GW1--00722_Well Construction - GW1_20240119

WELL CONS1'RUC'1'ION RECORD CW-]
For Internal Use Only:
I.Well Contractor Information:
RANDY OWNBEY 1 a I
.14,WATER ZONES - I I ----;
Well Contractor Name - --I
I(OM 'I'0 Itl•:SCI(1P•t'10;\' -----...—_.-.-....-
3214A 2F29 n• 230
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NI Welt contractor Certification Number I+• fL •
' IS.OUTER CASING(for nntitl-cased(Yells)OR LINER(if applicable) -AIR DRILLING I N C
_FROM •r(t 'DIAMETER TitickNESS MATERIAL. ~
Company Name O. ft. 87 _ fft. I
6 I ) in, PVC ..-
309184 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit 1I: PROM_ TO' DIAMETER TI11CKNesS_.-- -at:crl'_R1.\I.
l ist,oll applicable'yellconstruction permits(Le,WC,.County.State, Ilarianct',-ete'.) ft. ft, ---i,- , in.
3.\fell Use(cheek well use): ft. ft. I; in.
\1'ulcr Supply Well: — — ---------.-_ • .SCREEN. 1 - —
..:\!I'It'Illlln•a 11 a59.tt t. nl.t.t11•:'I'ai-1'.\LU'r S17.1•: r'floni..\h�. 1. tLt lElitm.I.1Muuicipal/1 ublic _--•--._..------
It, ft, in,.
. 1 iculhcrmal(I lealingi('uulin0 Supply) I'IResidenliul Water Supply(single) -� - -' ------ ---- - - -_-..
['industrial/commercialGlResidential 4\t 11' 't. 10.
ter Supply(shared) _--I__-
i.ilrrigalion 18,GROUT'
1.71Wells> 100,000GPO FRO,I To a1,t'rtl(IA1. l' 1pLACl( tl:NTmETI1lm.l•AMUi'vr Non-WaterSupply.Well: 0 ft* 20 Il• GROUT POURED
❑Monitoring 17Rccovery ft•
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Injection Well: n.
❑Aquifer Recharge EIGroundwater Remediation ft. ft.
ClAquilcr Storage and Recover I9,SAND/GRAVEL PACK(if applicable)
Y f=ISalinity Barrier FROM uO _atA rtatI,u_.•_..-________I_:Hrt\c.r.viEN 1•Meruuu --
CiAg Ili fer'I•est EJStormvvater Drainage ft. it.
- - -- - -`�' — -...._..-'(?Nporinu:nlnl'I'ec)Inuing)' I.'lSubsidence Control ft. i•l,
I• I
• :(icothcrntatl(Closed Loup) L,I'I'raccr 20,DRILLING LOG(attach additional sheets f1 necesruy) .__..
F.IGeulhcrntal(Healing/Cooling Return) (_101hcr(explain under 1121 Remarks) ---
FROM TO _ DESCRIPTION(wear,amrdness_wllirock a�•�e.,tale sill,cae,a
0 r`' 77 ft DIRT--I. L..l - . -
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4.Ottie Well(s)Completed: 03-28-2023 \yell IDtt 77 It245 '' ROCK • _._--
Si •
,Well Location: ft. f1
E & S CONTRACTING ---n------n,
fs - -
•E. ,~ e..�' L�
faeilina twee(; attic Facility II)1,(il':Ipplicablel rt. I'I. I „� C a,..,, ...
131 SPARTA DR,MOORESVILLE,N.C, 28117 rt. I.1•
1._9Physical Addle...City,autd'Lip ft. fh
IREDELL 4658073543 21RLI\'IARICS •'cir,:•:-.:c., -
Count)III) Puree)
1-5 $•_:i:ir. -•-7T-Lj 1
Identification Nu,(PIN)• 1'
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Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: „
--i Owen field,one lal/lung is sufficient) 22.Cerl( ion:
44.----' .. ' •
35° 37.528 N '80° 50.191 - \\,
3/28/2023
6.Is(nre)the well(s): IJPermanenl or flTemporary Signorure ofCet i0ul Well CnnuacQtt __-
Di'signing this Arm.I hereby c-o i//i'that die,n'e/!(s)tint(were)constructed in u,rur'd,urce with
' 7.Is this a repair to an existing well: ID Yes or I!1No /S;I rVC4C'02C.0/Ito a,'/S:I,V(':IC 02c.1120n awl call}7rvetia,,/Ui ndards,ard that a,,,/,•
U?hie II a repair,Jill out known well construction ig%rruutiva mad explain the nature ofthc' q/'Mix reesrd has hamp'o-ided to Mc n'ell(,),,,,tar.
repair'under t,2/remarks section or on the hack r f this Aim. •
23.Site diagram or additional n'ell details:
S.For.Genprobe/UPT or Closed-hoop Geothermal Wells having the same You may use the back of This page to'provide additional well construction info
construction.only I OW-1 is needed. Indicate TOTAL.NUMBER of wells (add'See Over'in Remarks Ros).You retry also attach additional pages il'neccsar).
drilled:•_
24.SU1111I'I'TA1:-;INS I'RUC:•I'IONS I.
9.'I'otal well depth below land surface: 245 (n,) .
I),rr,whrl'L-nrlls list ill depths r,•/'ddirryrtt texamp/c'-.I'll;?Ou'ua,/lr(u/00') Satbtnil this C\V-I within 3O days of�1•ell completion per the following:
f 24u. For All Wells: Original linen To.Division of Water Resources (I)4VRt,
I(1,Static Neer level below top or easing: 30
I/':,mrr tow/i.r(Awe easing,use (t,) Information Processing Unit, I61'1 msg.Raleigh,NC 27699-I G 17
24b. For Injection Wells: Copy u) D\VR, underground Injection Control (II ('I
I I.Borehole diameter: 6 lilt•)
Program, 1636 MSC,Raleigh,NC 27699-1636
12,Well construction method:
24e.For Water Supply 1m(1 Open-Loup Geothermal Return Wells:Cups'to the
(i.e.aura.rotary,cable,direct push.etc.) • county environmental health deparlIlienl of the county svhere installed .
FOR WATER SUPPLY WELLS ONLY: ,
24d.For Water Wells producing over,100,1100 GPD: Copy to DWR.CC'P('UA
13a.Yield(gpltt) 50 Method of test:AIR 'Permit Program, 161 I MSC,Raleigh,NC 27699-I61 f
13b.Disinfection type: HTH .- Amount: . .
form UW-I North C nruliun Department of EnvironmentalQuality-Division of Water Resource, : Ret-add(,..b..:'u I s
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