GW1--00603_Well Construction - GW1_20240118

WELL CONSTRUCTION RECORD (;W—I
{ For Internal Use Only:
I.Well Contractor Information:
CHAD HARTNESS i
14.WATER ZONES - 1
Well Contractor Name I+ROM TO DESCRIPTION
2901A 729 ft. 730 fL i , __----_--• _
NC Well Contractor Certification Number ft. fl. I --
A I R DRILLING I N C IS.OUTER CASING(for multi-eased wells)OR LINER(if applicable) -
tcuokt TU DIAAi.rEti THICKNESS MMATERIA__ -
Company Name 0 ft. 88 ft. 6 j i in. PVC
16.INNER CASING OR TUBiNGI(geothernutl closed-Iaup)
2,Well Construction Permit it: FM! TO DIAMETER TIIICKNESS MATERIAL
• Lis,all applicable well construction permits(i.e.UIC.',Corn,ty,State,Variance,etc.) ft. ft. in. -
3.Well Use(check well use): ft. ff. in. '--
Water Supply Well: 17.SCREEN —
L°.lAtp+icuhur;tl rites I TO DIAMETER • 8L0'I'SIZE '1•II ICKNEss MATERIAL
I,DMunicipal/Puhlie -
I IGeothernull(I letting/Cooling Supply) DResidential Water Supply(single) --•--(t-• ft.
in.
I !luciusu'ial/Cumntcrc tall fl, ft. �'-•_--- -- --.�
I:-IResidential Water Supply(shared) -------------1---
: .h'ri};aliolt IR.GROUT — ------•—•--_.---.—__-_--
I71Wells' 100,000GPD . ' ruo.I TO MATERIAL —` EMPLACEMENT METHOD,cAatuu:.S_'r
Ntttc-Water Supply Well: 0 ft' 20 ft. GROUT- POURED
LiMoniloring DReeovery - ----•---..--_--
Injection Well: •
ft. ft.
[_IAquIfer Rcchargo I.1Groundwater Rcmcdiation ft. tt' - _- -
I-aAquil'er Storage and Recovery 19.SAND/GRAVEL PACK(If npplicablc).
Y (-1SalinitBarrier FROM TO MATERIAL EMPLACEMENTNtEf=
riAquilcrTest DSto'mwaterDrainage ft. ft.
CDGxlierimcnlal Technology DSubsidence Control ft. ft. ---
❑Geolhcrmal(Closed Loop) D'i•racer 20.DRILLING LOG(attach additfoiud'shects if necessary)
[lGeolhental(Heating/Cooling Return) C10ther(explain under(/21 Remarks) FROM To DESCRIPTION tear,hardness,so0gnd<I)L�rr„:i.,etc.)
03 15 2023 0 ft. 78 ft.
• 4, Date Well(s)Completed: Well IN ' 78 IL 745 EL ROCK
Sa.Well Location: ft. 1't.•
--- ---"
BHG MINISTRIES n. ft. -(I.1" F
Facility/Owner Name Facility ID//of applicable) ft. ft.
570 FOX MOUNTAIN RD,HIDDEMITE,N.C, 28636 D. IL 1 JAN 1 ''S 2024
Physical Address,City,and Zip ft. '-- ft, _—._..—_—
ALEXANDERiaxe -;•"•e:,, ro'r.•+�^',.;11 7.`
21,RErMARt<3
County Parcel Identification No.(PIN) --_--
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: --- - —
(il'well field,one la(/Ion};is sufficient) --.__ --------•.-------- -- -.-r
35° 59.852 ,, 81 ° 00,521 zz;�(se,�ireaf9n; r'�—
�, , tg a w.4.--,-•,,,-----_ -�3/15/2023
6.ls(are)the well(s): IJPerntarent or DTetnpo•ary Signature ofCertilied Welt ContractorDane
By signing this fbr,n,/hereby certi/i'that die well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: DYes .or LlNo • /5A NCAC 02C.0100 or I54 NCAC 02C.0200 Well Construction Standards and that a copy
Olds is a repair.fill out known well construction information and explain the nature o/•the of this recent!has been provided to the ncl annex.
repair under 112 d remarks section or on the back()Phis faro,. I
• 23.Site diagram or additional well details:
3.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same YDII may use the back of this page to provide additional well construction tali,
(add Over'in Remarks Box).You.,
eti inay also attach additional pages tI necessary
construction,only I OW-I is needed. Indicate TOTAL NUMBER dwells
drilled: -
--.--_:--_--- : 24.SUBMI'I"CAL INSTRUCTIONS.
9.'total well depth below land surface: 745 -
•
1•eraurhiplc walls/iv all depths ifdg)i'rent(carample-.h h200'and 2(h)/a0') (rt.) . Submit this GW-i within 30 days of well completion perthe following:
10.Static water level below lop of casing; 1 00 (fL) '24a. For All Wells: Original !brill, to Division of Water Resources (DR I,
ill,aMr•b•rcl is allure MAN,Use",.. ttl'o'tmtliolt Processing Unit, I617 MSC;Raleigh,NC 27699-I617
•
I I.Borehole diameter: 6 (in.) 24b. For injection Wells: Copy toD4VIt, Underground Injection Control (1[JC;)
Program, 1636 MSC,Raleigh,NC 27899-1636
12.Well construction method:
(i.e.sego,rotary,cable,direct push,etc.) • 24e.For Writer Supply and Open-Loop Geothermal Return Wells:Copy to the
county environmental health deptiruuciut of the county where installed
FOR WATER SUPPLY WELLS ONLY: f
24d.Fo•Water Wells producing over 100,000 GPO: Copy to DWR,CCPC'UA
13a.Yield(gpnt) 5 Method of test: AIR. Permit Pregnant, 1 G1 I MSC,Raleigh,NC 27699-lo1 I
13b.Disinfection type: I Amount:
. I.
,
' Perm OW-I • North Carolina Department of Environmental Quality Division of Water Resources
Revised 64)-1.018
I. , t