GW1--00646_Well Construction - GW1_20240119

WELLCONS'I'I2UC'I'ION RECORD (CW 1 _ - •
For Internal Use Only: —',
I.We!I Contractor Information:
RANDY OWNBEY
14,WATER ZONES ! ! ----1
Well Contractor Name I?ItOal _IU DI:SCI(IP'IilOv
.3214A 229 f6 230 Fl.ft. I _--
NC Well Contractor Certification Number --_" -AIRDRILLING I N�' 15.OUTER CASING for multl-Cased,ivclls)OR LINER(if op illeahle)
PR[)\I _I'O ^UI:1\1h:'fI(n - THICKNESS \L\'I'GI t i --__)
Company,vane p n, gg ' 11. 6 - itt. PVC ,
366 y1. _:...—7
00 16,.INNER CASING OR TUBING(geothermal closed-loop)
2,Well Construction Permit II: I%a0at UI:\::\1E71':R I'lll(;KNESS atA'rltut,\I.
l.i.tt oil applicably well c•o»a'(ructiurt permits(i.e.WC,County,State, Variance,ale.) ft.—.. f O'. ft. --"_. _-__ __
3.Well Use(check well use): ft •---- ft. in. -- -
Water Supply Well: 17.SCREEN
L1Agrieulturt) moat n. ro n. ut,\.vlr:rr:u, st:o'rsrrt: 77ucti:erss alnrr:uist.
C1lvlunteipal/Public --_A! _... ---- ------ --stfir_rot: ___--._--.—..__.-__._.._.,..
•
I i(!cuthrrutai(I tenon)!/('tooling Supply) .fiResidential Water Supply(single)
: ;Intlu,u'ial'l'onuttereial • I.!Residential Water Supply(shored) -- 1.
Irri)iiiiott 18.GROUT ! _..
IT)Wells> I00,000.GP17 Mom I 'ftt� `\)A�rtialAt. -EMPLACEMENT Nu_•rI101) Allot vi-�
Non-\Va(Cr Supply Well: 0 rt, 20 n• GROUT POURED
i!M(iniu 'i°1' ClRccovcry __---_.... ----_._...._._._--- _..__---._-.
Injection'Well: ft. fl, I. •
__..
l7Aquifer Recharge L1Groundwater Reinetliation ft. ----•
ft` - -
19.SAND/GRAVEL PACK(if:malleable)
)
• Aqui lcr Storage and Recovery LISalinity Barrier Pt ROM -t•o MATERIAL'RIAt; EMPLACEMENT au:Ttion�-
Di\qui fer Test C1Stormwater Drainage ft. ft. 'i, -_-_.- ------
Dlixperimcntal Technology I:Subsidence Control . ft. 1 -- -- __.___.
fl
I.!Geothermal(Closed.Loop) EITracer - 20.DRILLING LOG(attach additional sheets If necessary)DESC
T
L.ICicolhcrntal I leatin' Return) PROM (l RII!'1'ION(c
olor,hiu'daczs,soilhvcl(Ir tc_ rniq sirs,cq,)
( b/Coolie t b ) ' IaOthcr(explain 1121 Remarks)
Q ft, 86 n• DIRT 1., .03-30-2023
4.Dale Well(s)Completed: Well ID//
86 n 245 _n• ROCK •
Sa.Well Location: --- I'I. ft. - - -- - -
TREXLER CONST ----- -- rn f ', °' "-�
Facility/Owner Name - Facility ID//(iI'applienblc) ft. rt.
514,AUTUMNLIGHT DR,SALISBURY,N.C. 28147 . ft, , rt. ,h "
Plriit ii Addres>.City,nn(I Zip it, . ft.
�ft' (::::2i •'r -`--- �°, A fi ..__ .- ROWAN ' ' 458E0,22
i
t'nu'tit Parcel Identification Nu.(PINT • , ---
5b,[Atli title and longitude in degrees/minutes/seconds or decimal degrees: -
• ol•wed field.one Wilma.,is sufficient) - -
35° 40.226 ,; 80° 33.175 22.C�1tn;et '
" .. 3/30/2023
�
G.Is(are)the well(s): InPermnnent or CITemporary , Signmur ofCcnified Well Contractor Dille -
' lb,signing this fbrin,I hereby yetilb•that the well(%)was(were)constructed in urvardunre u•irl,
7.Is this a repair to an existing well: 0-Yes or ' LINO /SA NC/IC 02C.0l00 or 15.1 NC:IC.'0.iC;.0200 Well Construction Standards end Aria a copy I/'this is a repair,,/ill out known well construction ir(lot•m,niwt and expl
ain nature of the a/
'his rerw•rI hits hewn prnvkled Iri ill"well un•neri
repair water 1121 renmrksarc•lion or on the hurl,•u/;this form.
23.Site diagram or additional well1detaifs:
S.For Gcoprobe/DPT or Closed-Loop Geofhe:mai Wells having the None you may ow.the back of this page)o provide additional well construction info
construction.only I GW-I is needed. Indicate TOTAL.NUMBER of wells (add'See Over'in Remarks Box),Yoti may also attach additional pages ifneee;ii-\.
24.SU13NI1'I"1'AL,INS'I RUC LIONS
-9.Total well depth below land surface: 245 (ft.)
/.'0,:multiple ire/A list all depths it dl/)chant(ornngph'-31.a 2Orl'and�(i)/T')') submit this G W-I within 31)days oI'wcll completion per the following:
l
10.Static water level below top of casing: 40 24a. ForAll Wells: Original ford to Division or Water Resuur es (OWN),ihhlotto./r.trelisabm'eracing,use•• (ft') Inlinnation Processing Unit, 1617 tit, 1,Raleigh,NC27G99-1G17
6 For Injection Wells: Copy to D\yR. Undergroutid Injection Control:111( 1
I I.Borehole diameter: (in,) •
Program. IG3G MSC,Raleigh.NC 27G9�t)-IG3G .
12.Well construction method: ' '
t,..•.nanny.noun,rattle,direct posit.etc.) 24e.For Water Supply and Open-1 loop Geothermal Return Wells:Copy lu die
county environritental health(lepottoibia.of the county where installed
FOR WATER SUPPLY WELLS ONLY:
• _ 24d,For Water Wells producing over,100,01111-GPD: Copy to D\LR,(.'(.'P('l_':\
13a.Yield(gpnt)•20 Method ol'test: AIR Permit Program, 1611 MSC.Raleigh.NC 27699-I611
7-(�
131).Disinfection type: lJ•I n - Amount: '
Form OW-I ' North Carolina Department of Iduvfrumnnental Quality-Division of Water Resources ( .
Revised G-6:!0I S