HomeMy WebLinkAboutGW1--01615_Well Construction - GW1_20240313 c.,---.... .,, .
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..... W&Li; •CONSTRUCTION RECORD(GW-1) For Internal Use Only: .
. tractor Information: 1
..\ecti 'wctf-141101-3
FROM TO .••• DESCRIPTION
Well Contrictor Name
• ft. 53 ft. 2 afyi .190' I:
" S-3- " .1 .69iYi
NC Well Contractor Certification Number
..1501:1TER:CISENGIfeFiiiiilli;elfied:ifems)
. , Yadkin Well Company, Inc. FROM TO DIAMETER THICKNESS MATERIAL
Company Name
1461-1NNEWCASING:OR:XUBINGirgeli'dfifinareTtiied;liiiiii)7:4==.'n'-aigW (j)
2.Well Construction Permit#: 07 99 w FROM TO DIAMETER. DECIMATES MATERIAL
List all applicable well construction permits(Le.UIC,County Slate,Variance,etc.) i. / ft. /it ft. to 579 in. .leg •, 64
. , 3.Well Use(check well use): ft. ft ! in.
•
, ' , .• Water Supply Well: '
FROM _ TO DIAMETER SLOT ME THICKNESS MATERIAL
DAgrictltural ' DMunicipal/Public ft. ft in. (4
OGeothermal(Heating/Cooling Supply) Aftesidential Water Supply(single) ft . it. ' in. , ' , •..• .
4-1\
DInduStaiallCornmerdial'• . OResidential Water Supply(shared) •• t.j , _f_i.:, ....L:__:.........__.,,,:::,2z.,.....,,, \,...„
Olnigation OWells>100,000 GPD FROM TO MATERIAL &ix-Aciao:mi miriio-i)&AmouNT
Non-Water Supply Well: ' • , . Of, " Li " goie P1415 PtiuieJ S IN sS
DMonitcuing DRecovery Ll ft' 27 " &meted:1.00i P.)4ri.1 • • c• 130413
- Injection Well: .
' • ft. ft , ,,
DAquifer Recharge 1:Groundwater Remediation
il;19:-'.SAND1GRANTZEiPXCEC(ifirpliChlile)1=1".1..=_
DAquifer Storage and Rec9very OSalinity Barrier 'FROM TO MATERIAL - .111PLACENIENT METH- OD
- DAquifer Test , OgtormwaterDrainage ft. . ft. , 1 • - . . ." -. ....r-
.. .
LOiperimential Technology . ' CISubsidence Control- ft. ft. '1
' bGenthermal(Closed Loop) OTracer E•201.1a1VIMG.IRIG'Crittaiiiid.alliiiiirslieiticifigeliiilifY)=7,"
eothermal(Heating/Cooling Return) DOther(explain Under#21 Remarks) FROM TO •,. DESCRIPTION(color,hardness,soll/rack type,grain size,etc.)
.. ,. Date Well Started i!igi.2ti a ft' IS it* _ ._1St)T'i
•4.Date Well(s)Complete : •jili.241 wen m# A
-'. il Q - °Dci 35 ft., 364 ft• • 6 ihe.;:i.,--4., c,:",„7:;.7,.r.....: ;\I(: , I.
Phone#33 6- e N 7-•11616 ft. it '-'•.'' • . .,
Sa.:Well Location: 1 •
-
•ft. MAN i • Z02 4,
Kart,e1 Saunyll S . .. .' .
. , Facility/Owner Name' ' ' ., Facility 1Dii(if applicable)S.' ft, , . • li ,
intz;:-Tcs.',?rPrr.... .5e:4
...
2'78 4,5'. Alt- 'I 6 bw -•.- 'Mitts Cii-4.9.;lik
- s"- ft ft. ••' - ..r ' CM Cti3Okii •
,;. 1,,''• - . Physical Address,City,and Zip me. -I1 : • ft.
ft
W;I k , ... •
. .,. ..,....
• e,s .., 172.11qt.EMARICS========-::
-.
' - County ' Parcel Identification No.(PIN)
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
- , (if well field,one tot/long is sUfficient) 22:Certificatiom.,, . , " •"-. - '
sti
• . 36g ° 141 17 N g)° . IC ' tiiii„
W .
..,........iurott.z:. • • . . . ..., .
. ilicik. s
• Contractor. i .
6.Is(are)the well(s): ?IA'ermanent or I:Temporary Signe. of C ed.Well• . - .. . ,.,
Date
By signing this:ibim.;I hereby C6;16"ihat the well(s)was(were)consti:gated in accordance with
• - 7.la this a repair to ane:Sisting*ell: • DYes or 121No 15A NCAC 02C0100 or 15A.NCAC 02C.two Well-Construction Standards and that a copy
. If this israrePoir,j111 out ImoWnivell construction information and explain the nature of the of this record has been provided to the Welt aivner.
' repair under#21 remicrla section or on the back ofthis form.
23.Site diagram or additional well detoih: .
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page t9 provide additional well construction info
construction,only 1 GW-l'is needed. Indicate TOTAL NUMBER of wells (add'gee Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: l'i . .
24.SUBMITTAL INSTRUCTIONS i
9.Total well depth below land surface: .3 co a' (ft)
Submit this GW-1 within 30 days of well completion per the following
For multOle wells list all depths if different(example-3(4200'and 2@100)
•
10.Static water level below top of casing: DO 24a. For All Wells: Original forin to Division of Water Resources (DWR),
(ft.) Information Processing Unit,1617 MSC,Raleigh,NC 21699.1617 '
.0,1iyarp level is above casing,use"+" . • , .
,.,
' 11:Borehole diameter: 6 ..onaBit Off: 4 1 1-11 24b.For Injection Wells:Copy to,DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636 2
e
' 12.Well construction method: G I r ro+-61 is), 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the <
..., (ie.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
Permit Program,1611 MSC,Raleigh,NC 27699-1611 43
13a.Yield(gpm) RO Method of test. 1',f I s a;1'
70% hth
' Date Site Visited: I a —41 `..- a 3 ....:
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• 13b.Disinfection type: Amount: I(.9 OZ Site Visited By: .A4 B Ilel
4-01 VA_.,„ 0 --1-c , , 1,3
Form GW-I North Carolina Depart/int RI:Environmental_Quality-Division of Water tD ces i 'f' Revised 6-6-2018 04
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Price: 1 777—
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