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Home My WebLink AboutGW1--02654_Well Construction - GW1_20240501 . . Print Form ` WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: • 1.Well Contractor Information: •Ken.Diediker ' -1 I4.WATER ZONES Well Contractor Name FROM ft TO DESCRIPTION : •• ft. n/a (federal employee) • - ft ft : .. NC Well Contractor Certification Number 15.OUTERCASING(for multi-cased wells)OR LINER(if ap Citable) -' US Army Corp of Engineers, Savannah District FROM " • TO DIAMETER THICKNESS MATERIAL ' • ft. •ft. ! in. Company Name 16.INNER CASING OR TUBING (geothermal closed-loop), ' ' 2.Well Construction Permit#: FROM, . TO.. . .DIAMETER . THICKNESS:. MATERIAL :. . ' • List all applicable well-construction permits(i.e.UIC,Counry,'State;Variance;etc.) 0 : ft, 31.1 ft• 2.' • . in. . ,SCH 40' PVC 3.Well Use(check well use): ft. ft. • in, • • ' Water Supply Well:' . 17.SCREEN - FROM TO DIAMETER- SLOT SIZE THICKNESS MATERIAL Agricultural 10Municipal/Pulilic 31.1 it, 41.10ft 2 i.P' 0.010 - SCH 40• : PVC. Geothermal(H.eating/CoolingSupply) DResidential'Water Supply(single) ft, ' ft.. - in, . Industrial/Commercial . . . IDResidential Water Supply.(shared) l i.GROUT ' Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water-Supply Well: ' ' , '. .' .' ' 0" ' .ft• 28.8 ft• Bentonite pouredd tamped pp y an from surface • • .x Monitoring • .®Recovery • • •: ft. . ft. • Injection Well: . Aquifer Recharge 0 Groundwater Remediation fL ft. '19.SAND/GRAVEL PACK(if applicable) ' , ' ' ' Aquifer Storage and Recovery' :El Salinity Barrier. FROM' . ' TO 'MATERIAL EMPLACEMENT METHOD" ' Aquifer Test .- _ID Stonnwaterl3rainage •- 28:8 ft... 41.10 ft• sand poured and tamped-from surface- : - . Experimental Technology . . , . • DSubsidence Control . . ' . ,.ft, ft. . • . Geothermal(Closed Loop) 'ITracer 20:DRILLINGLOG(attach additional'sheets if necessary)• • , Geothermal.(HeatinCool'in _ FROM. TO.. .DESCRIPTION(color,hardness,soil/rock type,.grain size,.etc.) . . g/ g.Return) 'pi Other(explain under#21:Remarks) 0 ft 11 ft. _ .. S . M t • . ' 4.Date Well(s)Completed:02/24./2024 •Well ID#69M1IV6R , 11 •ft. 35 ft- SC, 35' ft• ' 41.1 ft. SF ' 5a.Well Location: -� ~ : .-. Ft. Liberty . ' : . .. : .ft• .- ft. . __- , r_. ;.:. ,r Facility/Owner Name Facility ID#(if applicable) ft ft. Woodruff St. & Glider St., Fort•Liberty,-283.07 ft.. . . ft. . MAY J 1- 262.4 • . Physical Address,•City,and Zip -- . ._ ft. . , ft. . , IfVfC:'6";:ik'.f-,ii1, F•_ S bl Cumberland 21.REMARKS rY' C: r;-1-(:J .- : • County . • . ' Parcel Identification No.(PIN)' • • . .' • 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: . (if wellfieelld,one lat/long is sufficient) QR �+A . . . . . 22.Certification: 35.1555607 N -78.98346 DIEDIKER.KENNETH.D.160' w�1 .w . .. 723584 tgE.p;a:;�a Tgr. . . 04/24/2024 . 6.Is(are)the well(s)1x Permanent or Temporary Signature of Certified Well Contractor f Date ' " B Psi nin this forth,I herebycertifythat the wells was(were)constructed in accordance . . .1..Is this a repair to an existing well:. ' OYes x�or No with 15A NCAC 02C.0100 or IiA NCAC 02C.0200 Well Construction Standards and that a. , .•-`•, '- If this is a:repair,.fdl out known well construction information and explain the nature of the • copy of this record has been prov•ided to lhe'well.owner. I' repair under#21 remarks section or on the back of this form.' . .• • . . 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 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 . . . i. . . . • . - SUBMITTAL INSTRUCTIONS i , 41.10 . • ' 9.-Total well depth below land surface:. • . • .(ft.) 24a:'For All Wells: 'Submit thin form within 30 days of completion of well - - For multiple wells list all depths tf dterent(example-3@200'and 2@I00') construction to the following :. .- 32:8 • " . • • 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:4.25 Di: • �' ( ) 24b.For Iniection Wells. In addition to sending the form to the address'in 24a. •Auger •above,also submit one copy'of this form within 30 days of-completion of well -•• - 12.Well construction method: - •• constriction to the following: • - - (i,e.auger;rotary,cable,direct push,etc.) • g • • • Division of Water Resources,Underground.lnjection Control Program, : FOR WATER SUPPLY WELLS ONLY: . . . . . - 1636 Mail Service Center,Raleigh,NC 276994636 : 13a.Yield(gp•) . : . . Method of test: . . - . . . . 24c. For Water'Supply&luiecti'onl 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: - . Amount: . : • . ' completion of well construction to the county health department of the'county where constructed. - :. . Form OW-1 : North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016