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Home My WebLink AboutGW1--02289_Well Construction - GW1_20240410 aZI al 1t—...L CONSTRUCTION RECORD (G'W-1) For Internal Use Only: • 1.Wcil Contractor Informatio li _ J C.)CA/ '/1 4C/ Not 11s45 )/ ! ti'14z:WA17 S:k ZANES`:..i-•=:::- ,�.Mtj! er; p''}_. i.;4=aw� iix_... ••:••',;, Well Contractor Name /p FROM TO `DESCRIPTION f — /ag • , '�'oir. Q ., , it @` NC WellContractor Certification Number 3 4 5 ft. 1 S 0 ft e15:otrn e.ASING(foifmulti•eased;weliSIORLINKRi(if`QP lialiAL-272 1..'i"- Yadkin Well Company, Inc. FROM TO DIAMETER THICKNESS MATERIAL Company Name 4 0 it 4 Z. ft I .i 1( m. Oft.- Li P V C '16IINNER:CASING'ORTUBING(gedtliermar`rl6sedl&op) .: _' ::.`. ::.',.. 2.Well Construction Permit#:0-gilik F OR 4 Q°a 0 0 2 3 FROM TO DIAMETER THICKNESS MATERIAL List all applicable well construction permits(i.e.UIC,County,State,Variance,eta) ft ft in. 3.Well Use(check well use): ft ft in. Wafer Supply Well: Z1.7;SCIikE1`�."—m::_-.'� ="_ ____'.�—? _.`_._ FROM TO DIAMETER SLOT SIZE THICKNESS.: MATERIAL cultural ❑Municipal/Public ft ft, in. ❑Geothermal(Heating/Cooling Supply) liliesidential Water Supply(single) ft ft in. ❑Industriai/Commercial ❑Residential Water Supply(shared) '1• 8"GRODT 7-'",_ _ ❑Irrigation -❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 0 ft 1,0 it qi9 K Pew- eh,itp G/ ❑Monitoring ❑Recovery ft. ft Injection Well: ft. ft. :Aquifer Recharge ❑Groundwater Remediation -19-"5A1tID/GRAVES PACKCsfapplica2ile)::v"' .=::== = _-; ❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTMETHOD DAquifer Test ❑Stomrwater Drainage ft. ft ❑Experimental Technology ❑Subsidence Control ft. ft ❑Geothermal(Closed Loop) OTracer r205DR iNGI',OG(art's`c1iadditionalsheetsif.neceuary)'4^,�=` _ ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) PROM To DESCRIPTION(color,hardness,ealllrock type grata size ern) Date Well Started (i y-ti 19 C ® ft ft. 10 r 4. (.... W s Completed: a—7 d1-ti WellID# Oa ft. $.� ft A k E -'�,.-, �� ,..- 4. Date ell() p .i � ,, .. • Phone#:?2.5*-4-7C--7GC7 ft. 0 ft t.�. pg �D2, Sa�W,Well Location: �a U l+ec�/� (1 i • A 4 t r d i s ft. 1 Z, ft. Tani £t�,. P-4(°. Facility/Owner Name Facility lD#(if applicable) ft. '�0'� it ,d 'f„ R j iliniv:t^,, .';`t;] - "' • ,S 'n 6 -!.e�Gh� R Ilakini,l/�� 0% ft. q0 �5 11 �'. a r b t • "' � L:.. Physical Address,City,and Zip ft. it ./ l•l ki County Parcel Identification No.(PIN) ' 5b.Latitude and longitude in degrees/Minutes/seconds or decimal degrees: ' (if well field,one let/long is sufficient) 22.Cer.,C atio.` / 3C0l JL21 •`x go, .AY. 0,2 e` w , rig 141"1 a 6.Is(are)the well(s): rmanent or ❑Temporary M• Si:• ofC ed Well Contractor Date � By signing th orm,Ihereby certfy that the well(s)was(were)constructed in accordance with 5. 7.Is this a repair to an existing well: ❑Yes or L71V o 15ANCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy fp If this is a repair,fill out disown well construction information and explain the nature of the of this record has been provided to the well owner. repair under#2I remarks section or on the back of this form. 01 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 syl construction,only 1 GW 1 isieeded. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary. drilled: 1j 24,SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: e (ft) Submit this GW-1 within 30 days of well completion per the following: < For multiple wells list all depths if different(example-3Qa 200'and 2®100) 24a. For All Wells: Original form to Division of Water Resources (DWR), na 10.Static water level below top of casing: (ft) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 If water level is above casing,use"+" • 11.Borehole diameter: (-. (in.)B it Off: 6.8 SI 24b.For Injection-Wells: Copy to DWR,Underground Injection Control(IUC) e (� f, Program, MSC,Raleigh,NC 27699-1636 12.Well construction method: A;c I' e . y 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the `"=....., (i.e.auger,rotary,cable,direct push,etc.) county environmental health departinent of the county where installed tla 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 r � �IT 13a.Yield(gpm) a . Method of test: ( C C f e4vl JJ e 70% hth A oZ Date Site Visited:S-,�,�- �-� 7-1 13b.Disinfection type: Amount: ) 2_ Site Visited By: 003. I 5Z a''L/�ee,v4- (. 1`,1,-. �I.JJ\4,-,-,,,,J __Eorm_Gv�1Npr_ih_Casolina Department of Environmental Quality-Division of Water Resources' Revised 6-6-2018 1 1� �,, iv. 3 cat_ I. ,c4e4 6 ;�'a A 4 tic . Cb'