GW1--00639_Well Construction - GW1_20240119

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WELL CO\'S'1'RUC'I ION RECORDGW-1 • b J I Print Form
For Internal Use Only: .
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1.Well Contractor Infornnition:
NEILL PARDUE ;
14.WATER ZONES l 'I 1
Well Contractor Name __PItosi To DESCI�tIP,'I'ION
2609A 309 It. 310 ft. I
NC Well Contractor Certification Number ft. ft.• la. I� --
IS.OUTER CASING(Tar LINER(ifs neable)
AIR DRILLING INC —
I+It04� '1'O DIAMETER T111C.'KVI?ss )IA'rrwa). —
Company Name a 11• 113 1t• 6 1...'; in.
PVC
to.INNER CASING OR TUBING'(geothernull closed-100p)
2,Well Construction Perin it/I: FROM__ 'rO DIAm ti It(tt rntct:\Itss NI.t'I'l•:Ill tli --
l ist all applicable,cell construction permits-(i.c. WC,County,State. Variance'.ate.) ft. '
3.Well Use(check well use): ft• _— ft. i In.
. I Water Supply Well: 17.SCREEN I
l\gricultm-al FROM _ TO — DlAN11•"I'I•:R _SLOT SI/xli•__IIICKNIiSS"—
NWIIE12L)I.Municipal/Public ft.- —ft. in.'
Geothermal(Beating/Cooling Supply) DResidential Water Supply(single) -- _
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Industrial/Couunercial DResidential Water Supply(shared) '
Irrigation IN.CROUT
I?ROmt To_ in AT,:RIAL• E\II'LACENIEN to siIlOU\AN1Ot'N11'\r Non- ater Supply Well: a n. 20 p,
• GROUI' POURED
Monitoring DRecovery
Injection Well:
It. ft.
;Aquifer Recharge QGrotuldwalcr 12cmediatiun — ft
. ft' — —� --- — -
Aquifer Storage mid Recovery 19,SAND/GRAVI'sl.PACK(if applicable) —'
y E3Salinity Barrier • Atom, •O_ _MATERIAL EniPl_AcExtr,r\iarlum
nt
' 'Aquifer Test DStorwaterDrainage ft. rt. •
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'Experimental Technology DtSubsidence Control I.1. ft. —— — --_..._._
I Geothermal(Closed Loop) DTracer . 20.DRILLING LOG(attach uddititinal sheets if necessary) --
Geothermal(I Icating/Cooling Return) �IOther(explain under l/21 Remarks) rltopt -IQ-
__ulsc_utr rloN(�carat,h tiaraarss,xdlurnck type,(;r:du size.rlc,l
0 It 1e:; fly DIR.1 �tt..— _—.
4.DaleWell(s)Completed: 07 11 23 —•—•-- --------_I--_ -- —
I 1Yd111)Il 103 It ,)2(, II. ROCKi -� a-,r.
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Sa.Well Location: ft. ft. I, 1';'N &'z;a r q
PAUL HORNER • — —.,. -..—._.... _ — —
n• _ JJL .�._ .
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Facility/Owner Name Facility IUIi(if applicable)
--ii. -- ft. • — --' ----
1752 W RIDGE RD, SALISBURY,N,C. 28144 ft. ft. I '�`'= "^" :•v. �; '
l' C�:v^
Physical Address,City, and l __ O2_ Cl(. —_-.__--__
' Zipfly ft. .__I .
ROWAN
21,REMARKS I ' . - —
County Parcel Identification No.(PIN) --_-_____ _ --
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Sb.LatitudeInd lou Ilutle' I '
in degrees/miuttles/seconds or decimal degrees: ---. --_—__..— •
--- — — —
(il'well field.one I,n?InnlJ is sufficient) - ..._ •
35°42.677 80° 31,522 23-•C;crtitic: 'all t
t:
N W • �.
' 7-11-23
6.Is(nrc)the well(s)0Permanent or ❑ITemporary tidy uroo Cc t c 'at actor Date ---
By signing dtic limn, I hereby ccrt//i•shallthe well(s)was(urn)contracted in accordance
7.Is this a repair to an existing well: D Yes or 0No with ISANCAC•02('.0100 on IS:I NC.IC'OW.0.?00 Well Construction Standards.and that a
If this is a repair.Jill ma known well caas,raclian lolarnmthot and crplaiir the'nature oflhe, colui of d is record has hems provirlerlln lhi'well owner.
repair under 1121 remarks section or an the hock o/'this form. I
23.Site diagram or additional well details:
S.For Geoprohc/I)l"I'or Closed-Loop Geothermal Wells having the same You may use the back of this pttgi to provide additional well site details or well
construction,only I G\V-1 is needed. lltdic;tle'I'O'I'AI.NUMBER of wells anlslnlction details. You may alsolallach additional pages if necessary.
drilled:
SUBMITTAL INS'I'RUC'I'IONS '
9.Total well depth below land surface: 325
("u,unthiple ur//s list all depths iipl0lireni erm,rp/e-.1(1/1200'and 2(r)100') (It•) 24u. hot All Tells: Submit Ihiti Rpm-within 30 clays of completion or well
construction to the following: I
10.Static water levelD ielon'lop of casing: 40
Ifu•or level is ahnre l ,me••I (ff•) • Division of\\'tiler Resat reies,Information Processing(Jolt.
1617 Mail Service Center,Raleigh,NC 27699-1617
11.11m-elude diameter:6 on.)
241). For Injection Wells: In additicnt to-sending the Toros to the address in 2da
12.Well construction method: above, also submit one copy of this form within 30 days of completion of well
(i.e.super,rotary,cable,direct push.cle.) -- construction to the fUIlOW1Ilg: 1
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FOR'WATER SUPPLY WELLS ONIN: Division of Water Resources,Unileground Injection Control Program,1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gent) 30 Method of test: AIR 24e. For Water Supply & Injection Wells: In addition to sending die rich to
HTH the address(es) above, also submit itne copy of this form within 30 clays of13b.Disinfection type: Amount: completion of well construction to tlic county health department of the county
where constructed.
form OW-I North Carolina Department of Environmental Quality-Division ul'Water Resources
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