GW1--00721_Well Construction - GW1_20240119

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WELL CONSTRUCTION RECOR1) GW_1 e
I For internal Use Only: f I -
I.Well Contractor Information: f 1
RANDY OWNBEY 1
Well Contractor Name 14,WATER ZONES , 1- - —
1+R0.\I 'r•o DESCRIPTION 3214A 189 i•t• 190 ft• I I ` ---------- __—--. .
NC Wall Contractor Certification Number ft. fl. 1 I
A I R DRILLING I N C IS.OUTER CASING(I'ur multi-eased;veils)012 LINER(Rap)licable) ----'-
1�fdom _I'o ntA�u,rEa 'l•tnct<ESs M,rrt:RIAr.
(•unqum> Name 0 fl' 101 tt• - ur. -- --- -
6 =,, , . PVC
321008 lb.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit II: rao.\r
UL\A.117121t __ '1•Irt(:12Nt:SS ----_--1
List all applicably Well caasavcdrn parnrnr(i.e.WC,Gonna,Slug,Pariancr.rrc.l _.._-_ _-.I.�?._ _ -- 11:\'i'1?RL\l.
----- -- ------ ..I--- -- - -
3.Well Use(check well use): ft. IL I in,
Water Supply Well: 17,SCREEN• --i
LL\grieullural raoAl TO nlndua'Eit SLOT SIZE THICKNESS �inrr:i(Int:
[Municipal/Public ft. rt. in. -
OGeothermal(Heating/Cooling Supply) L•JResidcntial Water Supply(single)
FlIndusu'inl/Commercial L1Rcsidcntial Water Supply(shared)
I Ilrrigaurnt IN.CROU'I' ----
ClWells> 100,000 GPO ptto)t (_t•u_J MA•r•ERtAt. EMt'LAct•:atEN-raltrttOtt ANI0lIN••r
Nan-Water Supply Well: 0 ft. 20 ft. GROUT POURED
!IAAunil( i,tg I7.1Reec,vcry — ____ ------ -----__-___._.__....-_..
Injection Well:: rt. ft,
I_•Llquilcr Recharge I IGrounchvaler Remediation - - %
II' It. , --` - -_-. _-----_--- -
I lAquilcr Storage and Recoveryt'JSRlinily Barrier most
SAND/GRAVEL PACK(if applicable) --
most TO MATERIAL,_ EMPLACEMENT A1ET119I)
l 'Aquifer Test f lStormwatcr Drainage rt. ft.
C
all xperiutcnud , .Technology• ft ---ft ----i' ;
C1Subsidcncc Control ----------- . I
!'lCicolhermal(Closed Loop)
f Tracer 20.DRILLING LOG(attach additionrilsheets If necessary) 4I
I.l(icolbernrtl(I[eating/Cooling Return) I:IOIher(explain Lindd'1121 Remarks) ?R°M -----•tc�------- DESCRIPTION(color,tturth s,soWrpcl_tytm.rain size,sic.)
0 II' 91 ft' DIRT i
4.Date Well(s)Completed: 4-4-23 Well ID//
91 IY. 205 I. ROCK l,
So,Well Location: _.
PRINCETON HOMES --n: rt. __—_-----------` - -�1 '= /4�. . It
Pacilily!(.)a'ncrNi1010 Facility IDl7(illrpplicahlc) rt. --- rt ---- -- -'
120 CEDAR BRANCH CT,MOORESVILLE,N.C. 281�17 rt. rt. __.__�-- �'�� �-� EG2�' {
Physical Address,City,and Zip rt. — (l, --' — lR,r�� ':!` j�
IREDELL 4639204060 1 �:.vizi L'
21,RE\9ARlCS ` �'cab . - -_I
County Parcel Identification No.(PIN)
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: -__-
- •(irwell nC1ll,one Iatllunt,IS suflieicnt) -----._..- - --
' 35° 37.658 22.Cart' .lion:N 80° 54.570
\' 4/4/2023
6.Is(tire)the well(s): !IPermttnenI or ❑Temporar}• Signature ofCenil)ed Well ContractorD•,ue ---
By signing Ihia fbra;,l hereby cm lili'that the trcli(r)tray(Wen')cvnSirtuVd in accor./tnt c norb
7.IS Ihis a repair to an existing well: I._IYes or t!INo /S:I A'C.I(.'02.(•',(1/1111 at !Sd NVC:•I('(I'C.(1200 Ilr,!l C•ans•avcriutt sunwards tad lbw a ny,•
if ibis i.e a repair.fill out known well construction irtlbramtia,,and explain the nature a/'the ul'Ihis•resord has been prur(rled ro the u's/Plumy,•.
isprtir under t11.I remarks seetian or on the hack q/•this./i,rnr
23.Site diagram or additional well details:
You may use the back of this page ici provide additional well construction loll
S.Fin.Gcoprobe/DP'1'or Closed-Loop Geothermal Wells having the same
construction,only I (iW-I is needed. Indicate-TOTAL.NUMf3GR of wells (add'See Over'in Remarks Box).You may also attach additional pages if ncccssau'y.
drilled:
24.SUI3N11'I 17hL l Vs'I'RUC'r1oNS I.
9.Total well depth below land surface: 205 (ft.)
' FLr mnlrip(r sell•list all depths i/'di//i•renr(example-.i(Fc!T.00'and 2.(ii!/00') Submit this C,W-1 within 30 days of well completion per the I'ollo\ving:
24tt. For All Wells: Original form Ito Division of Witter' Resources IDWR,.
10.Static water level below top of casing: 40
!/lrar r level is above rasing,use +" 61•) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
I: i
I I.Borehole diameter: 6 (in.) 24b. For Injection Wells: Copy to D4VR, Underground Injection Control (WC)
Program, 1636 MSC,Raleigh.NC 27699-,1636
12.Well construction method:
(i.e.auger.rotary,cable,direct push,etc.) 24e.Far Water Supply and Open-Loup Geothermal Return Wells:Copy tothe
county environmental health department(tithe county where installed
FOR WATER.SUPPLY WELLS ONLY:
24d.For Water Wells producing over 100,000 GPD: Copy to UWR,CC'P('liA
13a.Yield(gpn- 20 Method of less: AIR Permit Program, 161 1 MSC.Raleigh.NC'-27699-161 1
131).Disinfection type: HTH Amount-: •
form(AV-I North C:arolina Department ul'Environmental Quality-Division ul'Wmcr Resources
Revisal tr_A_2111 S
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