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Home My WebLink AboutGW1--07934_Well Construction - GW1_20231208 WELL CONSTRUCTION RECORD (GW-A)"' Foi•Internal Use Only: . • 1.Welt Contractor Information: Chris King . . FROM-' TO • ' DESCRIPTION.. . • Well Crnitmdor Nanie 2080-A• 114 tt. NC Well.Contractor Certificaiien Number - ' . 15.OUTER CASiNG(for.milli-cased wells)OR LINER(if ap licable) Aqua Drill,-irlc;_ . • . FROM '- 'TO. ' , DIAMETER - --THICKNESS.. -MATERIAL. ft. . ft.: t J in.. t f • Company Name-. • V•- C� �� 51)iza.i: p)i tC. . - ?_ sS J�� /{ '16.INNER CASING-ORTUBING'(geothermal closed-loop). 2.Well Construction Permit#: J 'i U7 L. }�1-1I7-�,16�3®`i - FROM ' . • ,TO' .... ' DIAMETER - THICKNESS • ' MATERIAL List all applicable well construction permits(i.e.U/C.CounttjtSlSlate:Variance,me.) fL fL in. 3.Well Use(check well rise): tt.' ft. . • in; Water Supply Well:. 17.:SCREEN FROM . TO • ' DIAMETER. SLOT SIZE. •THICKNESS -MATERIAL Agricultural.- Municipaupublic. . Geothermal(Heating/CoolingSupply) .43raesidentialWaterSupply(single) .• - .-ft.; - .' it: -in. 'Industrial/Commercial jRcsidential Water:Supply(shared) • . , Irtioation •• - . . . •.. . .. • • . . • MATERIAL .- ' EMPLACEMENT METHOD'&AMOUNT. 18 GROUT' .Mu Water Supply Well: : .. . ' . . • . . • �t.:ft.' r1 ft. CCh'1 e . Monitoring. •. . f Rccovcry tt. tt. hljection�i'ell: ft. ft. iAquifcr Recharge DGroundwater Remediation rA utter Story a and Recove I: 19.SAND/GRAVEL PACK(if applicable) q g ry (Salinity Barrier FROM -PTO •MATF.RiAI .EMPLACEMENT METHOD.. aciitit rTcst. . . D•StormwaterDrainage • • . Experintenral Technology 0Subsidence Control : : : • l't. I -ft. •.Geotnernta!-(Closed Loop) • ' . DTracer 20:DRILLING LOG(attach additional sheets if necessary) Geothermal(1 Ieattng/Cooling Rettim). Other(explain tinder#2:Remarks), FROM TO DESCRIPTION(rotor,hardness;soiUrockt♦pe gain s'vs,cta) • 4.Date Well(s)'Completed:j J ')6- 3 . •Well lD#b.j.. .. .J ft.: t•( ft. •/�C• / . 5a.Well Li:cation:. .. .id 57-ft.- . '[is I Well • 1310c- : IZAN . e_ ' F.tcili;_;t:rrnc•Shu:io . : Facility IDii(if applicable) ft:.I. :� 1:-....;`a - ft. sr _ .:..j 'rt. ft. is 7 •.P:ty;icid Address.City:and Zip ' ' ft. •'I.• .. ft. : . F 4 - :8:1ti(-3 ' � 7li d.. • 21.REMARKS' - County Parcel Identification No.(PIN) •- G.v vim,'?(„ . 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ' • " ' • .. : • (ir'well field.one lai/long is sufficient) ' _. 22.Cer'fication • 6.Is(are)the�t•ell(s); e. rmanent or Temporary Sienaturc ofCcrt)tcd Well Contractor Data Br signing this fin*.I hereby cerii&•that the wailer)was(were).consouled in accordance 7.4 this,a 1•epf.i.c to an existing dent; ElYes .or ai,Vo . • itith.15.9 NC.IC 02C.(1100 or 15.4 NC4C 02C.0200 fic!1 Consultation Standards and Matra ' If this is.a rq)dir,fin±no kuai:•a well cam:,•urliori ht/ia•mation and erp/yin tin.Flanire of the ' colic of this rerOrd has heed pun•iticd to the itellati,ner. ' repair rimier Y21 reinarkc section or•on the hack(if ilcic./ornhi. 23.Site diagram or additional well details: S.for Geop obe/DPT or Closed-Loop Geothermal Wells having-the•same • , You may.use the;back.of this page to.proi+ide additional well Site details or well - 'cOil-t ctin'.only 1 CIW-1 is needed. Indicate TOTAL NUMBER of wells construction details: You may also attach additional pages if necessary. . - drElied:, • SUBMITTAL INSTRUCTIONS ' 9.Torzl Opell dertth below land surface: j.� t� (ft) .24a. For All Wells: •Submit this.form Within 30 days of completion of well For nuftirk ells list all depths if different(eramp/c-3(hih_00'alit!-(ai100') construction to the following: 10.Static water level below to of casing:g (ft.) • Division of Water Resources,Ynformation.Processing Unit,If wale,ierel is above casing.use. 1617 Mail SeilAce Center;Raleigh,NC 27609-1617 ' i 1.lion c2 g!e dl It:etcr: (in.) 24b.For Iniection Wells: In addition to sending the form to the address in 24a �f� 1 above,:also submit one copy of this form within 30 days Of completion of well 12.it�ell curstrucrion method: /- ) R. ---� 1 I I construction to the followin (ce.a zr ua .rosary.cable.direct push,etc.) b: 1 ' Division of Water Resources,Underground Injection Control Program, l OR tW ire SUPPLY WELLS ONLY; • 1636 Mail Service Center,Raleigh,NC 27699-1636 I3a.t'rid(,ptn) . Method of test: 1 CI h i-. 24c.For Water Sunuly& Iniection''Wells: In addition to sending the form to ��]: the address(es)'above; also submit One copy of this.form Within 30 days of :.'+b.i?i iL'c 570:: :ype:—s-1 1-� Amount: ) d completion of well construction to the county health department of the county • where constructed. Purr.c.1-! North Carolina Denartntent of F.nvimnmem,t n,,,n...-n;,.;,•;,..,.;f Ill(......0.......-....: _ . .--- -- . . Gcar..,pokt):COUNTY DEPARTMENT OF PUBLIC HEALTH Division of Environmental Health,Water Quality Unit . . ' •' 400 W.Market St.,-Suite 300; Greensboro, NC 27401 ' • . ' . : :: * Record Of Construction, Repair, or Abandonment of Well . : Address of Weli: ) . iZog elks: , 1t140/11 JZ di . : . : : - LATITUDE 3 : : : : .. : : • • .: Well Permit Number: 27. 76 6 -6 io)4:12 - 00 jo:0 .. . LONGITUDE .. ,.: : Well Contractor Company: • . . Aqua Drill, Inc. : • . .- Completion Date:II'.k.-)3: Total Well Depth:c/2:C. . ft.. . • Well Yield 2. : : . gpm . Static Water Level 7 6 . : ft, . : Outer:Casing : ,.,Material: : : : . : Formation Log :: : '' . . '• : Casing Diameter i Co 7.q :in.: Casing Depth -1 10: ft. . Depth : . Description From n ft. TO:.3 . ft, rted c Ilqy Inner.Casing Material.... • - . : .., From : 7: ft To )6 S-ft.. . 3 4uvd.: Rot.E Casing Diameter : . . :in. Casing Depth . ft: From )61ft. To::Lifi. : 17,1V -- : : . ' . : :: : :, : : : , . : .• :. :: :: From . . ft. TO: ft. : . ._ : :.• • - -...: ' . : .. : . . . . . : Grout . : From: : 'ft: TO:: - ft. Depth .: Material : •Method: ' From : ft; To: ., :ft. - ' - .:: :• .-1: ., .: ::. : • •: FrOin:p. ft.To: ;20 ,ft.: ap+0.11,4-- - . -Tritid . : :from; :.: ft.'To . ft : .- : 2: Froin: ft. To: : ft... . - : : : - : PrOM:. '•:Ie. TO: ft. • -: ;_• : '.: : . : : .frozn: , ft.To: -- ft: : — : .- ' :: - ...: . : :: From: ft: To: : :ft. Water Production Zones : : : •: Depth jg 4ft. : : . ' . ft ft. 1 • : ft.' . .- . . ft : - .: ] ., •.. ft; : : : ft: . -. • .: : . . . Yield:: ...:02_ : .gpM !''... , i : gpm:- : . :-: .gpiil : . gpM: . , gpm gpin . ipTil : : • : - • . Method Of Repair: - - . i - -: . : : - •. : - -- -- - Method of Abandonment:: .. . . I hereby certify that this well Was constructed,repaired, or abandoned according to Guilford County Well , . Rules in effect on this date and that a:Copy of this record has been provided to the well.owner: Well Contractor: Chris 1910 ad-;..I: :01._ -.1". CertifiCation 1-i 2080-A to4,6:. il' i ‘" 23 . . : . Record of Pump Installation Pump Installation Company: (': 15,-,-(=x-.....Di,:-. .‘,\ 1 --147' 'Completion Date: 11: Pump Depth: 400 ft. Static Water Level -6'i.0 Pump Brand: .Gruw.N.4.4-c:,S . I C5 0-10 t- c-t.0 Pump Size and Rating: I . :.hp ./.0 gptn - - ' %.;•>\ SV.roc:.:c.Si :- . • : I hereby certify that this pump was installed and wellhead completed according to the Guilford County Well . Rules in effect on t''. da and t) t:a py of this record has been provided to theiwell owner 1 . . • Well Contractor: . • . . - l., . " : , . Certification#:'9`41C fr. Date:•iAki 1 ept7to Revised:Jantiatir 1,2009