HomeMy WebLinkAboutGW1--00591_Well Construction - GW1_20240118 WELL,CONSTRUCTION RECORD GW-1 lror 1.
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Internal Use Only:
I.Well Contractor Int'Urination:
CHAD HARTNESS , ,
Well Contractor Name 14,WATER ZONES I •
I+RUM! TO DESCRIPTION --
2901 A 509 510 IL -' --
---- --- -- I=- - -- --
NC Well u;teor Certification Number ft. ft. !
Qm
AIR DRILLING I N C 15.OUTER CASING(for multi-cased wells)OR LINER(if ap likable)
F!IONI I TO DIAMETER •weNNIiss -1 MATERIAL
Company Name 0 rt. 65 fty l6 I 1" IIPVC -
2 16.INNER CASING OR TUBING(geothermal closed-loop)
Well Construction Permit II: moil To UL\ME'rtin 'riltCKNEsS NL\'ttRL11_.
Lim all up/Ma/hie well twnsirucuian permits(i.e.UK',County,State,Variance,ow) ft. ft. I In.
3.Well Use(check well use): ft. n—--- I in, — ,
Water Supply Well: 17.SCREEN •
❑Agricultural FFROMvu DIAMETER' st.oTsixs 'rluCKstiss A_r MtERtA I.L:Municipal/,ublic ft. ft. in.
I1Gcolhe•mal(Pleating/Cooling Supply) CIResidential Water Supply(single) ---
ft I'h In.;
Ll Industrial/Commercial - OResidential Water Supply(shared)
Dlrrigation IS.GROUT
D Wells> 100,000 GPD [IRON! TO MATERIAL EMPLACEMENT NIETnot&AMOUm'
Non-Water Supply Well: 0 - ft' 20 ft GROUT POURED
I!Monitoring DRecovery ft. — ft. 1
Injection Well;
I !Aquifer Recharge LJ0roundwatcr Remediation rt. rt.- -- -
I !Aqui ler Storage and Recovery L7Salinity Barrier19.SAND/GRAVEL PACK(if applicable)
PROM To ibATEI(r\L EM1'I,ACEMtiN't'NIE'I'IIUU
I IStornnvater Drainage I'l. ft.
TechnologyFilIxperimental 17.1Subsideice Control rt. rt - — _
I I(;eothcntal(Closed Loop) I7.1Trucer 20.DRILLING LOG(attach additional sheets if necessary) -
i_IGeothe•tnal(I!eating/Cooling Return) l:!Other(explain under 1121 Remarks) PROM TO DESCRIPTION(color,hardness, nil/rocic Imc,yr^ao:i.e,etc.)
0 ft' 60 It DIRT •
4.Date Well(s)Completed: 04-12-23 Well ID// . 60 it 525 ft' ROCK ,
Well I -st Location:
I't. ft.
JIM LAINGEN n. ft. .-
Facility/Owner Name Facility 1Dll(if applicable) It. ft.
2015 CASTLE VISTA CT N.E.,CONNELLY SPRINGS,N.C. 28612 ft. II. J } " '8- 2024..
Physical Address,City,and Zip ft —"— fh fo.me `! Pr r^ nBURKE •
21.REMARKS Wittr jt}4.3
County Parcel Identification No.(PIN)
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Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: -• -- —+ — _.
(if well field,one ha/tang is sufficient) trn 1Carlifien mt: - -
35° 46.626 N 81° 31 .469 Wr 4:, �', ,- -r__
- --4/12/2023
(i.Is(are)the well(s): 1°!Permanent or 17Teniporary Signature of Certified Well Contractor Date T
- By signing this Arm.I here•M*certi/i•that the well(s)was(were)ermsu•uc•Ity/in accordance with
7.Is this a repair to an existing %yell: Ill Yes or 121N(i 15.1 NCIC 02C.0/I/0.ar•154 t\K.:IC'02C.6iuibu IVc/l C'onsu•uc•rinn Standards and Au a cup'
If this is a repair,fill out known,cell construction/r(lin•uta/iou and explain the nature gl'the a/7his•t•vcarrl has inc.'"provided ro the-welluu'rrch••
repair touter 01 remarkserliuu or un the brick y/'this•Jbru,.
23.Site diagram or additional well details:
You may use the back ol'this page lii provide additional well construction loft
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same -
construction.only I OW-1 is needed. Indicate TOTAL NIIMI3ER o1'wells (add'See Over'in Remarks Box).You may also attach additional pages II'ncccssnr).
drilled:
24.SUIIMI.1'TAL'INSTRUCTIONS`
9.'l'otal well depth below land surface: 525 . (ft.)
For multiple%elk,•list all ricprh.a'ifdiif reta(ccaniplc-3@200'anrl?a 100ry Submit this GW-I within 30 clays ol'Nveil completion per the mowing:
I
70
t
I11,Static water level below top of casing; (fl,) 24a. For All.Wells: Original form o'Division of Water Resources (DWR),
1/limy level is above easing,use^I•^ Information Processing Unit, 1617 MSC.,Raleigh,NC 27699-1617
l I.Borehole diameter: 6 (in.) 24b.For Injection Wells: Copy toDWR, Underground Injection Control (WC)
Program, 1636 MSC,Raleigh,NC 27669-il636
12.W\\ell construction method:
(i.e. ell,rotary,cable,direct push,etc.) 24e.For Water Supply and Open-Loup Geothermal Return Wells:Copy to the
• county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: I.
24d.For Water Wells producing over 100,000 GPO: Copy to I)WR.CCI'C'[A
l3ai.Yield(gpm) 1 Method of test: AIR Permit Program, 1611 MSC,Raleigh,NC 27699-1 6 1 1
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131i.Disinfection type: HTH Amount:
Form I Wl North Carolina Department of Environmental Quality-Division of\\hoer Rusources
Revised 0-6:.,
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