GW1--06645_Well Construction - GW1_20241108

II
WELL CONSTRUCTION RECORD (GW-11 ' For Internal Use Only:
1.Well Contractor Information:
i ;
Markus MacNamara . 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
ft. ft.
4646-B ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Redox Tech LLC FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. • in,
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop) -
2.Well Construction Permit#: WI0501096 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. in.
Water Supply Well: 17.SCREEN •
PP Y FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
DAgricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18,GROUT
❑Irrigation ❑Wells>100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
❑Monitoring ❑Recovery ft. ft.
- - Injcetiou Wcll:--- -- - - - -- - - - - - -- -- .- ft. ft. -
❑ __ -
I Aquifer Recharge IJGroundwater Remediation '
19.SAND/GRAVEL PACK(if applicable)
DAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft. ft.
•
•
❑Experimental Technology ❑Subsidence Control ft. ft. '
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0 ft• 1.5 ft• organic rich soil
4.Date Well(s)Completed: 10/14/2024-10/29/2024 Well ID# DPT01-DPT27 1.5 ft• 10 ft• Red Clay
5a.Well Location: 10 ft* 30 ft• white sand and grgyel ^ <--, -,- ti _
?.ft ft. 4 C.w.,... ...„,,, -::< fir' r-'•a,F
Johnston County Industries INC 14048016 30 Clay '
Facility/Owner Name Facility ID#(if applicable) ft. ft. N O V 0 82014
1100 E Preston St, Selma, 27576 ft. ft.
Physical Address,City,and Zip ft. ft. 0" "" '"`'' ;,: ,"'� >'� �'i.''i l.'1 t'i'
Johnston 261410-26-7907 21•REMARKS
County Parcel Identification No.(PIN) Refusal at-30'for each well.Geoprobe 6610DT 1.5"tooling
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: •
(if well field,one lat/long is sufficient) 22.Certification:
35.52480 N -78.28409 W Markus Rudi MacNamaraiDig"ally alOned by Markus Rudi MacNamara
Dale:2024.11.0411:28:30.0500 1 1/4/2024
6.Is(are)the well(s): OPermanent or In Temporary Signature of Certified Well Contractor; Date
By signing thisform,I hereby certify thbtthe well(s)was(were)constructed in accordance with -
7.Is this a repair to an existing well: ❑Yes or nNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the 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 construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).you may also attach additional pages if necessary.
drilled:27 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 27@301 (ft.)
For multiple wells list all depths ifdifferent(example-3@200'and 2@100') Submit this GW-1 within 30 days of well completion per the following:
Unknown 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft') Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing,use"+"
24b.For Injection Wells: Copy to.DWR,Underground Injection Control(IUC)
11.Borehole diameter: 1.5 (in.) Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Direct Push 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: • Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resourcies Revised 6-6-2018