GW1--00740_Well Construction - GW1_20240119

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:. -
1.We11 Contractor Information:
NEILL PARDUE
• 14.WATER ZONES I I
Well Contractor Name FROM TO DESCRIPTION.
2609A 449 11• 450 ft' • 1
NC Well Contractor Certification Number ft. ft.
AIR DRILLING INC 15.OUTER CASING(for multi-cased Wells)OR LINER(if applicable)
FROM TO DIAMETER! THICKNESS I MA FERMI.
Company Name 0 ft. 80 It• 1 6 11n. PVC
326102 16.INNER CASING OR TUBING(geothermal closed-loop)
Z.Well Construction Permit II: FROM TO DIAMETER; •rulct:NEss MA'rttRl\t.List all applicable well construction permits(i.e. U/C,County,State, Variance,etc.) II ft. ' ;In. -3.Well Use(check well use): ft. ft. in.
Water Supply Well:
17.SCREEN
ATricultural I ROM TODIAN P:I'I:R I RI,O'1'St'/.1•: THICKNESS MATERIAL
Municipal/Public It. ft. ia.i
Geothermal(Heating/Cooling Supply) DiResidential Water Supply
(single) ft. U. iu.
Industrial/Commercial Residential Water Supply(shared)
1S,GROUT
litigation FROM TO MATERIAL EMPLACEMENT METHOD A AmouNT
Non-Water Supply Well; 0 ft• 20 ft' GROUT POURED
Monitoring DRecovery ft.
rt.-
Injection Well:
ft. ft.A ui ler Recharge DGroundwatcr Rcncdiation Aquifer Storage and Recover19.SAND/GRAVEL PACE(if applicable)
y OSalinityBarrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test DStormwater Drainage ft. R.
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) a fracer 20,DRILLING LOG(attach additional sheets if necessary)
Geothermal(Heating/Cooling Return) �Olher(explain under d121 Remarks) FROM ro DEscRtP'rtoN(color,hardness,soil/rock type,gram size,etc.) _
0 ft• 70 ft• DIRT '
4.Date Well(s)Coin pleted: 09-22-23 Well ID# 70 ft• 465 ft• ROCK
So.Well Location: R. R.•
SPIVEY CONSTRUCTION • ft. ft.
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Facility/Owner Name Facility IDII(if applicable) ft. ft. ,
1 C :, i '!Th
1281 BRAWLEY SCHOOL RD,MOORESVILLE,N.C. 28117 ft. ft. ', •' a�, "Q.,;; V
Physical Address,City,and Zip ft. It. JAN �U?4 _--
•
IREDELL 4636155519 21,REMARKS
County Parcel Identification No.(PIN) PrC•`.y .r Ut;l+I
DVv Q1 i3OU
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: —
(if well field,one Im/long is sufficient) 22.Certi" f
35° 33.812 -N 80° 54.697
w ,CtedfAes 9-22-23
G.Is(are)the well(s)DIPermanent or DTcmporar3 Signature of Certified Well Contractor Date
By signing this firm, 1 hereby certify than the well(s)was(u•ca c)constructed in accordance
7.is this a repair to an existing well: DYes or DNo with/SA NCAC 02C.0/00 or 15/1 NCAC:62C.0200 Hell Construction Standards and That a
If this is a repair,fill oral knauu well canstrtwlinn inJorrnatioa and explain die nature oldie copy of this record has been provided to the/well owner.
repair under 1121 remarks section or on the back of this•fbrm.
•
23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also tallithadditional pages if necessary.
drilled:
SUBMITTAL•INS'PRUCTIONS '
9.Total well depth below land surface: 465
(ft•) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifd(rreut(example-3@200'and?a@100) construction to the following:
40 I
10.Static water level below top of casing: (ft.) Division of Water Resources,!information Processing Unit,
// toter level is above casing,use"+" 1 G1711'tail Service Cenlet;Raleigh,NC 27699-1 G17
11.Borehole diameter:6 (in,) I i
- 241). For Injection Wells: in addition to sending the form to the address in 24a
12.Well construction method: above, also submit one copy of this font within 30 clays of completion of well
(i.e.auger,rotary,cable,direct push,etc.) construction to the following:
Division of Water Resources,Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 12 Method of test: AIR 24c. For Water Supply& Injection Wells: In addition to sending the 12n•m to
HTH the address(cs) above, also submit one!copy of this form within 30 clays of'
13b.Disinfection type: Amount: completion ofwell construction to the county health department of the county
where constructed.
Form Ci W-I North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016
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