The URL can be used to link to this page

Home My WebLink AboutGW1--03092_Well Construction - GW1_20230428 WELL CONSTRUCTION RECORD (GW 1) For Internal Use Only: 1.Well Contractor Information: Landon Phillips 14.WATER ZONES . Well Contractor Name FROM TO 1 DESCRIPTION 3441 A 1 ft. 1 S ft. 5Pm NC Well Contractor Certification Number 75 fG t?6-0 ft iL C p F M 15..OU.TER CASING for'multi cased wells OR LINER if NW Poole Well and Pump Company FROM TO D1ADiErEa THICKNESS MATERIAL Company Name 'i f fL n ft. _in. - I 'CTI,Itl:;tLb� 16rINNER CASING OR TUBING eother a[closed-loon) 2.Well Construction Permit#{: FROM TO DIAr*IMR THICKNESS I MATERIAL List all applicable well constrictfohh permits(Ke.U1C,County,Stare,Variance,etc.) ft. ft. in 3.Well Use(check well use): ft. ft. [n. Water Supply Well: ,17:.SCREEN.. ❑A ricultural rROM TO DLAMMR SLOTSIZE THICKNESS MATERIAL g ❑Municipal/Public tL ft. in. ❑Geothennal(Healing/Cooling Supply) InResidential Water Supply(single) ❑htdustrial/Commercial ❑Residential Water Supply(shared) ft. ft. in. 18.,GROUT . ❑Irri ation ❑Wells>100,000GPD FROM TO MATERIAL EMPLACEMENT h1EIHOD&AMOUNT Non-Water Supply Well: ft. t� ft. ❑Monitoring ❑Recovery M ft. Injection Well: ❑AquiferRecharge ❑GroundwaterRemediation ft. ft. ❑Aquifer Storage and Recovery .'ff9::SAND/GRAVEL PACK if a liable❑S.isiz ty Barrier FROM To MATERAL EMPLACEMENT 11IETHOD ❑Aquifer Test 'i i . ;li I iwater Drainage ft. ft. ❑Experimental Technology ❑Subsidence Control ft. R. ❑Geothennal(Closed Loop) ❑Tracer ,'20i DRILLING.LOG attach additional sheets if necessary) ❑Geothennal(Heating/Cooling Return) ❑Other(explain under 421 Remarks) rnonl TO DESCRIPTIONcaar,lClmrdn"s,sou/rock type, nin Sim etc. ^ ft. ft. OP vbl 4.Date Well(s)Completed: r -a -7. Wc11ID# a ft. g tt Sa.Well Location: ir ft. 3�5 ft. e a ft. ft. �h�l APR 2 8 2023 Facility/Owner Name FacilitylD#(if applicable) ft. ft. ft. ft. _GVJQlt3'Ji.� Physical Address,City,and Zip fL ft. r1 hn,5-�� 21.REMARKS County Parcel Identification No.(PiN) Used hardened steel drive shoe. .5b.Latitude and longitude in degrees/minutes%s!ecoads or decimal degrees: (if well Gcld,one latlong is sufficient) 22.CCrtificati 35 6.Is(arb)the well(s): '❑Permanent or ❑Temporary Ssgnaturc ofCcrtifled Well Contractor Date ' " By signing this forit,I hereby ceriffy that the.well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: , Dye's or' nNo JSA NCAC 02C.0100 or 15A NCAC 01C.0200 Nell Construction Standards and that a copy If this is a repair,fill out known well constriction ithfortrtatioi and explain the nature of the of this record has been provided to the well oitalet: repair solder 1111 remarks section or ah the back ojtliisjor`ar: 23.Site diagram or additional well details: 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Ovee in Remarks Box).You may also attach additional pages if necessary. drilled:+ , 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 36` (fL) For nudtiple wells list all depths ifdterenJ(ezaahple; rt 1'3 00.'and 1®1001) Submit this GW-1 within 30 days of well completion per the following: (ft) 24a• For All Wells: Original farm to Division of Water Resources (DWR),10.Static water level below top of casing: D Ifirarer level is above casihhg,use"+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 i1.Borehole diameter: 6 (in.) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC) "Rota Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: ry (i.e.auger,rotary,cable,direct push,etc.) 24c.For_Water Supply and Open-Loon Geothermal Return Wells:Copy to the county environmental health department of the county where installed FOR ATER SUPPLY WELLS ONLY:� 24d.For Water Wells producing over 100,000 GPD•Copy to DWR,CCPCUA Method of test: 13a.Yield(gpm) ® BLOW Permit Program, 1611 MSC,Raleigh,NC 27699-1611 13b.Disinfection type: HTH '` 1lb. Amount: Font GW-1 North!Cruolina Department of Environmental Quality-Division of Water Resources �: � Revised 6-6-201 C I WELL PERMIT Permit No:190041 Johnston County Environmental Health 309 E.Market St. Smithfield,NC 27577 Date: 10/19/22 Phone:(919)989-5190 Name: JOSEPH MASSENGILL Address: 1616E BUFFALO RD WENDELL,NC 27591 Location: INTERSECTION.OF LAKE 1NE140ELL.RD AND BUFFALO go LOT ON RIGHT S/D&Lot##: Construction Type of Well: DRILLED Type of Facility: NIA Number of Connections: 1 2 Use(check one): Private Agricultural/Irrigation X Semi-Public/Non Community Well Contractor: Phone Number: Permit Issued By: ft Systems shall be.installed as shown in sketch.This permit is valid for 5 years from date of issue. THIS PERMIT IS FOR AN IRRIGATION WELL ONLYAND NOT FORA DRINKING WATER WELL.THERE IS NO CROSS CONNECTION ALLOWED WITH A PUBLIC WATER SYSTEM.AN ELECTRICAL AND PLUMBING PERMIT IS REQUIRED FROM THE BUILDING INSPECTIONS OFFIC I NOUX �rjx :f I CIO x 9.0, �^320 1v oL cam, rp IUOL+ -Srio9 , C�Ntn Wfl NOT TO sAL_FAx PJ(,tkIO Ito "JUG 96ulC hI.I�I Inspections: Sitting/Location: t',i; �':'� '''`ti I";l''�' GPS Coordinate:Lat- Long- Grouting Inspection:' .:r.I :', I I I Slab: Well Head: WeII Tag: Pump Tag: Water Samples:Date: r s i .,: Office: Private Lab: Disinfection Device:Yes No ***To be filled out,signed by well contractor and returned to the Johnston County Environmental Health Office*** Depth of Well: 30S1 An on-site Investigation has concluded that the area designated on the permit Depth of Concrete Grout: 1 i should meet all necessary setbacks as provided by the Johnston County Well Static Water level: a� Regulations. The well site has been located using the best available I Inforrriation as provided by the property owner/or his agent.The Health Depth of Casing: GJ� Department.will not be responsible for improper location of wells due to Well Diameter: ('D ILI II erroneous information provided by the Health Department, mislocation of Capacity of Well: _�)1�- Gals./Min; wells by the contractor,or quality,or quantity of the water supply. • Date Completed: O I certify that the well designated on the property meets the setbacks from all I certify 'that the e�nstrueted on I!,the above property meets all property lines,easements,rights-of-way orstructures indicated on the permit requirements of th Johnston County WeII Regulations in a ect on this ate. and that I am the owner of the property or his/her designated agent. Signed by: ✓ ' / I Jo irttk wtw�ol_t irn ,wi OCt 23 2022 (Certified Well Operator) (Certification Signed: Date: /W OD'e I, I�r (P.ropeity0wnerlAgent) (Well Company) 1 ll (Date) „ Certificate of completion: Date: I I I