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Home My WebLink AboutGW1--00756_Well Construction - GW1_20240131 i L1,CONSTRUCTION RECORD(G`rW-11 For Internal Use Only: 1.Well Contractor Information: 011 94 F,J. WATE `ZONES::;;..,.:,f7:1? .r.13%:..- . ,,.-:_._:'? ;i-- -- - Well Contracto NDam_e" 9 FROM` ft. TO .f' •N DESCRIPTION.1•Y..^` •--. ..- . _ �y • fi( ,/I- / p)� and g3 ,e. y7,2/I �03ft. 0-is-ft b ! P� �� NC Well Contractor Certification Number ?15::OUTEII CASING•(foi`:multi-cased:ltlli):ORLINER(ifii`lica'lile);=L Yadkin Well Company, Inc. FROM ft. TO ft DI TERM THICKNESS 1 MATERIAL Company Name ,ry 16cIIQNEit.CASING:ORUTIIBING(geot}Ter`malclo'sed=laop)•<=.:t`'1="= _:_ .: ii..- 9 2.Well Construction Permit#:(I)I cg-7( -. 9`12-•3 FROM TO DIAMETER THICKNESS MATERIAL _ List all applicable well construction permits(i.e.UIC,Cow*,Slate,Variance,etc) 4. i ft. 3"C:1 ft L`1).�1 e� g a d f, t,e. cp 3.Well Use(check well use): ft. it nin. c`J p d� = y y Water Supply Well: FROM TO •'�- DIAMETER y SLOT SIZE THICKNESS MATF1UAI. a ❑Agricultural ❑M/unicipal/Public ft. ft in. i.Z. OGeothermal(Heating/Cooling Supply) presidential Water Supply(single) ft. ft. in. - ❑lndustrial/Commercial ❑Residential Water Supply(shared) 18 GROUT_``"7- `- —_ r--'= ---_-_ 0❑Inigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOIUNT I Non-Water Supply Well: to ft. , ! ft. 9424,alien Jo®(,1-ed ❑Monitoring ❑Recovery ft ft. e/ Injection Well: ft. ft t\d ❑Aquifer Recharge •❑Groundwater Remediation _� -.--..#P=19:.SAND/GRAv.mi:PACIC•ifiipplicchle)';�.r_' -:52- -- __... , ❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD~ �, DAquifer Test ❑StormwaterDrainage ft ft. c'' ❑Experimental Technology 0 Subsidence Control ft. ft. OGeothermal(Closed Loop) ❑Tracer 01331i.1T INGT:OG'(littachaddihonal�tieets"ifneceu `'� FROM TO DESCRIPTION(color,hardness,soillrock type,grain size,etc.) OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) Date Well Started /-/.. ft. ft :: : : b0t&1: / 9g• Phone((��#�' `•y(> L��1-/��/ it ft ^ ,; _ - DeLd IA (.i Or t( k C ' ft. ft a ,a' ., 4-a J•P., 'TO:1: Ek (14A `e-Fi evil Leg DN ft e::.9-'t ud-i-w. JAN C I, Facility/Owner Name f- L.i L� Facility ID#(if applicable) / R [G24 ' �R-�. Cew1- !dfr•?,41-- / a '♦,v e +�. ft ft. 1ni:. Tr.,'_ z,,, r)r.-..,„:_ ., . , Physical •ddress City,and Zip /J e,-• 7 r.d ft ft j 1 . ,• .` County Parcel Identification No.(PIN) ex....s:',15 (AKA e 16-e.4:14:-% 5b.Latitude and Iongitude in degrees/minutes/seconds or decimal degrees: pr. k e % 4® 1 ®-° (if-well field,one�lat/long is sufficient) 22.Certification: fea t ne C CT C N 8. n.1 I R40 w dl 9/ c 6.Is(are)the well(s): dermanent or ❑Temporary gaahue ertified Well Contractor Date By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or so 15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy ' If this is a repair,fill out known well construction information and explain the nature of the of this record has been provided la the well owner. , repair under till remark section or on the back of this form. 23.Site diagram or additional well details: 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info i construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add See Over'in Remarks Box).You may also attach additional pages if necessary. J drilled: o 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: (ft.) Submit this GW-1 within 30 days of well completion per the following: 'IA multiple wells list all depths if different(example-3Q200'and 2Q100) 1/4.,11, 10.Static water level below top of casing: ��• (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR), Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 Ifwater•level is above casing,use"+" 11.Borehole diameter: C. On.)Bit Off: 6.1.9 5. 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC) ® , Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: �,�a Yl f 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed FOR WATER SUPPLY'WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA 2 ® � Permit Program,1611 MSC,Raleigh,NC 27699-1611 �' 6 13a.Yield(gpm) Method of test: �' J 70% hth Oz Date Site Visited: I •-y- -3 Y/ 1'ti Poo . 13b.Disinfection type: Amount: „ S. Site Visited By: I -1 U Fern OW-I ____-_North Carolina .enh th,ne i,€Rnviianmental Quality-Division of Water Resources Revised 6-6-2018 . \, 1 - Price:j I ,