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Home My WebLink AboutGW1--02657_Well Construction - GW1_20240501 WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: . • ; - I 1,Well Contractor Information:. . . : • Ke.n Diediker.. _ . "e14:WATER ZONES --` - : `r .' FROM TO DESCRIPTION . . . . . . -. Well Contractor Name . . ft. ft. . n/a (federal employee) ft: ft. NC Well Contractor Certification Number +,15.OUTER CASING(for multi-cas I iwel(s)OR LINER(if ap licable) US Army•C.orp.of Engineers, Savannah-District FROM TO DIAMETER THICKNESS MATERIAL ft ft f 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,County,State,Variance;etc.) . • 0 .ft 22.1 ft-...2 in, .SCH 40- PVC- . 3.Well Use(check well use): Water Supply Well: . . 17.SCREEN FROM . TO. --DIAMETER SLOT SIZE. THICKNESS- MATERIAL.•. IllAgricultural DMunicipal/Public ft. ft. ii{. . 22.1:.. 32.1 2. . 0.010 . SCH 40 . PVC: . . Geothermal(Heating/Cooling Supply) .DResidential Water Supply(single) ft. ft. : • -in. . Industrial/Commercial DResidential Water Supply(shared) 18,GROUT _` - ..• (Irrigation•. .• " . .FROM . - TO . . MATERIAL . EMPLACEMENT.METHOD&AMOUNT. . . .Non-Water Supply Well; • .. 0. . •ft• 22.1 ft _Bentpnite. poured and tamped from surface • xDMonitoring. : ' . 0Recovery • . .: ' • .:- ft. ft. : -Injection Well: - . 'DAquifer Recharge . • . - Groundwater Remediation t ft f • . DBAquifer Storage and Recovery [0Salinity Barrier:, FR SAND/GRAVEL, TOPAC. .MATERIALif e). ,. EMPLACEMENT METHOD . . • ft Aquifer Test DiStotinwater Drainage_ . ."• 2Q.1 ft, 32.1 : sand ; - - poured and.tarnped from surface - Experimental Technology ' _OSubsidence Control . . - ft. - .ft. . -• Geothermal(Closed Loop) - (Tracer 20.DRILLING LOG(attach additional sheets if necessary) Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks). FROM TO DESCRIPTION(color,hardness,soil/rock type grain size,etc.) • p ft.. - 09 ft- -SM • 4.:Date Well(s)Completes:02/24/2024 Well ID#69MW19DR 09 ft. 12 ft. SC • • - • 5a.Well Location: - -' 12 ft, 20 •ft: CL + - - Ft. Liberty . . . - 20 . . ft, .32 ft.. SP-.SM .. ...: ft. ft. +.�I P• t �t . . Facility/Owner Name Facility ID#(if applicable) , h"r "Woodruff-St & Glider St., Fort Liberty;.28307 ft:_ ft. KAY ki--.1' 202,i - Physical Addiess;'City,and Zip ft. ft. . . Cumberland , . . E , _. .i 21•R MARKS- Ifr`v ti i� :f b } it ;}C:ill G County ' . Parcel Identification No.(PIN) 1 `t }�_r}1�� . . i . . 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: . . . . . . .,. , . • . .. . . • (if wellfield,el one lat/long is sufficient) . . .• QQ�1 GC ..� . 22.'Certification: - . ' ' • • • - 35,157774 •N -78.98'1559 w DIEDIKER.KENNETH.D.160l ��aw o rs • . . . _ _ : ._ - . '7235984 froii � ,of 04/24/2024 - . . .6.Is(are)the well(s)Jx Permanent. or.JTemporary 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: ' ([ Yes . or EiNo,' with- 5A NCAC 02C.0100 or 13A NCAC 02C.0200 Well Construction Standards and that a ' .If this is a repair,fill out known well construction information andexplain 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 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 mayalsoattach additional pages if necessary. drilled: .• SUBMITTAL INSTRUCTIONS; ' 32.1 9.Total well depth below land surface: (ft.) 24a. For All Wells: Submit this form within 30.days of completion of well. . . For multiple wells list all depths if different rexample-3@200'and 2@I00) . . . 1 ? - construction to the following: • • 10.Static water level below top of casing: - 9'58 - - . • (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 :.(in.) • • ' 24b.For Iniection Wells:' 'In addition to sending the form to the address in 24a . ' - Auger above; also submit one copy-of diis'form within.30 days of.completion of well; . - •12.Well construction method: • . construction to the following: , •' : - (i.e.auger,rotary,-cable,direct push,etc.) . . - • Division of Water Resources,Undergroundlnjection Control Program, FOR WATER SUPPLY-WELLS ONLY:- .. . 1636 Mail.Service Center,Raleigh,NC 27699 1636 . • .13a.Yield(gpm), Method of test: 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:' • • Amount: • completion of well construction to the county health department of the county • .. where constructed. I Form.GW-1 North Carolina Department of Environmental Quality.-Division of Water Resources Revised 2-22-2016 .