GW1--01601_Well Construction - GW1_20240308

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: i
1.Well Contractor Information:
i
Rawlins E Clarke IV 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
20 ft. 45 ft.
NCWC 4234-A
ft. ' ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap Gcable)
Clarke Generations Drilling LLC FROM TO DIAMETER THICKNESS MATERIAL
45 ft. surface ft• 45 rn' geoprobe rods
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop) '
2.Well Construction Permit#: W10400614 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO _ DIAMETER , SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 45 ft. 15 ft. 45 in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑lndustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL � EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 45 ft. surface ft. Neat cement grout Tremmie from bottom to top
OMonitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge @Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
DAquifer Storage and Recovery ❑Salinity Barrier FROM - TO _ MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft. ft. N/A
❑Experimental Technology ❑Subsidence Control ft. ft.
0 Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks)
15 ft. 36 ft. Brown,Reddish,Saprolite
4.Date Well(s)Completed:2/19/24-2/29/24 Well LD# IP-01 - IP-13 36 ft. 45 ft. Greyish,LT:white Bedrock
5a.Well Location: - ft. ft. C c.r i IE,;..,,
Tarheel Army Missile Plant ft. ft. MAN
qq ryryA�Yl�f
Facility/Owner Name Facility ID#(if applicable) ft. ft. ��l\ Q CQL4
204 N Grahm-Hopedale Rd.,Burlington,NC 27217 ft. ft. e:^Y
ante rn-.c.,�n: rt•r. ,f, tir*.
Physical Address,City,and Zip ft. ft. DWQl'DLG
Alamance 21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
36.098803 N -79.408845 �, � r U N , .
I' 02129/2024
6.Is(are)the well(s): DPermanent or @Temporary Signature of CeKified Well Contractor; Date
By signing this form,I hereby certi/y that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or dNo 15A NCAC 02C.0100 or 15A 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 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 construction info
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.
drilled: 13 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 45 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3@200'and 2@100') I
24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: 20 (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing,use"+"
11.Borehole diameter: 4•5 (in.) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Sonic
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health depa tment of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1 6 1 1
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018