HomeMy WebLinkAboutWELL-03-2022-167724.TIF WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Russell Well Drilling, Inc. 14.WATER ZONES
WcHC'ontroctorNarne FROM I TO DESCRIPTION
3254 A 80 ft. .225 rt-
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap llcable)
Russell Well Drilling, Inc. FROM 1 TO DIAMETER THICKNESS MATERIAL
0 ft. 85 ft. 6.25 SDR21 PVC
Company Name
RB P R-02-2022-39984 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM 1 lt) DIAMETER THICKNESS MATERIAL __
List all applicable well construction permits ii.e. U/C.County.State.Variance.etc) ft. ft. In.
i
3.Well Use(check well use): n. i I't. In.
Water Supply Well: I?.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Ags culturtl ❑MunicipalPublic ft, ft. in.
❑Geothermal(lleatin /Coolin Supply) C3Rcsidential Water Supply(single)
ft. ft, in.
CJlndustrial/Commercial ❑Residential Water Supply(shared) ix.GROUT
Irrigation ILI Wells> 100,000 GPI) FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 20 ft. Grout Poured
❑Mort itoring ❑Recovery fl. ft.
Injection Well:
rt. ft.
❑Aquifer Recharge ❑Groundwater Rentediation
19.SAND/GRAVEL PACK(If applicable)
flAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test CiStotmwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control I't. ft.
['Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOX:(attach additional sheets if necessary)
FROM TO DF.SCRIPTION(color,hardness,soillrock type,grain sloe,ere.)
❑Geothermal(I leafing/Cooling Return) ❑Other(explain under i/21 Remarks)
0 it' 80 t. Dirt
4.Date Well(s)Completed: 6-14-2022 well wa 80 ft. 225 ft Rock
ft. ft.
5n.Well Location;
Mark Dellinger D&E Properties rt. ft.
Facility/Owner Name Facility(DP(ifapplicable) (I• ft.
3470 Storybrook Ln, Sherrills Ford, NC 28673 ft. ft.
ft. rt.
Physical Address City,and Zip
Catawba 21.REMARKS
County Parcel identification No.(PIN)
5h.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,nue lat/long is sufficient) 22.Certification:
35'59,954' N 081 .04.856' W 7/13/2022
6.is(are)the well(s): COPermanent or O1'em ors Si attire ofCcnitle Well Contr,� Date
P ry
Rt'signing obit form.1 hereby cerl Ji'that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yet or inNo 15A NCAC 02C.0100 or/5A NCAC 02C.0200 Well Construction Standards and that a copy
If this Ls a repair.lilt out known'veil construction infix-motion and explain the nature of the of MO record has been provided to the well owner.
repair under t12/remarks section or on the buck of this farm.
23.Site diagram or additional well details:
8.For Geoprohe/l)PT or Closed-Loop Geothermal Wells having the same You may use the hack of this page to provide additional well construction info
construction,only I GW-I is needed. Indicate 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: 225 (ft.) Submit this GW-1 within 30 days of well completionper the following:
Fur multiple wills list all depths ifdii different(example-3Ca;'200,and 2@1O0') Y 1
80 24a. For All Wells: Original fool to Division of Water Resources (DWR),
1(I.Static water level below top of casing: 80
information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
If water level Sr above casing.use"1-"
24b. For Injection Wells:Copy to DWR, Underground Injection Control(1UC)
11.Borehole diameter: 6.25 (in.)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Air Drilled
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.Fur Water Wells producing over 100,000 GPD: Copy to DWR.CCPCUA
25 Air Drilled Permit Program, 1611 MSC,Raleigh,NC 27699-1 61 1
13a,Yield(gpm) LJ u Method of test:___ _
13b.Disinfection hype: HTH Amount: 1/2 Cup
Form G\L-I North Carolina Department of Environmental Quality-Division of Water Resources Revised(1-6 201k
Analytical Results r, STATESVILLE
ANALYTICAL
Catawba County Public Health
PO Box 389
Newton, NC 28658
Receive Date: 11/08/2022
Reported: 11/10/2022
For: D & E Properties LLC 3470 Storybrook Lane Sherrills
Ford NC
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
221108-28-01 Nitrate 03-2022-167724 <1 mg/L 353.2 11/09/2022 CL
221108-28-01 Nitrite 03-2022-167724 <0.1 mg/L 353.2 11/09/2022 CL
Respectfully submitted,
yl a2.J. 2
Melissa Myers v
NC Cert#440,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
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122 Court Sttcel Statesville,NC 26677
704-872-4697 mFja;g og
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NITRATE/NITRITE ANALYSIS
County:_Catawba
WATER SYSTEM II)EI: 3 -�r3 .L J^ __
Name of Water System:,,.__1?,...±_ ._
Sample Sam e T CI Entry Point Spteial^Not tomplianet
�yr�
Location Where Cotleeted:,... �fSL_....-- r
Fad lity ID No.i7 4..._ a w«
Sample Point:r''••t,. 4.1,,� 11. • Oin Tim ectbe
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Collected By: _ ll Fie (`r„ ,��,."',�._. - ar.ar
row nm
Mail Results to(water system representative): S28)465-8270
I CATAW BA COUNTY PUBLIC HEALTH now tr: ( 46..
_r...._,__. (828)485.8278
1 ENVIRONMENTAL HEALTH Fas H _(8 _,_— _ —
a.paPWie Perna l emu:
PO BOX 3- _._.--.—_.___�.•_-..........---- EHAdtnin@atawbecowttYna•8ov -._.
NEWTON,NC 28658
a
I.AJORATORY II)if: 37755 0 SAMPLE UNSATISFACTORY CJ RESAMPLE REQUIRED
3"" REt2l11RED woe. (1t)AN7tFitiD .LL(rWAHLF.
CCr.`Ttt.+t xf'_TtMKt ItElt)(ROL shirt Na<RRt.I It0YUCTS• LIMIT
C-Utx CgprTAMihAtrl CODE iRRl IX) -, ..-{
1040 Nitrate
r7yL 10.00 mt 1.
1041 Nitrite ss3 7 0.1U mgfi _..-....-._._ `n„,,. -.==1
weeds olio analytical molts to the State on day test completed
•Note:If result extteds allowable limit,the Gthorxtaty must fax attalYt
.t
DATE: TIME: //��
ANALYSES BEGUN: l I.7 Oil�7 22 ! — �.PM.
i
t ANALYSES COMPLETED: L l 1_wow1 z -....�:��, �M
y a,.^.P..: 3whM.Mq_.
Laboratory Log.It 21 .. 4 .tk µ_ <:erliOed Br:___"'-'_..'_".-{,.-. -_..........._....._......_.m..... .....__.._
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• :o0 ! tt4L: .fl61 ni NCB)1644^t6t4
p ..v.u....u w.,-l...:...•A..-..II,.FM,.1614 MU.S.r,1 Cesar,RaMWs►
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PO Box 228 • Statesville, NC 28687 • 704/872/4697
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