GW1--00649_Well Construction - GW1_20240119

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WELL CONSTRUCTION RECORD (CW-1) For internal Use Only:
I.Well'Contractor information: I
RANDY OWNBEY ; ! _
well C'uniracun'Name -I . /L...'!dt!ONES 1 1 -
FROM TO - 1/ESCRIPTION
3214A. . 289 ...ft: 290— _.
NC Well Contractor Ceitilicatb it Number ft. ft. I I • -•--------.-_._
IS.OUTER CASING(for multi-eased Wells)OR LINER(if up licablel
AIR DRILLING I N C `-
FROM TO - DIAMETER THICKNESS MA't'EIuAL
company Name 0 rL 45 I rl. Ig I in. GALV
371866
I6,iNNCR CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit if: FROM TO' ' DIAMETER THICKNESS MATERIAL
List all applicable,re•//Corisirttcvion permits(i.e.(/IC,County,Slate,Variance,etc.) a. rt. in. —'
3.Well.Use(check well use): ft, ft. in. --
Water Supply%Veil; i
17,SCREEN. -------.
I./\I;I'ICL11LLI1'al •
FROM _r0 DLult fl?It S1.m.SI'ZE THICKNESS N1A'i't'J I.
LIMunieipal/Public ft. ft. iri.
f 1Geothemal(Heating/Cooling Supply) C.]Residentiai Water Supply(single) ---- -- --__ -
CllndustriaUCommrtcial ft. ft., 16,
L1Residential Water Supply(shared) -
['Irrigation is.GROUT
❑Wells> 100,000 GPD FROM TO . MATERIAL EMPLACEMENT:M E'(tilt)&AAR/:V'I'
' Non-Water Supply Well: 0 fL 20 fL
I!Monitoring __-__ _ GROUT POURED
❑Recovery ft. ft. -..Injection .
i i;lquilcr Recharge I'IGroundwater Remcdiation ff R. ---- -----------------
Aquifer Storage and Recovery I..ISatinity 131trricr 19.SAND/GRAVEL PACT.(ifnpplicnhlc) .
((Aquifer Test . FRO\I To ;MATERIAL P;YI 1'LACEM ENT SI IlTI 101)
IJSlormwate'Drainage n. rt. -•---_-...___------
[IIixperimenlnl'fcchnolo -- ---
b) f_lSubsidence Control IL ft. 1' ------,-----__....
CIGe)thennal(Closed Loki) \::\Trace I
20.DRILLING LOG(attach additional sheets if necessary)
I(Geothermal(Ileating/Cooling Return) I_lOthe•(explain under1/21 Remarks) FROM TO DESCRIPTION(color,hardness,sowrocl<inti.lrain.size,Fte.L-
3-22-23 0 rt. 35 - ft' DIRT i
4.Date Well(s)Completed: wenmil85 ft. 305 fl ROCKp. -- _
5a.Well Location: • 1't. - (�''; -^ .— -
t_
LUKE ALMOND - ft, -- ft. p (�
Facility/Owner Name Facility TOO(il'applict,bte) ft. fl. J/ N-1-9-2Q24-- -
860 HIGH ROCK RD,GOLD HILL,N.C. 28138 ft. rt. --- ;_.�A; �:_ -____---
fni t,,.:.l ;l i r x
I'hysicnl Address,City.an(L7ip ft ft — C7pDaG.—_.-____.-
ROWAN 21,REMARKS 539073 I' ' —('Dandy r. •
farce!Identification No,(PIN) I.
Sb.Latitude and longitude I in degrees/minutes/seconds or decimal degrees; I_
Iit'„•alI field.one Ioc•I,nri;is suMeient) '----'—'- ._----- -..
35° 31 .561 80 20.316 22.Cetilie '
N W I' 3/22/2023
6.ls(are)the well(s): I°JPernutnent or CI'I'emporary '
Signal ofCertif. Well Contractor I Date
• By signing this.%r,o,1 hereby cerli(b that the ore•/l(.,J was(mere)constructed in accarehince•with
7.Is this a repair to an existing well: LI Yes or C)No IS:I NC'lC 02C.0/00 or/Sa A'C.IC 0.?C;.0200 lie/l Construction Standards and dun a ropy
ifihi.r is a re/mir,fill out known well c•onslrue'tion io%rntation and(splada die nc)6a•e gfthc• ofthis record has here proylclef lu the»r//earner.repair muter 02/remarks section or on the hack oftlrisfbrat.-
' 23.Site diagram or additional well'details:
S.For Gcoprobe/DP'I'or'Closcd-Loop Geothermal Wells having the same You may use the back of this pagc;lo!ptovide additional well cousu'uction'infi,
(add'See Over'in Remark);Box).You may also attach additional pages II'ncccssar}'.
construction,only I OW-I-is needed. Indicate TOTAL NUMBER at'wells
1 drilled:
- - . 24.SUBMMrrrAL INSTRUCTIONS ,
9.Total well depth below land stirface: 305 ,
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For multiple wells list all depths i/'dii)i'reat(example-3@7.00'and a 100') (ft.)
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Submit this GW-I within 30 days of well completion per the following:
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10.Static wale level below top of casing:•20' (ft,) ,24a. For All-Wells; Original form io Division of Water Resources (DWR),
//'ucn,•low/is above easing. ' i." - Information Processing Unit, 1617 MSG,Raleigh,NC 27699-1617
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I I.Borehole diameter: 6 (tit) 24b.ForInjection Wells: Copy to DWR, Underground Injection Control(MC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method!:
li.c.antler,rotary,ethic,di,nel push,etc.) 24.e.For Waiee Supply and Open-ILot1p Geothermal Return Wells:Copy to the
county environmental health deparurient of the county where installed
'FOR'WATER SUPPI.A'WELLS ONLY; ,
1 0 24(1.For Water Wells producing over 1(10,000 GPO; Copy to DWR.CCI'C'U,\
1:4a.Yield(gpnt) Method of test: AIR Permit Program.1611 MSC.Raleigh:NC 27699-1611 .
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13b.Disinfection l)'pe: HTH Amount; .
Form LW-I North Carolina Department of Gnvironmcn»11.Qu,lity-Division ol'Water Resources
i Revised b-G::?(l I S
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