Recoveryl7Salinily Barrier 19.SAND/GRAVEL PACK(If npplicnble)
FROM TO MA'I'EIO U EMPLACEMENT METli0D
[lr\quifi rTest ❑Slormwater Drainage ft. ft.
IJlixperimentttl'1'echnology ❑Subsidence Control D. rt. -----
L.IGcotherrnal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
1:1Geuthcrmal(l leating/Cooling Return) 1=10thcr(explain under i121 Remarks) PROM _ TO DESCRIPTION(color,hardness,soil/rnci<q.:L grain size,cw.)
0 It. 57 i'• DIRT
4.Dale Well(s)Cnmpdctetl: 2—6-2023 Well IINI 57 '' 305 F' ROCK I, -- ___------____.--
Sn.Well Location: fl. 11 ---- 1-4-4.,r ,_,{ ham-- %_-
HICKORY WELL(PAUL HUGHES) rt. It. j %. 7-=11 if r— r
facility/OsvncrN:one Facility IDI/(il'applicable) f6 H. JA l\j v�` 2024 �---
6751 NUCKOLLS DR, MORGANTON,N,C. 28655 rt. rt.
Physical Address,City,and Zip 1'L ft. !n `n 7'7-"•..-'4:'0--J"r--."---REMARKSD'"�'"'
B U RKE 52254 21.REMARKS
County Parcel Identification No,(PIN)
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: - -.--_...—_- "-- _.-
Orwell Field.one IaVlunl;is sufficient) 22.C 1" lion:.
35° 37.053 N 81 ° 49.012 . w ��� 202 2/6/ 3
6.ls(nrc)the well(s): l!Permnneut or 1DTempormy Signature of Certified Welt ContractorDule
By signing this firm,I hereby ceriifb That dre wet!(.,)wa.s(were)constructed in accordance with
7.Is this a repair to an existing well: ElYcs or 1!INo 15.1 NCAC 02C.0100.or/SA NG-0C 02C,0200 Well C•ansntrction Standards and Mat a copy
//•this is a repair,fill our known well construction io%orattu(oa and explain the nature of the afthis•rmwelline tee„provided to the weld ownr.
repair under 1121 remarks section or on the brick of this firm.
23.Site diagram or additional well details:
S.For Ceoprobe/i)P f or Closed-Loop Geothermal'Wells having the same You may use the back of this page ui provide additional well construction in lb
construction,only I (]\V-I is needed, Indicate TOTAL NUMBER of wells (add'Sec Over'in Remarks Box).You may also attach additional pages if necessay.
Drilled: 24.SUBMITTAL INSTRUCTIONS!
9.'1'utal well depth below band surface: 305 fL
Par multiple wells list on depths i/'dl(/i•rc•nt(example-.i(rr120(1'nnrl3�t)i(Jll') ( ) Submit this(SW-I within 30 days(Woven completion per the following:
ilh Static water level below lop of casing; 70 ff m24a. For All Wells: Original form ito Division of Water Resources (OWE).
Il'wanr level is rebore rasing,use"i' • ( ) Inlbr alion Processing Unit, 1617 MS
iC:Raleigh,NC 27699-1617
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I1.Borehole diameter: 6 (in.) 24b. Pm Injection Wells: Copy to 1)WR, Underground Injection Control (IIJC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12,Well construction method: 24c.For Water Supply and O en-•
Lolo)Geothermal Return Wells:Copy to the
(ix.;nor,rotary,cable,direct Push,etc.) county environmental health department ofthe county where installed
FOR 11'A TER SIJI'PLY Wii1,LS ONLY: 24t1,For Water Wells producing over 100,000 CPU: Copy to D\VR•CCPC'UA
6 AIR Permit Program, 16.11 MSC,Raleigh,NC 27699-1611
Ian.field(gent) Method'of test:
13b.Disinfection type: HTH Antonnt:
Form(iW-I North Carolina Department of Environmental Quality-Division of Water Resources . Revised 6-h-201 s
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