GW1--01526_Well Construction - GW1_20240312

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
I i
Robin Webb ,14 WATERZONES .';,'' U* ,-.,',;!,,,`„--,0',:-„ ,, �. `
Well Contractor Name FROM TO DESCRIPTION _ _
0 IL 305 ft. iuissl
2418 ft. R. ,
NC Well Contractor Certification Number =15OUTER'CASING(for multi:cased wells),OR LINER(if applicable)
Greene Brothers Well &Pump, WT Inc. FROM TO_ _ DIAMETER THICKNESS MATERIAL
0 ft' 35 ft. 61/4 in' PVC
Company Name S O S-2024-0050 '16•'INNER-CASING ORTUBINGi( eotherntal'closed-li op). „
2.Well Construction Permit litFROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State, Variance,etc) ft, ft. i in.
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3.Well Use(check well use): ft. ft. _ in.
17.SCREEN 4
Water Supply Well:
'-R. •. ,
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
III Agricultural ]Municipal/Public . ft. ' . ft. in.'
•
!Geothermal(Heating/Cooling Supply) !Residential Water Supply(single) ft. ft. in.'
il!Industrial/Commercial DResidential Water Supply(shared) _.iS:GROUT
! I Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft- 20 ft- Bentonite
siMonitoring ['Recovery ft. ft.
Injection Well: ft. ft.
!Aquifer Recharge 0Groundwater Remediation
.19.'SAND/GRAVEL PACK(if applicable) -_ .- - ',-
nlAquifer Storage and Recovery Salinity Barrier FROM To MATERIAL EMPLACEMENT METHOD
NI Aquifer Test DStormwater Drainage ft. ft.
**Experimental Technology OSubsidence Control ft. ft.
III Geothermal(Closed Loop) 0ITracer r20.DRILLING LOG(attach additional-sheets if tiecessacy). -
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
MI Geothermal(Heating/Cooling Return) QlOther(explain under#21 Remarks) 0 ft. 35 it• Clay
4.Date Well(s)Completed:02/13/24 Well ID# 35 ft' 905 ft' Granite
�.,
, 5a.Well Location: ft. ft. 1,,.--')I. -.( ,'� ', t•' 1 a
David Hughes ft. ft. MAR {j /,
Facility/Owner Name Facility ID#(if applicable) ft. ft. ��^ ` V�T
151 Trillium Garden Trail Fletcher 28732 ft. ft. ? lnfO;,;%: ?r-::4y;r;a l_;„K
Physical Address,City,and Zip ft, ft. j; '14 U.;',. '
Henderson 9662-92-1292 fn.REmARKs`•'u. ._-1 "
I
County Parcel Identification No.(PIN) I
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: 1
(if well field,one lat/long is sufficient) 22. rtifi ation• I I `
35.410 N -82.459 W b2!e-
02/13/24
6.Is(are)the well(s){JPermanent or DTemporary Signature of Certified Well Contractor Date
By signing this form,I hereby certifr that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: DYes or 12 No with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If this is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under#21 remarks 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 site details or well
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled:' SUBMITTAL INSTRUCTIONS i
9.Total well depth below land surface: 905 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@I00') ,
construction to the following:
10.Static water level below top of casing: 800 (ft.) Division of Water Resources,Information Processing Unit,`
If water level is above casing,use"+" 1617 Mail Service�Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 1/4 (in.) 24b.For Infection Wells: In a dition to sending the form to the address in 24a
Rotary above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 1/4(.25) Method of test: 2 hours ,. 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: HTH Amount: 165 tabs completion of well construction'td the county health department of the county
where constructed. I
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources, Revised 2-22-2016