The URL can be used to link to this page

Home My WebLink AboutGW1--06992_Well Construction - GW1_20241119 • 'WELL CONSTRUCTION RECORD (GW-11 - For Internal Use Only: 1.Well Contractor Info tma'ot 0 /�/� ��y' ro 3c/)( Lt ilto a6 (A a r s /-,,„'WA.TE `Z....:..;;i - .•i i•'.(= '. .. • . ,... . ✓FROM TO DESCRIPTION Well Contractor N 4 S 6 6 A • ft. 10& :: ft �h .6 ft NC Well Contractor Certification Number ' ,OD, TEIZ;rG-1ASILVG'(foimiilli asdd'# '`:ORF2liEIt;(ifap`7icalile)-`•..'isi:i.:. . .. E . - Yadkin Well Company, Inc. FROM TO D THICKNESS MATERIAL 4/ I ft. 8aft. (.min- cop,-2( p VCR Company Name CP `•16= ;CASING'ORU'U,8ING-(geotlieimalela'seTlo"ir - ">`' '.'::i'__ .. 2.Well Construction Permit#: O°2.O Sp a 2. -�24- •FROM TO . DIAMETER THICKNESS l, MATERIAL List all applicable well construction permits(i.e.UIC,County,State,Variance,eta) ft. ft. in. 3.Well Use(check well use): Ski 9-- • 905 ft ft in. M_,_, Water Supply Well: i"al CRF 7: .i...ems' .."_'_r'....<.... •?�.=4-.ez",.:'_.. • ';__,,};ta'.ad PP Y FROM TO DIAMETER . SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑�MunicipalPublic ft ft in. ❑Geothermal(Heating/Cooling Supply) rsesidential Water Supply(single) ft ft in. ❑Industrial/Commercial'. :7. - .> '.oResidential Water Supply(shared) O- ,. ,, _.__..,`:.:.,, ❑Iuigation 5 ^_ "' '.r' ❑Wells>100,000 GPD FROM TO ,�TI•RTAT• CEMENT METHOD&AMOUNT Nov Non-Water Supply Well: 1 9, 2024 C ft._ 2 ft f �_tL. ,4S g� a` t p ❑Monitoring ❑Recovery ft ft , �' Injection Well: • - -7-, ...•: ft. ft. ❑Aquifer Recharge 'r''" .DGroundwater Remediation • g t'19:SAND/GRA:v.e. 1bitgtil L"licali]e) .:a - r;;:-.�;.-: i1.: ,5: :: �'?; . ❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD . . • ❑Aquifer Test ❑StormwaterDrainage ft. • ft. , ❑Experimental Technology . ❑Subsidence Control ft.. ft • ❑Geothermal(Closed Loop) ❑Tracer ;20.'DRI]CIaNG-I;OG'(a'track'fi2ditianitslieetififadad'sary)1:.':;: f:=.M9;4: 1 ❑Geothermal(Heating/CoolingRetnm) ❑Other(explainunder#21Remarks) FROM TO DESCRIPTION(color,hardness,scillrocktype grain she,ens.) -Date Well Started •--". - . A �q - - • --D I v -. CLG,,/ .-- -.- . - - 4.Date Well(s)Completed: I0`(j-1 al Well ID# AC4 370 1 L ft 66. ft n,-'1,.- - 5a.Well.Location: . Phone#:eG).4 t 3Y•- SJ412 6 ` ft 70 ft . ( rl J 'p Lucas. CLA vee GA' 7( ft 0 0 ft /c--0,A0 Pt- Facility/OwaerName Facility ID#(if applicable) q I ft. 36'a.ft rani k . qi- 479 3 2' Ylt/ 6i,± (ri6� kh Ay,Al d.J/11 e. ft. ft ` Physical Address,City,and Zip . • S ft. ft (VJU r (d1� :!7.1. 2E141±alr.C..,.,Act' >ol i rv,•`• :?y',:4I;_4..halls r._... :n..a•;;_:tg"a,l',.:;,� County Parcel IdentificationNo.(PIN) M - ry . 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one let/long is sufficient) 22.' •l�'cation j ib' • 3C, %l//.51 • N $i�,. -71Cr . . . w . i J Al, 1. ,_e ,I,� ro 1 f 2u\ 6.Is(are)the well(s): Weermanent or OTemporary Si eo ell Contractor •ate �� By signing thisf• n,I hereby cert fy that the well(s)was(w• constructed in accordance with 7.Is this a repair to an existing well: DYes or 1,fl o 1SA NCAC 02' .0100 or I5A 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 reinarlr section or on the bock 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 G,W-1 is needed. Indiratr TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary. drilled 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 1 ( ) (ft) Submit this GW-1 within 30 days of well completion per the following: For multiple wells list all depths ifdifferent(example-3(g200'and 2@100) 1 24a. For All Wells: Original form to Division of Water Resources (DWR), 10.Static water level below tap of casing: ( 0 (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 Ifwater level is above casing use"+" °� 11.Borehole diameter: C (m,)Bit Off: S`i /0 24b•For Injection'Wells:Copy to DWR,Underground Injection Control(IUC) Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: Air t' e 1.P, 24c.For Water Supply and Open-Loop Geothermal.Return Wells:Copy to the 3 (i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed FOR WATER SUPPL 'WELLS ONLY: • 24d.For Water Wells producing'over 100,000 GPD: Copy to DWR,CCPCUA cri r Permit Program, MSC,Raleigh,NC 27699-1611 13a.Yield(gpm) • Method of test: o / Date Site Visited: g- 8--:72, V , 13b.Disinfection type: 70 Io hth Amount: ( 4 OZ Site Visited By: O: 3' 1 i Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018 Price: p?A ,' 1'- "viz.