HomeMy WebLinkAboutWELL-01-2023-188007.TIF nal WPDT Report
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Area of Interest (A01) Information
Area : 3,134,508.72 ft2
Jan 30 2023 15:44:29 Eastern Standard Time
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r 17.,S;slerr Roads — One.State Agency Route 0 0, :;.2 .:7 4 km
Fedeca Route — SeCOndary Route
Non-System Primary Roads
Otter System Roads Interstate
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— NC Route
7971 Tradewinds Dr Sherrills Ford NC
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Sep 11 23,02:11 p p.2
WELL CONSTRUCTION `WP -) "))-1f 79)l
RECORD(GW-1) For InfernEl Use Only:
1.Well Contractor information:
Kyle C. Shaw 14.WATER ZONES
FROM TO I DESCRIPTION
tvdl Contractor Name •
4521-A . (160 ft. 6,5 ft V asi3 t'2
ft ft. �.
NC Well Coa>actor Catifi�don?�Tum6c 15.otTrERCASING(fur multi-eased wills OR LINER Vag liteWie) J
Advanced Well Drilling, LLC FROM _ To , DIAMETER i-iiicavrss MATERIAL
0 rt. 445 n 6 Ln• Heavy J PVC
Company Name 16.INNER CASING OR TIMING(geothermal elJsed-Ioep)
2.Well Conshvcttott Permit N: ( 1(-3 1-201;13'i ec.3c2 7 FROM I TO DIAMETER THTCs S.S f MATERIAL
Lirr all applicable wen ccuurnicr'ca pennies ilia L7C.Courtn-,Sure.t?antic etc) l R. (L in.
3.Well Use(cheek well use): ft. I t la
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE I THICKNESS , MATERIAL
❑Agricultural D.MunicipaliPublic -
n ft in.
❑Geothermal(Heating/Cooling Supply) EIResidential Water Supply(single) n. n • In_
I
C]Industrial/Coinnrercial DResidential Water Supply(shared) 18_ ur
❑hsistatian DWells>lO100D GPD FROM TO MATERIAL EMPLACEMENT METHOD&AAIOU-r
Non-Water Supply Well: 0 ft tie)1(2 ft' Bentonite Poured
❑Matitoringg ❑Rac nove I ft. re.
Injection Welt:
CL4quiferRedtarue 17CrrouadnaterRemrxlialion 119.SkND/GRAVEL PACK(if applicable)
❑Aquifer Storage end Recovery ❑Salinity Barrier ' FRO NI TO MATERIAL EMPLACEMENT T METHOD
°Aquifer Test O mm StoaterDrainage ft ft
C]Eaperimental Technology ❑Subsidence Control R- ft-
❑C3eoiltermal(Closed Loop) 0Tracer 20.DRI.LLlicG LOG(attach additionol sheers If necessary)
FROM TO DESCRIPTION(cobr,�s esiealtrvtklrpr.ersinshe.etc)
OGeothetmal(Heatire'Cooling Return)) DOther(ehplain under C21 Remnarks) ✓ rt e it. j l/( 1,
ii"
4.Date Wells Completed: -2-7---16-1- Well ft • ft. 24"
''
5a.Well Location: i SJ R. 4_/�
�-c; r,r 8C SuSn g1 4�8 ft ,t7
R ;��t . t
Facility) Vr) kame ��ppFaccility ID.(i7�plicablei rt- SO ft' A24-, f('-rv. !�,._
`?c �t j _ro. L I(,r2-4 t7- 7h t-�t(� r AJ( / rt ‘° 4-i` f`e / �lrl T'- -
Physical Address,City,and Zip G0 ft( (..�5t I 0 C ,c?e j-
6 . 10. 21.REMARKS .
( -
Cotmty Paco!IcicnIitica1ion No. TIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,ore lzt/long is sufficient) 22.Certification:
;,C 6 e 5C N '0-9 ›Y w, rj
6.Is(arc)the iTdll(s): t`iPcrxrw Poran nent or Clem S>En of Ccnified Well Contractor Date
Brstgnfng tiilsjarat I hereby cemfp titar the.tents)1iur(were)consrruered in accordance frith
7.Is Ihls a repair to an existing well: ❑lies or !No 134.VC.-IC 02C.0100 or 134l ClC 02C.0200 Wail Construction Srareardr and that a cop,
Ifthls is a repair.fill otti blown cc!!oaurrocti ,i it*ornwriott and explain the nature oldie clans record has been provided to the well a.,in
1 epair Polder#21 remarks'section or out ate bad dulls fornc 23.She diagram or additional well details:
1
8.For Geopr•obclDPT or Closed-Loop Geothermal Wells having the same au may use the back oft this page to provide additional well construction info
construction,only 1 Guy 1 is needed. Indicate TOTAL vZ11IBER ofinelts (add See Over in Ronrtks BON).You may also attach additional pages if necessary.
drink:
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land smfuce: 6 C/6 (if)
For earl tpie wells list ell depths ifd ffcrerrr(example-/ 207' Ord 2 a1001 Submit this GR'-1 within 30 days of well completion per the following:
10.Statielsaterlevelbelawtopofcasing; l�/% ( ) ltrtr21a. For AB Weihe Original form to Division of Water Resources (DWR).
tinnier level is above easing.nee..y" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
IL Borehole diameter: 6 (in.) 24b.For Infection Wells: Copy to DWR,Underground Injection Control (1UC)
Program,3636 MSC,Raleigh,NC 27599-1636
12.Well eonstructlon method: 'j f 4\ry 24c-For Water SUODIv and Open-Loop Geothermal Return Wells:Copy-to the
(i.e.auger,rotary,cable,direct push.etc)
count'environmental health department ofthe county there installed
FOR WATER SUPPLY WELLS ONT,Y: 24d For Water Wells prude ' over 100,000 GPD:Copyto DWR,C�CGA
Air Permit Program,1611 MSC,Ral�gb,1C27699-1 6 1 1
13a.Yield(gpm) ?o M Method of test:_
Lit.1?fslnfectiontcpe HTH Airnottnt://.ram
-c:- iv-i Yeah.Carolina Department of Environmental Quality-Division.of Water Resources Re.iscd.--_-,: