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Home My WebLink AboutGW1--07402_Well Construction - GW1_20231117 . WELL CONSTRUCTION IBIECORD.(GW-1) . For Internal Use Only:.- • •• • I.Well Contractor Information: • Chris' Cing 34.WATER ZONES::. . I . V1'ell Cellist ctor Name: -• "FROM TO ' -DESCRIPTION • • • .• • NC Niell ontractor Ccrtiflcat,onNumber' ::1S.OUTER CASING(for mu1H-cased wells)OR LINER(if ap licable)C • : Aqua rill, Inc. ' • . .: • : • • ��7 FROM TO '' •DIAMETER- 'THICKNESS• ' MATERIAL • • Compa��' lame. . 16.INNER'CASING OR TUBING(¢eothermaldosedloop)-. , ' 2.Well aonsti•uctionPermit#i)•3 -.CS6' 6..)!Vi(IZ-OCI.3OI , -FROM TO • • •. DIAMETER . THICKNESS ' MATERIAL' .Gisuhll ao !ic•oLk'hell causjrucnon'pernhits(i.e.UIC;Counry;.Stale Varinhice:etc.)• 'ff.. • dt. in. 3.Well se(chectt well use). • . . • .. , .. .' .. . • :- - ' ft. ft is ' Water S'pply Well: . . . . . •. . : .• A , MATERIAL . . A 17 SCREEN - " - • FROM .TO... DIAMETER 'SLOT SIZE- THICKNESS fATERI L ' Agnew.arai. • . . . '.. OMunicipal/Public -- . • ' Geothe r-al(Heating/Cooling Supply) K1,i Residential Water SupplY(single) - •-. -ft. -,ft.: ' in. ' • • 7ndustr ai+Commercial QIRcsidential Water Supply(shared) irrieat=m ' ' -- ' - " • FROM : TO MATERIAL •EMPLACEMENT METHOD&AMOUNT- 1Con-W er.h Supply Well:- it.:,/d ft. r1_ ,4-, : /iZvC/C- • .. . Rccovc ft.' . .. . •'.it. Monita ma � rY - • .. . . '.. .. injectlo Well . , t)Agaife Recharge . • - ' GroundwaterRemediation . • " -ft. ft: ' : - 19 SANDlGRAVELPACKfd'app7icallc) - ' Aquife Storage and Recovery LlSalinity Barrier • " . - FROM•.• ' TO. ' ' - -MATERIAL " EMPLACEMENT METHOD• ' Aquife Test• .: - ' . DStormwater Drainage. . - ' ' • - Etcperi•rental Technology•" : • . QSubsidence Control ' - • ', ft.- ' $: '•- . - '' - - ' : , ' • iIGeotli t, nal(Closed'Limp) OTracer ': - 20.DRILLING LOG additional sheets If necessary)-- - • " FROM'' ' •TO' ` ' DESCRIPTION(color hardness.soiliroek tspe:main sue;etc.)• • ' ' • Geothe al(Heating/Cooling Return) ' Other(explain under#21 Remarks): Q•rt � f�.�a �, ! 1 / 11 pp • :.•• :.'. 4.:Date ells)Completed:l,,!4'23 Well • .t.J... eP ft 15.7 ft."5AAJd ' eoGr' • -c 5a.We!!Location: : - / :. . .�� ft.�.�ft. Dive �J91i1 �'e K. •Facility°O rncr\ame• Facility ID#(if applicable) - ft, ft.: -.••;. ::a 1,.- , , .� . Pliysical'Adtl ss:Cny.and Zip- ' . •Jt,! (� . - :' ff. - � •� .R' + -., - •- ,rr 21:REMARKS r :. .:. County Pared Identification No.(PIN)' . 5b.Latitude and longitude in'degrees/minutes/seconds or decimal degrees: •, . (it welt tictld,one lattlong is cu cient) ' . '22 Certific loon: ' : , • . • N W. . . ,• 6:Is are;the well s - • • •Signature ofCcrtificd'VzVeil Contrr r i'. ( ()if', semen nt: •or' Temporary • , : . . By aibning tlut form 1 herehy cerhlfr that the well(s)Was(ivere)cothstniaed in accordance 7-Is this a repn2 to an existing.itell: Oyes o io „ : • tt ith 15.1 NCAC(PC-0100 or.154 NCAC 02.0.0200 lie!!Construetian Standards and.11tat a • - I/this is a repair.f11 out/mien n well eanstructiotr inf a mattnn.and.splain the nature plate' .cop,.t f this record has been pro ided to the well goner .. .. . repair:unr .er.-21 rcinarks scciu,n or on she hack oftlrtc firnh.' m 23.Site tliagra or additional well details • 8:For Ge oprobe/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;ma also attach additional pages if necessary. drilled: SUBMITTAL LNSTRUCTIONS ' 9.Total tell depth below land surface: fol. • (ft.) 24a. For.All Wells Submit this fonts within"30 days of completion of well - . For multi le wells list all depths ifd eri'nt ictanhplc-3(t�-00'and 2(41100')' • • ' ` construction to the following: ' ' 10,Stati water level below top of casing: ' ' ...3d ' (ft.) Division of Water Resources,,Information Processing Unit, If trater/c e1 is iohorc s ailtg.use -F -1617 Mail Service Center,Raleigh;NC 27699-1617 • l i.Bore sole diameter: (in.) 24b.For'Infection Wells:-In addition to sending the form to the address.in 24a . above,.also submit one copy of this form within-30 days of completion of well ' 12.Well construction method: • 41.•I L. sib.) I '• construction to.the following: - (i.e.auger riitary,cable,direct push,etc.) - .. . Division of Water Resources,Underground Injection Control Program, FORW t.Ti ER SUPPLY WELLS ONLY: . • . 1636 Mail Service Center,Raleigh,NC 27699-1636 13a,`4'!c.d r pm) ) J .. • Method of tests $l-t Ji`'. . . 24c.•For Water Supply&Injection.Welis: In addition to sending the form to . �'�7'��f •the addresses) above; also.submit one;copy Of this fonts within 30 days of 13b:Dos r-fection:type:My Amount: /l el'. - • . • completion of,well construction M.the county health_department of the county ."• where.constructed: Porn,GW-1 - North Carolina Department of Environmental Quality.-Division of Water Resources Revised 1.22-20I6 ' GDEPARTMENT OF P LIC HEAL GUILFORDLFORD:COUNTY' UB Tfi - - :: Division of Environmental Health,Water.Quality Unit, • : _ . - 400 W Market St.;Suite 300, Greensboro,NC 27401 - : .Record of Construction, Repair, or Abandonment of a Well • : Addr Ss of Well;66:O0- - C/?S' 9iz ..:z6 - LATITUDE 3__ Well Permit Number:P Well ontractor Company:: :. Aqua Drill Inc.. - . : : . Completion Date:)/-I Cf 2 `> Total Well Depth: s ft. • Well Yield )57 ..gpm : Static Water Level; '70 ft : Dute Casing. Material j bit 2 l Pt l/ C Formation Log . : Casin Diameter: 7r- in. Casing Depth ISO ft: . ... ,Depth , ; Description : - . . . :From. 0< ft.To:� I �.ft. :�e : •C`/1�1}� Traver Casing. . Material : From 6 ft To:73" ft. 5 A Kid 1zoe l Casin Diameter: - .. in: Casing Depth: ::. • ft. .From.76 ft..To:,2025 ft. flue G iz-e4rui'> : From ft.To: ft.:- : :_ _. E - : Grout From. ft To• ft. : - Depth. : .. ' • : Material : Method From : ft To: :ft 1 . From 0.: ft To, O. ft C ew+eiu4 .:Trzoc fc. From : ft To: ft From.1 .. ft.:TO: - _.: ff. . : '--. _ From. . ft To ft . From 1 . ft.To: . ft ..- . : 1: ' From •: -. ft. To: ft` . . Water Production Zones Depth .J>O .ft, ft ft . ft: : . . . • ft. ft. _. ft : Yield )gpm. .gpm: gpm . ..gpm gpm 1. gem :gpm Methokkd of Repair. • -_: : Method of Abandonment. .. . - I hereby certify that this well was constructed,repaired,or:abandoned according to the Guilford County Well: : Rules.:n effect on this date and that a copy.of this record has been provided to the Well owner: : - Chris KingdA: 2080-A -Well Contractor: % • Certification#: Date:// ./9-,2; . : l a . ,Record of Pump .Instal a �:tion 1 - Pump Installation Company :. Li :s0A,L Z. 7:;cJG - Completion Date ////‘/Z3 : Pump Depth: if,-0 ft., Static Water.Level D f. ft. Philip Brand: it O�II e` p/OJQ7 P. Pum .Size and Rati n A; hp m I hereby certi that this um was installed and wellhead:coin leted accordin to the Guilford Count Well Y- fY p l? p g Y Rules n effect on this date and that a copy of this record has been provided to the well owner. Well Contractor P _ G Certification# 6'17 7G Date: l64 Revised:January 1,2009 1