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Home My WebLink AboutGW1--02493_Well Construction - GW1_20240422 . . . . • . • ... ...__ . • . ll Print orrn .. .. . . . WELL CONSTRUCTION RECORD(GW-1) 'For Internal Use Only: . . . I.Well Contractor Information: • • . • . . . ' . . . Cameron.Bazin• - . • : • - . - : . :. •14.WATER ZONES -' - _•,, •:: . • • '•- , . ' . • FROM TO . DESCRIPTION - • Well Contractor Name i . . 285 fL . fL 4 gpm I . • . ' . 4518-A .• • • ft. . • •• • - . • NC Well Contractor Certification Number • -- • 15:OUTER CASING(for multi-:cased;wells)OR LINER(if ap.1iCable) . ... _ - Aqua Drill, Inc. . ,• .. • . . • - . .FROM- -TO . DIAMETER TIHCICNESS . -MATERIAL - '• - -- --'- • : - " 0 • ft' .108'.' ft.. 6 . in• ..• - . :. PVC • . .- • ' . . Company Name . " ' • 16.INNER CASING OR TUBING(geothermal closed-loop) .-'. . • 2.Well Construction Permit '203969- . • FROM TO DIAMETER --THICKNESS- '-MATERIAL -List all applicable well construction permits(i.e.UIC,County State.Variance,etc.) ft. ' ft. . ' . • . . . ft. .. . • 3.Well Use(check well.use): - - ' • . :,' • . ft in. " . Water Supply Well:• . .' . • ' • • ' , , • FROM' s TO - DIAMETER SLOT SIZE THICKNESS. MATERIAL Agricultural , °MunicipalfPublic 1 . .'; . : .ft.- ..11- in. - . . . E3GeothFrznal(Heating/Cooling Supply) °Residential Water Supply(single) - •ft. - . ft. .: in, . • , °Industrial/Commercial • °Residential Water Supply(shared) ,18.GROUT:' _ . . .. • - • - _ , . . ' DIrrigaiion - - - . . .FROM .TO ' . ,.. . . ..• MATERIAL. EMPLACEMENT METHOD&AMOUNT -. 1sliinAVater Supply Well; • ' ' • ' .0 ' • ft•• 22' ft• Chips ' Poured • °Monitoring ' 'ORe6ovcry • • . ' • ti. 'ft. . • . . . • Injection Well: ' • . . - ft. . ft. • • . . 111 Aquifer Recharge • . IDGroundwater Rernediation . . . . • . • 19.SAND/GRAVEL PACK(if applicable). . . • . . . ['Aquifer Storage and Recovery' °Salinity Barrier* . .•. • • FROM • TO • MATERIAL . EMPLACEMENT METHOD • ' 111 Aquifer Test " °Stormwater Drainage , ft ft. • . . . . . . . •. . ' • In Experimental Technology • :• ' °Subsidence Control •. : ': • -,ft.. - : :ft. .'.: . 1 . . • . . . . . . . . . . ,.°GeOthermal(Closed Loop) . . ..-. DTracer . . . :. .: .. ... - 20.DRILLING LOG(attach additional sheets if necessary) "„. , - • • . . . - TO DESCRIPTION(color,hardness,soil/zilch type,grain size,etc.) • • • .' ' ndeothermal(Heating/Cooling Return) Fri Oth er(explain under#21.Remarks). . .FROM 0 IL 1 00 ft' sand • . - .. • • • • . . . ... • , . • 4.Date Well(s)Completed:•4/10/24 • - Well ID# - • - - . 100- ft.: 325 .ft. .• . . . ' • . . . . . . . . . ft. , .• ft • ' ' 7.7 '• . . 5a.Well Location: . . .• • •• . r:7-7 17..F-7-. ' . . - . ft. • ft. 5 la ok....L..'ft,..„,/ s 1„,,il i • Carl Castoro . . • . . . . . . • . ' Facility/Owner Name - Facility 1138(if applicable) . ft. • ft. . , APR 2 22024 5265 Birchleaf In Claremont,NC . . . - • ft.• • ft: • . . • .. . 'ft. L • trr.,..>::,,,,..•,,.1 : ....0.?,•-:-.1j t.11`4.1 • Physical Address City,and Zip • : • • • • I' • ' - ' • , ' - •' ' f-- ' • ' Fkir.,11 .r, Catawba : ' • . . . • . - . 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: . • . ' • 35.78018 N 81.16079 - . . . • • . • . . W ,T"417S-A /f3t„e_:_ .4/10/24 . . • • . . . . . . . . . . . . of ' 6.Is(are)the well(s)OPermanent . or DiTemporarySignatureCertified Well Contractor . Date .. . . By signing this form,I hereby certifi,that the well(s)was(were)constructed in accordance 7.Is this a repair to an existing well: DYes Or ON° . with'ISA NCAC 02C.0100 or ISA 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 diagrain 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 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: 325 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well For'mUltipk wells list all depths if diffeient(example-3@200'and 2@.100') - Construction to the following: - , . 10.Static water level below top of casing: 40 (ft.)‘ Division of Water Itesourfes,Information Processing Unit, If water level is above casing, "+" • " ' 1617 Mail Service Center,Raleigh,NC 27699-1617 I 11.Borehole diameter: 6__ On.) 24b.For Injection Wells: In addition to sending the form to the address in 24a Rotary above,also submit one copy of this,form within 30 days of completion of well .12.Well construction method: construction to the following: I(i.e.auger,rotary,cable,direct push,etc.) " I ' Division of Water Resources,iUnderground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 . 13a.Yield(gpm) 4 Method of test: bucket 24c.For Water Supply&Injection Wells: In addition to sending the form to the address(es) above, also submit one copy of this form within 30 days of 13b.Disinfection type: HTH - Amount: 160Z completion of well construction fo the county health department of the county where constructed. I i Form GW-i North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016