The URL can be used to link to this page

Home My WebLink AboutGW1--05602_Well Construction - GW1_20240916 Print Form WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: r- ie Well Contractor Information: I Lloyd Mares 14.WATERZONES . I Well Contractor Name FROM TO DESCRIPTION ft. ft. 2547-A ft. ft. NC Well Contractor Certification Number Inc15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable) Register Well Co., n FROM TO DIAMETER THICKNESS MATERIAL 0 ft. 149 ft. 4 " in. 40 pvc 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.) ft. ft. in. 3.Well Use(check well use): ft. ft. 1 in. 17.SCRE N Water Supply Well: FROM E TO DIAMETER SLOT SIZE THICKNESS MATERIAL ri Agricultural DMunicipal/Public 149 ft- 169 ft. 4 in; 1.016 pvc P Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ft. ft. in' i-`I Industrial/Commercial .I Residential Water Supply(shared) 18.GROUT ig I Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT ' Non-Water Supply Well: 0 ft. 20 it hole plug pour _ NI Monitoring 0Recovery - ft. ft. Injection Well: • ' ft. ft. ®I Aquifer Recharge D Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable) *I Aquifer Storage and Recovery D Salinity Barrier FROM TO , MATERIAL EMPLACEMENT METHOD ®I Aquifer Test DStormwater Drainage 149 ft 170 ft #2 gravel pour ®Experimental Technology [I Subsidence Control ft. ft. $I Geothermal(Closed Loop) 0Tracer 20.DRILLING LOG(attach additional sheets if necessary) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.) ®Geothermal(Heating/Cooling Return) I Other(explain under 421 Remarks) 0 fL 33 ft: sand Clay layers 4.Date Well(s)Completed:08/26I24 • Well ID# 33 It , 60 ft. clay,.: . . . 5a.WeIl,Location: 60 . ft. 61 ,ft. rock Soft-10" 1 > "s" , ' Riverlanding Bldrs ' . 61 _ft- 77„_ ft• . clay "['- `-•"''i.. .1 Facility/Owner Name • • ' Facility ID#(if applicable) 77 ft. 84 ft.• sand' S EP 1. t!D 7 ',, 112 Forsythia.Ct Wallace NC 28466 84 ft. 86 ft• rock 2 ll-st..,, `��4 Physical Address,City,and Zip86 ft. 101' ft- sand;medium . �5+Fw.y ,:'0, Ys ty, 44.^��. _. Duplin 21.REMARKS avty 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: 34.740658 N -77.934706 W 1--L13 7 4 09/11/24 6.Is(are)the well(s)MI Permanent or DTemporary Signature of C ied Well Contractor Date By signing this form,I hereby certifr that the well(s)was(were)constructed in accordance 7.Is this a repair to an existing well: IYes or ONo - with 15A NCAC 02C.0100 or 15A 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 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: SUBMITTAL INSTRUCTIONS I 9.Total well depth below land surface: 169 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths ifdii different(example-3@200'and 2@100') construction to the following: 10.Static water level below top of casing:21 (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:6 3/4 (in.) . 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.e.auger,rotary,cable,direct push,etc.) . I - Division of Water Resources,Underground Injection Control Program, _ FOR WATER.SUPPLY WELLS ONLY: . 1636 Mail Service-Center,Raleigh,NC 27699-1636 13a.Yield(gpm) 50 . .Method of test:air 24c. For Water Supply&Iniecti1 niWells: 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: 8 OZ completion of well construction td the county health department of the county where constructed. Form GW-1 North Carolina Department ofE vironmental Quarty;Division of Water Resources I Revised 2-22-2016 I -' • ' '77,-._ '.7,-:::-.. ,--2,-1;, - ; r•---,-- . 4:\ , . 74 I : '' CUSTOMER: ir it, i , ADDRESS: 7/4— ::;fi'-13r.,:i'U*A r 6, (-7 1:THICKNESS FORMATION THICKNESS FORMATION FROM TO (CLAY,SAND.ROCK.ETC.) FROM TO -- i: (CLAY. SAND,ROCK.ETC.) 33 - , . .z0 _--.33. i . , . . . . _ . ..., . ,'''''' ' 464, • `,6 I rir L -- . 7-- ' ' . ,• . . ... 94: 77 ,,,,,-.,,- : :4 1 , : ..„.- - ,.. .r.(7 f 01 -,' te - - e -. ,, ,, , .. ,.. :y, „., , ','1,:bit:::11:',,44el'-,'‘4-',ki.,,iiit,:',"te7:k:14-- ,be..,oeinf irtrie.' '''''''''. '. i---. .,.„1: , - , , ,,, , _,,,--,.:-„,"-,:,-, ..-)kr.'- ./H- - ! I iiVit tivrst, wfts.,-...-;--44y ,-;,/ -Avel.;i; t. i l‘ , i ! . .. .-A4 :: ,, ,,,,,t--;. -,., . ,,. . 4;1_L,-• -„, „,....„ -4.-,,,,,,,,,,,:.-- ... ...,...,„, 1, , ,-; ,, ,4,,, J...,„...,,,,,., .- .-. - . . ,.. ,.„,,..,..iz,..,-,.. ...,.-„, ,,,,:›ce , .....,,,-„,,,,c,,,-„......;..r „...„,.....,,,,..%,.:.. .... .., , . lior: - . st7t) ..Lq...ot, . . , .,- 4,' 11 .0,:-'' rn.-:,:t ;./.- .. , 1.„,,,.. .. 1:It ' I tt .. ., i:: ' , ..,_. , . , ',,,,,...,-,, : „ k '.. I( I . -''''. .-: -