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Home My WebLink AboutGW1--02186_Well Construction - GW1_20240408 I ; pri->atrForlr'J� • WELL CONSTRUCTION RECORD (GW-11 For Internal Use Only: • 1.Well Contractor Information: . Garrett Clause a s, f =Wig,---Z~� .xga:4 :_`•K :F ' . FROM TO DESCRIPTION . Well Contractor Name "10 ft yd, ft y 4550-A o ft ft NC Well Contractor Certification Number t «_ z Y„<_ 1S.'Oc?ASRI,G)'(fP.r..mn'IZcase3'�Pa11.+)'b�t? tyr.$a'(ifr'u'ical'le);;.;. ;�.-?c�:,•,. • Morgan Well&Pump, INC FROM TO DIAMETER THICKNESS MATERIAL ft' ?. a yg in. S PV1,\[ P v C Company Name _.,_-_ L/ I- �. ,r •ti`1_'64C- _ :012�I3$I_Pl.(z':�otliezm�^c`f�nsed'-1pb��r��,.��.,�;_�,..;,��kr;: 2.Well Construction Permit#: FROM TO DIAMETER MUCHNESS .MATERIAL List all applicable well construction permits(e.VIC,County,State,Variance,etc.) ft ft in. 3.Well Use(check well use): ft ft in WaterSnpplyWeIl: t :S'CREE6T>`�yGY4�_�, � s_ v>rt:: _^T • FROM TO DIAMETER. SLOT SIZE THICKNESS MATERIAL I Agricultural 0Municipal/Public ft ft. • in. I*Geothermal(Eeating/Cooling Supply) Eagesidential Water Supply(single) ft. ' ft in. *lndustrial/Commercial DIResidential Water Supply(shared) ,�,,,,-. ----_: -:� • ��8�,4('��.�'.�:�.c.s�-�f:£[��_r.'�•~_ „;�-r�Na r_.h�..��.i�'r.'..-�--'�� 'r'.r�.*'.. .`:�'.e;.3;'r:`��'�" IITrrigation FROM TO MATERIAL EMPLACEMENT T.'TROD&AMOUN • Non-Water Supply Well: ' 6 .ft D ft. ,il-c___ vU L.,mi) Monitoring [Recovery ft. .ft. Injection Well: - ft ft. *Aquifer Recharge 0 Groundwater Remediation F. u r- «� ,�> tigaL�AYMVA�ACl (i a`PPliabrOWait' �i :.ZR.�� i1—WI` z *Aquifer Storage and Recovery . LDJ SalirityBarripr FROM TO MATERIAL EMPLACEMENT METHOD Ni . 'erTest 0StormwaterDrainage ft ft. • ;I Experimental Technology I01Subsidence Control ft. ft • .UI Geothermal(Closed Loop) DITracer O GXOtx`(Ot c'Ti-ad:iitionals`heets': necessary 3 'W. WS:41f',`', Geothermal(Heating/C.00ling Return) 1 Other(explain under#21 Remarks) FROM TO ESCRIPTION(color,hardness,soil/rocktype,grain site,etc.) G ft ft ��r b- 4.Date Well(s)Completed:/��`1-1 y _Well ID# 5—ft o ft j6 ro jA Vol-- • • "`v ft. G� ft. 3G� _ y z 5a Well Location: Facility/Owner Name FacilityID#(if applicable) it ft fL r:` 7� I .: ?,(:/ 6gdd S.l- V�CV1✓I awol ft. ft. A fp R 0 g 2024 ' Physical Address,City,end Zip G/ `WSJ ft ft. y VC W.ryv //` Y2-3 9 ., 3.oE,i1'1bRKS;`: x=._..' r�:==?;:\..::'--�,u>'7M<'t r- ,,,,. "gi- zv.- ' .'wv� County Parcel Identification No.(PIN) 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ' (if w��e{ll-,tine 1 q��cient)'N � �� W 22,Certification: I • - . • / I i ,�J L r�-7� ti �G't'"\ \ \ • Wz k. • 6.Is(are)the well(s)YA,'ermanent or DITemporarp • Signature of Certified Well Contractor Date By signing this form,I hereby certify that the well(s)was(were)constructed in accordance 7.Is this a repair to an existing well: DYes or 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 Closes-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 ' 9.Total well depth below land surface: 3. �� (ft) 24a.For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths ifdi�erent(example-3@200'and 2/@I00) construction to the following: 10.Static water level below top of casing: %�' (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: 11(la-) 24b.For Infection Wells: In addition to sending the forn to the address in 24a above,also submit one copy of this form within 30 days of completion of well 12.Well construction method: IL° r construction to the following- I ' (i.e.auger,rotary,cable;directpush,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) /�-- ' Method of test:. (( ?rag,-I=— 24c.For Water Supply&Injection Wells: 'In!addition to sending the form to 71 D the address(es) above, also submit one copy of this form within 30 days of 13b.Disinfection type:errs n'f 4C Amount: 1 completion•of well construction to the county health department of the county n where constructed. I Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources i Revised 2-22-2016