HomeMy WebLinkAboutGW1--02325_Well Construction - GW1_20240410 • .•., I _ . . _ .___
WELL CONSTRUCTION RECORD(GW,1) ' For internal T...I.e9Only: 1 _H-•..; !
C.-Ld
,
14,Well Contractor Information: '
, .
• • )
, q , _.. ,. - J_, i
-rlialiftWATIWZONV.k.r1 I:4X. 1 '''..'-: '...- ..i."'-'.7,e::-`:i .,%i--1',..t:;:i:...,...:,-i• :-••.•-. •
"•,..'„':,•!,;''-1:1'!...'...-.-",Well Contractor Name . FROM TO '':•' DESCRIPTION
!ill 5f ft. 'I ifq.;.:it1ST I -
3
iv
i.•-•' •i-:. • - • 63G kt .p ft- : .4s-1.:.ft I .1 NC Weil Contractbr C-etificiitignNumbhr '
15:'0ITIXEC;ftislITO'ffeliiiiIii,enree:dVeltiI: ftifliiii'lialleijnIM:;.'•1.•
Yadkin Well Company, Inc. 'PROM TO „DIAMETER• THICKNESS MATKRTL
_ . A
....."'
-3 '''• 8 7'....IL /0' I bi• a zso" 16/42.4 51fet,/ tts
_ . . _
--,.,..,-_,,..,...,...•compny Name'
1.i...:.•,:::,_ ,. 4 z a '7 a/1 V ainThINKRIGLSINV.ORMU3I19:Gf(kr6trifinircleirearloirpT.:if...;:41a:;*61'11Ve...11 s-•.,....%.•......
(3.'s'• '.•, 2.Wen Construction Permit#: so 1 i I-L, 0 ! PROM TO •''. , DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.WC,CounV,State.Variance, ..i.a.) +1 fL 1 I'Tit. 6TE ilL 0 iiSgAr 6a6 •
1- , • 3.Well Ihp(check wellpse): ft. ;ft ! - in.
. -_ - -- ril....aaRkilL‘ri“.•'..*.r.•22'.',7,:i&j.i;r7R.If:Vidn'.-p.o:.M:;:r;,,i,..ti:: ,.M.'•'. ..':;'•.....-: 7:22:4`i''.;1).%!tza
Water SuPpIy WeR: - -
FROM 0 . DIAMETER SLOT SIZE -THICKNESS MATERIAL.
OAgticultural :OMunicipal/Public •OGeothemial(Heating/Cooling Supply) ›totidential Water'Supply(single) i ft.
' ' ...7.-t-Jt. 11;0/"..--- ..,,V/ ''':'-
' : . ' .J • " riogAd
Olnclustrial/Commercial . DResidential Water Supply(shared) :iA.HITOrOlrr' i 1 . ','',..:2-11;ZZiigir. t.'•i?•/`---1‘`zad,t4,-1.7-thr-7- 11--:Z•R:41!'';_
Olrrigation ,OWells>100,000,GPD
p FROM , 1 To . MATERIAL0ft f TACEiIVIE.NTITHOD&AMOUNT
Non-WaterSupliWelli _ ( 61-1/q4PkrPa , 64 I I •
I t live
, 0/vIonitating ' [ORecovery _ 73 ft. 4 Ic It. 2-Th_„, -
• P
a 4v4.. gE : '
. _ _
Iniegoonweni - - --
OAquifer Recharge 13Grarmdwater Remedial:ion co:• fi• 3 .. j,ft• ` ..::;..ik.',.::'ce;i14::--
,49;siasitirmvAiloggrifsi:,-yrikrtAiroi.c..r.,012:i:7.:7:314.;',i1V) .:7;2,..•,-: ;
OAquifer Storage and Recovery OSaliaity Barrier PROM '' TO - - EMPLACEMENT MEITIOD. " - -
.
:
OAquifer Test OStormwaterbrainage ft. ft. "' ' . '''--J -... .-., --:. • r"'' ,-,
ClExperimental Technology 1OSubsidence Control ,...../../rt ......X. ....„,./"....: •
• ' Ocreothemsal(Closed Loop) DTracer ,-;*011:0R1r.IIN-GLOG(iittiZeklia difillifallIiiitiifilaliElliFyM11=1.17- 1-7-04-11 Sr ,
' l''. color,hardness.,soil/nick type,gain size,etc.) .
OGeothemial(Heating/Cooling Reims) -0 Other(ekplain under#21 Rem TO . DESCRIPTION
Remarks) TO_ -
Date Well Started 3--IS--a mi it• r-7 rc• - -5.6, i r . . . , • -
. 4.pdtelvg,u(s)compietea: I-, k.$...an wen m#X.4/2-7 0 9.r , 3-7 it . 1 11 ft, .s .t,ism-- boi.44.1.,:;j1. .eifrin, -
La.Woll Location: Phone#:.704''' Jol# Iton , lit ft. ,20.. .ft• 6:9-. , 4- ilfikfto4
A i i 1 n I . '70 N- 6 2 I,-,n,3o ft ;ft
breks. .1 111g.i.oels
h DO getk . , , ..
•i . , 1,7,7_7 r---:,il---7..:\ ,-...!--:rf,-,- -.-- .. ., "
. ft
FacilityiOwner Name 'a Fscilitylb#,(if applicabl e) ft , •. _ , • , -,,• . . .. ,
_ _ _ ,.
10 45... Fr isia tAmtv LA ...St.listury ,
, ft•. ,ft. I
APR' 1 e 2074 - -
ft ;ft . I, ' .Physical Address,City,and Zip .
--
RO'6,Ail 1,•alaatacalcs , . . .w.k.mizt..-
County - - - Parcel Ideitification No.(PIN) ' , 1..,•.` 4...5:J..- • , • .
......=••
•
• .
5b.114titude and longitude in degrees/min ntes/seconds or derlmil,degrees: ' ._, - <C.
Of well field,pee latilong is sufficient) 22.Certification: '.: : . i!',i . •
, 3 s', Sleiti 0
N go/ 133;7 W ___ JLo. .._____Z 1:' '' ' ' . • •
Signature of 'g ed Well Contractor ",i'-:',
6.Ts(a.re)lhe•well(s):IKE'ermanent or OTemporary
Date
• , I, ',
lly signing this firm,lite;eby cerbh rn&the,1444(s)was(were)constructecl.in aCcoriltatee with
7.Is this a repair to an existing well: DYes or NIP :1111101C 02C.0100 07;15/INCIC 02C.0200 Well Construction Standards and that a copy II)
if thls is a repair,ftu out;aloft well construction information and explain the nature of the ,ofihix record has beenliI;pvide:d to the well011'nen• .
repair under#121 remarks section ores the back ofthis form. • " . . .
23.Site,diagram orrirlditional well details: ' , '
You may me the back of this page M provide additional well construction info (14 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only I OW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary. .
drilled:
,24.SUBMITTAL llISTRUCITONS. ' '
•
. 9.Totpl well depth below land surface: 0?0,2. (ft) . .s GW-J.within
. For nutlnpleweffs list all ckpths if different( la-3@t200'caw 12(g100) Submit-this.,thi 30 days Owen completion per the following
. , ,
10.Static water level below top of casing: 3o „..., ,24a. For All Wells:'Original form to Division of Water Resources (DWR),
. . t''') Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 •
• ' ywater levelis above,casing,,use"+"
1_._.' 03
st
. ' II.Borehole diameter: 6 •cui.)Bit Off: 'C. 19 3 a'If ,24b.For Injection Wells:Copy to DNB,Underground-Injection Control goo)
Pmgram,1636 MSC,ltsleigh,N92769971636
1 9)
... 12.Well construction method: &it 4 Mgt k rok+k ty 24c.For Water Supply and Open-Loot)Geothermal Return Wells:Copy to the
, (i.e.anger,rotary,cable,direct push,etc.) I county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: •-
24d.tor Water Weis producing over 100,000 GPD:Copy to UM.,CCPCU.s.'
) r Permit Program;161 I MSC,Raleigh,NCI 27699-1611
I . 13a.Yieldtpm) ei.14 k../ Method of test: iir/3 .41 i , ,,
% hth ..Iti z Date Site Visited:
-21 INl II • '
137°b.Disinfection type: - Amount: ...c 7 ° Site Visited By:'' I I
If.
. '..)
1.1- • '"Torn GW-1 North Carolina Department of Envirorunental Quality.Division of Water Resources Revised 6-6-2018
r:c.,;:;',•?-1 • - .
r-• - Price. . ,,
i-- -