HomeMy WebLinkAboutGW1--06642_Well Construction - GW1_20241108 I
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WELL CONST1WCI1ON RECORD(GW-11 For Internal Use Only; l'
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L WeU Contractor bdbrmatimi: . .
--Garir.Thompson • • •- '
. MOM TO: • InfiCRIPTMIT U
Wall ContractorName .
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' 4418-A • •. moil KS ft. Ffis%C.iOr I i'M OM
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NC Wall ComactarCartlficenantranita . • IMIlITP&CASDR;tratambleasetirens)ORLUVEROt-- ashlar••• .-.%.-..,,..
Aqua Drill, Inc. .• • • -11ROPS TO =ram= TOICTIVESS"- OTATIMAL
'Company Name• -- 0 ft. r14 ft. 611 soz21 PVC •
• 15.11VWERCASING ORTIMING feenthuntal desalusai'!.:', "''''•--, -•'••::-
L Well Construction Permit& 3eti1S - F110131 TO DIAMEOR Imams= armanti.
Mal/applfcabfa wall masmardanpannft;0.e.UM.Coway.State.Variance.eta) ft. . rt. tn. •
3.Well Ike(checkwell use - ft. ft. • in. ' •
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Water SupplyWell: • • mom To anima sic;sues unfitniss , mantsarat
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rural rata/Pada fr. et. kb
' Geothemnd(Mellor/Cooling Supply) Reside' Mini WaterSupply(shigle) ft• fr. • in.
•Industrial/Commercial Residential Water Supply(shared) „is.Gaon.. .... .... .•:„.•.. • ...- •...; . 7 ...-...•. . • •
Irrigation FROM To armearm. -istmaimnier amnion&sato=7 '•
Non-Water Supply Well: 0 il a2. ft inepoit. Pouf +wick-oat.
ElitOnfoilitoling Inftecovely ft. ft..
•lbjection.Welk . ft ft.
r Recinuge II GroundwaterRemediation • •• '
War Storage end Recovery Eleolimly Benitr • enom TO IIIATEMAL 1 isstukaiMninsinnsi •
• , AqutTer Test OStormwater Drainage it ft. - • i .
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Experimental Teelmology riSubsideneaConhol ft. In ,
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, - Geothermal(Clog=Loop) E211-acer " •10.DRILLINGILOG(attiehoddlatiral sheets ifincenars)- "-• : • , .
,--Geothermal(Heating:Cooling Return) Flatter(eriplaht under f21 Remarks) Timill TO erseelallealteaar'eraemmtarmaeaumenwize*6" • ,
(-) r4 IS & R4c1, CIA-y
4.Date Welke)Completed: 10-22-2-9 Weil mg * 1 S ft• 641 fr., Se.rv4 eo 1.1c
go.Well Locadom . &q. ft. r18-1 ff. rt.. GT.ra.41.0•(% •
RelsetA Weiclaa el 4 ft 22514 id4 Gran:-.1,te---— ---
FacaftylOwner Nam* . 'rally MEI(IfoppUsabft) ft. ,ft. - • ;
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...... ft. ft.
14444E higMhtteb tidy bc loloacEoullte All. moat tt0ii 6-G 2024
• Marti Adtheas.0y.[car* ft. ft. i.
ZIREMARIG
Canty Parcel Ekraifforaballo.(PIN)
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5b.Latitude and longitude in•degreesimiontesbecoods or deeinml degrees:
• Vfwall field.one latflang is saincime M.Certirmattom• . ' -
N %, cl b.2S. 19 .R" • w
1 10-2.c,2q
• 6.Wore the weff(t)OPermancot or Dlimporary oi.11Oinedetar
Data'
By aping&Islam.I hereby ter*that trie'wdl)Ina(ow)caraintzted tit accardtatre
7.1s this a repair to on editing well: Dines or,,NITo with ISA NCAC WC.0100 or ISA NCAC 02C.0200 IrglICanonteffenifastairkeildthata • •
. vird,qtampabollamik,,,,„ftwirmatonabungion azgaitAgerilure qfthe wavered;record ha kw prewldaltit lks well owner.
tritafrserder OM texettlasealan arcs the 14thoferfsfana 2.. We diagram or addidontd well ditailm . .
. IL For Ca:agree/RFT or Closed-Loop Geothermal Wells having the same You may use the back of this page to Feelde"Mimi well ate details or well
construction.only 1OW-1 is needed.Indic'ate TOTALNUMEEltufwells• =sanction details. You may&oats&adrliticmal pages vfnecestery.
drilled: SUBNIITTAL INSTRUCTIONS i
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&Total well depth below land surface: • '' 2 2.5 00 24n,for All Wellse Submit this thmt within 30 days of completion of well
Arturdriple walk Itsiallelapils fdiffaent(exampre-3®269'aad MOO) , construction to the fhllovdmic . , ,
10.Static water level below top of casing: 4 0 (ft.) Maid=of Water Resourecs;,Information Processing Unit, 4
feloterkvel frahavaeadna axe"4. , • 1617 Red Service Center,Italefgb.NC 276994617
1L Borehole diameter: ts 00
24b.yror Medan Wells: In addition to sending the Sara to the address in 24a
above,also submit one copy of this fin='within 30 days of completion of well
• I2.Well construction method: foi odv A.1 •
construction to Ste follonno" x . I •
CuLnaer.rotaiy.alle.diseetpuskete) "wk,,.. '
• DIVisibn of Water Resources,Undergantmd Infection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Con*,Raleigh=27609-1635
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.1.3e,Tleld(gpm) 15 Method of tesb C6.4 IA 61 la 24e.Far Water Snooty&Infection Wells; In addition to scans the form to
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the address(es)above,also submit one copy of this to=within 30 days of s
.13b.DIshithetionfype: Rill 1 befe° Amount: it, 02. completion of well construed=to the'county health department of the county
macre constructed.
Fenn GW•4 • NorthCazolinnDepenment ofEnvinumiental Qualby-Division°Mater&sauces Revised2.2240g
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