GW1--05548_Well Construction - GW1_20240913

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,,,,y192-Lt CONSTRUCTION RECORD,(GW-11 ' . For Inteinalthn Only:: "_:4-,,,(.'-','..:..,::,.;,--::•_';-,..`-'::-..'.' ..'"--, -'•. , '•• 3:,
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1.Well Contractor Infor illation: ., .
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Well ContractorN e •... -
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NC Well Car/hector CedifidaliiviNambet t 16701:11ER:aXKNOffaliiVirar-aiielarole.LINMir-iiaireT7-:::5.1.'' ' fa-I;
Yadkin Well Company, Inc. PROM.. 'TO . ,DIAMETKR TRIMNESS- .' MKTERIAL t•
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CompanyName . XX61/10/Z1116151BG:ONXIIBMG;(fferraliirm-a1 ilii1i846811):=1-- -VE,":_c7r.c•_,:';'.::„L
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2:Well CnnstractionFermit.#1 _e)1...it etr4,-Z..f.)`4.-ar07. . .. 2 PROM ..TO .. - ularzora . ,Traciate7sn„,... .-tyri.,-prim. . • . ..,
Liza all applieablewlt eons'fritetien peitnitt p.e;WC County State,;Variance etc) ft, ft
ft. ' ft ' ;- .ill- .. -.•-•.. . • .. ,-- ,
3.Well Use(check ivelltse):
a_ __ _ _ _ __ _ — -._ - lZ,-Sekika'::•,..-Z'.:;:5::::--f-,!.:g:ZI:V;..'fi:25::::,'-.-7afIT,r•Z.-:.:Z.:2•'...V.:7.:::::::"Zt_.---------------21:i'.1".-1-.:1
'Water Supply Well: . .PROM . TO:. ..._ DIAMETER SLOT SIZE THICKILERS .MATER1AL
• tlAgrioultural , OMOnicipal/Falilio ft. it.,' bi: .
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EIGeothernial gloatin /Cooling Supply) 103‘sidentialWater Supply(single) ft. ft. in, ; ." ,
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-Ohadustrial/ComnierciA' Water si,„.1,h,(A.,,,,n, •
ijiteSidelitialW"—'''''''''''.----7' V,...liff:Morrri::Z:"?,:;":.::;/_!;C'•%.;4;1!:'CL..;.'.1: -Z7;?.r..7 Z.,:e...'::....
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113ktigation ._. _. _. ._ .. CIW.ells>100;000,CiPD . __ FROM '.TO-, . - . EMPLACE1VIENTMETHOD 8c AMODRT-
,Non,Watex Supplit Welk' - • ..0 /1,1 ft. ! '•;ft Folit. c bi-fr 2'; .' .:'.
ElMonit-ding ORecOvery . _ . . - _,..
Injection Well: - ..
ft ' ft. . ., . . - .
13Acplifer Recharge liGroundiraterRegnecliation
11191:siriblatilk'VEtilikii0(iMstrealle)1-:-''''--•-•"7-1-:•••-..z.: --7-- •,,,...-.4;2,:„1,...0.•',, .
'ClAquifer Storage andlieboyery ElSallitityBehriet ;PROM. ,TO _ MATERIAL 1 . ,ENEPLACEMENTMETECOD••.- : •
ElAcptifer Test CIStomrivateiDfainage , fi. ft. " • -- , . • ..•
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ClExperimental TechnOlogy EISnbsidedide Control , ft. ', ft •
OGeothemial(Closed Leop) .ElTracer ',F.}.201-DRIELINGIBG:(itetidatidittiiiinTeliiitaft.iielliar-II.;6Q7i:aa_z:::1::•-z-r -iT,::,--)u ., •
_odeothmEno.(Heatthwagolitgit , uoother*plaid undoltuRermit4 . 103.9.T.,i 7 ,_.70,_ _, _ DESCRIPTION(color,hirdiaeat Soil/rbik tYp firain size,— dd.)--
Date Well Started. I:77 ., .. ._ '•-: I
MI4 _ 0 ft'. ,,.2_G. ft. . Q or- 4- .,. . ..:,.... „ ,
4:Date Well(s)-ComPleted:ta,-_I .',2 ' ' Well IDff 4__LAdSkR_•_ `_ a IL 41.-. .7,' , . - ft. . • ' ft• - .
2 6, 40 IL DC),'' •
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5i.WellLocatiOtti Phone#: a 56-i 7=7'2Y V"kng'4 ' Z S.4' i't• .10'- 4- , 1,,,,,:_z...--;.•...,:,;.; :.....,:,--,.. '..;.... .
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,f.i. ft' ! t:3 .ft-__ .5.pa.,, . ._ ,-..1,,s,-,...-i:L.:-.',.c..,i;-..,-P::,:f,„'?"-i•.,,-5---„. .:,.
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Facility COirterNanit • Facility Di#ftispplicable) &4 726 ft• cp tk,";4 t- - ,.. ;
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-; -ft.-. ..1'' 'ii,k;:,-.‘•, • - ::•- ;2024-,'v'''•iV.-
, -6 o 4(41,1e_U . I-64e XI./11 114. . ft. • . :"!-;?::-.-•--,:;.-.,-,2':.. : • G.:::...
PhysiCalAdercas,City,and Zip ft. • -i...;..4.-..`, si!..'--,i;i:' ...a,:
County Pared Trle.tiftr.AtIonIslb:(PIN) .- ------- .-•, -
5b.Latitude and longitude in degreeshitin' utes/secoudt-or decimal degrees ' -4'; - ,--,- 7 " • , . '-' " ' - - ''';- ' ;..,';:,,),,,,,_.. _ ,
(If well held,one latilonginiaffitiont) tt all/teeth:1n: , ' ,„ - ,•. • •J '
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of. "...d......&Contractor ',' ..Date • „.'• -':..,;-;•...'• •••
6.,Is(axe)the well(s) Werilla---nent' or' CiremitiOrfity•
krOviii..thireby eio-0 that the well(s)was(were)conitruetedineecordaOcO'wfitii-;:.
7.,113 tiiis a repair*At auHA:big went, tlYes or 1111o. 15.1iN • 02a.0100 or ISA IICIC 02C.0200 Well Construcilon Skaulfirds Ood,gifit a cop.V;-..'•-.
this tea reablfal out blown well construction information and evieriirthemitur„ithe, eats reconthas beeoprovIded to the well otveer.
repair wider#.21 retired section or on the back ofthie form. 15.Site diagram or addititniatlivell details: •.• '')-;:------7,',,,,:.,:.:,y,':: .
You may ose.the,back of this page to provide addifitinaL well p5: sliation info
8.For deoprohe/DFT or doted-Loop;Geothennal Wells Miring the same
constriction,onlY 1 G'W-1 it needed:ludidate TOTAL NUMBER oftvells (add Tee Ovef in Re:narks Box).Youmay also atbieliarldial Pagenif necessary.
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drilled: - __--__ I_. _._ --1- 0. 24 SUBIVRIVAI.,INSTAtleTIONS: • .1.,.. .
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• 9.Totslweit depaili_eleiviand stelAce:. _. . —-_ _. _ _ __. _(ft)' &lb:nit-this 0;44 twain 30 days dwell compioon.peclh,e. foilacrin.
.For multiple Welk list clack,'the ydijjhrent,(exionple-3®200,'tokl2gil00):
10.,Static waterIerelb dint top of easing: # 5 i , 24a: For Al Wells: Original form to Divigion',Of Water Rdsourca';(D*), '. ...
' ---- - --44 Inforiatition Processing Unit,,1617,MSC,Raleiglt,$p'27099'4617, i•-e---- '
If water level is above casing use"+" .
20:For littection:Well8:Copy to DWR,Uridertroundinjectien,Contiol(ItIC)
It Borehole diameter: . . - (1%).-1..-..•".'..,.__,_.._!_. :-___L__, . ,
MD riff 6 (..)s 5-
17rogranl,,I636'MSC,Releigh,14e27.699-1636. . •- -,•,:7-....:-,;::: -."':-..". -:. -•••.; c.4
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12:Well construclioit inelhod:._At.,_g. L _ —_ry . __ ----_ 24c:For Water Supply and Open-Loop Geotlini'Mnlieturri-i-Wella:.6OPY,&the Vqj
(i.e.anger,natary,cable,direct push,etc.) bonnty environmental health department of the county•ivjaara installed••---'' ,••:-.'••• ' 11
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FOR WATER SUFFLYWKLLS ONLY: • ,24d.,lior Water'Wells produChift over 100000 GFtipylo DWR.;CCPCUA ,- t•--._
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15a,Yield(gpm) _._ Method of test _-__ - --- --
_3 .PerriiitProgtani,1611 MSC,Redc184.Np 2799,1013.,,,:-,--1;-;,...,. ..z.. .,)
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70% hth. 2 g. oz Date Site Visited:_7.•_,T 0_,f--.1.•Y',.,- .:'.,:;;::,,,,,-.- .:-.
•13b:Disinfection type Amount: _ _ - -_ • ,Site Visited By b 4s.!--i•-•,;.z. •.:,_!,.,,,,:t..4";. '
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Form GW--1- . North Carolina Department of Environmental Quality-Division of Water Resources:'' ,;.;;:-..Y,,-..,7,,,''';' -: Revised 6-6-2018 ..;
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