GW1--00729_Well Construction - GW1_20240119

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WELL CONS1'RUC'I'ION RECORD (GW—I) For Internal Use Only: I
I.Well Contractor Information: 1
CHAD HARTNESS i , I
Well Contractor Name l 14.WATER ZONES i I --1
I+ROJI TO DESCRIPTION
2901A f 689 ft. 690 fl. I I - --- I
NC Well Conottetor Ccrt`ification Number ft fL I I —`
15,OUTERCASING(formulti-cased wells)ORLINER(ifapplicable)AIR DRILLING INC —_i
FROMTo DIAMI I'I'%RI THICKNESSU,sfLRtA1, i
Company Name i 0 ft, 60 ft. 6 I lin. PVC
2,Well Construction Permit II. 2023-1440 I 16.INNER CASING OR TUBING(geothermal closcd-loop)
FROM TO _DIAMETER I THICKNESS MA'I'IiRIAL
List all uppticabie trod!construction permits(i.e.WC.County.State, Variance,etc.) IL I'L I lin. """"
3.Well Use(check well use): ft. ft. I, in, — '—
\Vnter Supply Well: 17.SCREEN I'
:_lAgl'ictlhur„i FROM TO DIAMETER I. sLO•rsize Tntctcn9•_ss JIA•retsi. t. _
CJMunicipal/Public. ft. • R. in.I. . ._
_ I
Llceothermal(Heating/Cooling Supply) !'!Residential Water Supply(single)
ft. ft. in.l' '
!Industrial/Commercial ElResidcntial Water Supply(shared) —.
18,GROUT 1, —---
FlIrigation I I_D Wells> 100,000GPD FROM TO MMATERI,\l. EMPLACEMENT METHOD,e_taiu_t5^i_�
Non-Water Supply Well: 0 h. 20 Ir. GROUT POURED
LiMuniloring I ElRecovcty — ft. — rt. ---- — j
Injection Well: 1 — I'
.]Aquifer Recharge ElO1'elIlldWatct'RCI17Cl11atioti IL It 1 .I
ClAquilor Storage undiRccovot IS.SAND/GRAVEL PACE(if applicable) _I
y ❑Salinity Barrier FICOM To NI rEtou i I:Ml't.ICEMENrMtiT110n
I !Aquifer Test ElStorntwater Drainage ft. ft.
ElExperinmenial Technology - ElSubsidence Control ft, ft. --- --
I ICieolhertnal(Closed(Loop) DTracer 20.DRILLING LOG(attach additional sheets if necessnr•)
•
f.'IGeolhermal(Hcatint/Cooling Return) (JOlher(explain under//2l Remarks) t'RO\I TO DESCRIPTION(color,tinniness.selt/roe c Iyg5 Train size.ere,)
0 f`' 6011' DIRT .
4.Date Well(s)Completed: 05-1 0-23 Well full 50 i•t' 705 ft. ROCK 1 — ---
5a.Well Location: ft. 11. --- „�— --— ---
SPIVEY CONSTRUCTION ., ¢` r' — _
ft.
fl, i c J��� f�..� '/;, y Vic..,
Facility/Owner'/Owner Name ''' -i- •w.C
> F;teility IDO(if ttpplicnblc) rt. ft. 1' , .�„ 1
662 LANGTREE RD, MOORESVILLE,N.C. 28117 ft. ft. jAr,}-
Physical Address.City.and Zip ft I'I. I,—�tv� —i` 7r^�—^^
IREDELL 4635918590 21.REMARKS1. ":,C,J,.q ;cr --
County 1 Parcel Identification Nu.(FIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: •. _
Orwell field.one lot/long is sufficient) ;
a2.('�drt r 1(on:
35° 31 .551 ! N 80° 52.985 ��, .--., - `'
i . /10/2023 '
6.Is(are)the well(s): ClPermattent or ❑'Temporary 1, Signature of Certified Well Contractor ;, �;; Date
11)' — —
' signing this/brat,1 hereby certtt/i'that the!�i
i rell(s)was(were)constructed iniccordance with
7.Is this a repair to tilt existing well: :Yes or L'1No /Scl iVlAC 02C.0/00 or 154 NCWC 02C.020(1 Well Comm.:a:tion Standadrand drat a -ape
if this is a rctair,Jill out knoll'!well construction ittlormatiolt and explain the nature of Me
l l this record has been J»prided to the Well ii rare.
repair sunder 1/?I renmt•kts section or on the bock of this form. •
23.Site diagram or additional well details:
8.For Geoprobe/DPTIor Closed-Loop Geothermal Wells having the same YOU may use the back of this page to provide additional well consul coon inlu
construction,only I GW-I is needed. Indicate TOTAL.NUMBER of wells (add Over'in Remarks I3ox).You I d ay also attach additional pukes iffleeess;ut.
drilled: — _
24.SUBMITTAL INSTRUCTIONS 1,
9.Total Well depth below Ilan!surface: 705 (fL) I
For nnihiple wens list all depths i/'di/Ji'retu(ecample-3@200'ancl2(i),100') Submit lids OW-1 within 30 daysh of well completion per the following:
10.Static wale'level below top of casing: 50 • f 24a. For All Wells: Original form to:Division of Wafer Resources (D\VR).
1/limIel'level is oboe!'rasiiu,use"+" (l.) furormation Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
l I.Borehole(diameter' 6 (ill,) 24b. her Ii jeclion Wells: Copy lti DWR, Underground Injection Control (Il!(:)
1 Program, 1636 MSC,Raleigh.NC 27699-'+636
12, Well construction Method:h, 24e.For Water Supply and Wells:Open-LDop Geothermal Return Copy lu the
(ix.auger.rotary,c;iblc,dl'cul push.etc.)
county environmental health department of the county Where installed
FOR WATER SL1PP[Jl'WELLS ONLY: 24d.For Water Wells producing over 100,000 GPI): Copy to DWR,C('P('l1A
13tt.Yield(gpm) 1 Method of test: AIR Permit Program, 161 I MSC.Raleigh,NC 27699-161 1
13b.Disinfection type:i HTH Amount:
1
Form OW-1 i North Carolina Department or Environmental Quality-Division of Water Resources Revised t-6 20I s
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