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Home My WebLink AboutGW1--07302_Well Construction - GW1_20231109 • • WELL CONSTRUCTION RECORD(GW4 . For Internal•Use Only ••. 1. elI"Contractor Information: I vId B®Icher 14:WATERZONES 1 Woll Contractor Natoli . FROM. TO DESCRIPTION . " : . .45 4A ::. . NC, ellCeatractorCeittficdtioaNum6er �I '��) R -3�4.� 3�9 f•[Rl�l� Sb��'lts'@� : ' A ua orCert' • 15.WIE•RCA81lG(formultteared;ens OR LINER(ifay. .ht.)_ - , . r. `t , FROM I To rDIANETER THICKNESS' MATERIAL - . Compa•ny Name,. . ., • - • • - .: C) Cl5 .-I 6 5 Io,'.. . • •• • • : 16. CASINGTUBING oth rma1c�9•�l• nt UC; 2:W ConetrwilanPermlfii t`�3.•0$•*.lslAili'R,• OR (T a _R. DINERased•Ioou . • - -,List lcpplicable well Odirtm elonpermlfs(Le.Ulg.Cow±ty&aze Forrian a etc,) :X "� FROM '. DLtMETER' THICKNESS" MATERIAL n Lb •'. .. .3.Witil U (check use):'.-• .: - . . - -. - . . ' Water'Supply Well; 11BCREEN . . MI Agn.Culturel • D OtioipaUPeb.icl TO DIAMETER_ .-SI.o•I•t3IT TIHCKNess MATERIAL ' • I Geothetinal .. ;' m: -• •�. . . In.: •• . . � : . • - - • (Heati6g(Coaling Supply)•. Residential Water Supply(single) : -- .. : -f •t. .- I; • • III IndustiiaYCommerctal • • • • ' ' _ �Resideahal,lNattir SnPP(Y � . . •in+ltadon•.• S. . . Non-�ytiter Sd • • .. _ pply WeU: • EMENT AMOUNT-'GROUT ': �: FROM• -to MATawAr', -.EMPLACEMENT INErr[OD6� . i�•Mopitorin • • ft.• y CPtn n -. n � F'15UC ty�,I-VI_ trliGr,< Ioiecjioa WeU: ft . NI'AqutferRecharge . . GnoimdwaterR •• : • DI' Teo ng and Recovery. ,13Salinity Harder- FR SAND/G:To --.PACK(ifapauable) , •Aquifhr . •. :-.' . •DStoimwateriDmmag • sa°•- • 'To _ - - , •,;tartal Tectinolo . MA • . . •• .. . ey" ,.. . ._ Su6aidence Control ,. . • *Geo:he tmal(Closed Loop)' Tiacer - =". , . • •� -2U DRiLLINGLOG(efhehiddiHonelaheebff G ($eetingJCoolingReturn) 'Other(ormlainuadcr#21:Rcinaliisj 'PROM , TO .• .DESCRIPTION(cow;teas wWraekbpsRaIndaaate.) . . . : ''4.Date Well(e)Completed:•1:1.S.r? Well lmu: • . 4t. 5 ft- Sc.Well Locations • t ft- : . /ci•� Ij l • • • '�t5 3G5- • lire .: : :: .- ' Facility0eraarI4>.� 1 • - � . . _•' . . .. , - ... • ' .. . . . . :FacilityID#(ifappikable) • • I :'it • �.i ,,-. °73 p jii(: .1It , luicto 61 ' ' etlbsrinu:ll� iljCa4 u9 R. . • ••. ::PbyaicatAddeoas,Clty,and`Rip f t • f •• : NO. � '� J 7Q73 - • . Parcel Identification No.(PIN) • • Ft.`I ". i 1-%:,ca. • - - Sb.Latitude and lon .. degrees/min ` ;:_„- • : gttude r1n uteslseconds or dcdmal degrees (liwell field,onelat/long isauSclem) ' 22 Certltiettlon •- :. 3(,°1(1.kt):3" * g9p• 341• ' (4t!':.--; ••• -:1::—— : •-: :;;.1.1 J•• •e. "L :..•_—:-: : ' : : : ' — • . • '.- • :• . -' : • • ...:: : .-' :' . 6.Is(ai1e)the Wells)f ermanent or Tem o. . P •may' slgnmraofCettiHedWallConlmetor { B a ter di •� , .. : ''..m • • Y � S is join,,I hereby cert{/y that the wwe1l(a) sun(were)constructed bi accordance •7.Is ths a repair to an existing well: • IDYes or No 'with 15it NCAC 02C.0100 or 15ANCAC 02Q.0200 Well Corirtnicfdn Standarrla'ond that a ffthisisp repair,ill oaf known wel1 congri*ion bite nation ade.aplatn the natta>?ojtka -copygjihtareeeedhgs beenpmeMed to the well o wrer •repalrunder#21 remarks section or on the heeL ofthisjons.• • • I l :23 Site.diagram or additional well details: 8.For Geoprohe/DPT or Closed-Loop-Geathermal Well having the same • • ' You may use thu back of this;page to•provide•tidditionel wel site:details:or:well constm jtion,only I GW-1 is needed. Indicate TOTAL'NUMBER of wells. may also attach additional pages if necessary: ronstnictioR details. You - ' dulled•" . ' . : .. • , -. . - • •,� ' . . - $UBMI7"i'AL INSTRUCTIONS �' 9.Tote well•depth below lens snrtaee 3Ce 5 • For ata le wells t b thla d erarr (R')• •�4a.is air:in•Vvelise•Submit this Morn within 3U. deg , U' (exmapie!3@20).'sad201o0) days of completIoa.of wen conshnetioa to tho folloing: . • 10:Sta 1e waterlevel,below tap of casing: - 4t) , - - • '((t:) Division of Water ae. - i .. Ywater tev010..abwe casin.5 ttse+- Reso»rcte lRidelg tlon Processing Unit, 11.Horl ole diameter . 6 . pna • 1617Mad$ i C - ' 24ti.For'ideation Wells: In additionitosend ng theor the address in 24a . 12.Weil convfeitctlou nretllode ar},it` A;s f ys Lon o abov also sobmit ono copy bf this'ohm within 30 da of comple' ' fwell• e,. (L.a euge;rotaiy,amble,chant per;etc.) ' ' . construction to the following: . FOR N' TER SUPPLY WELLS ONLY •" • Division of Water Resources,Underground Ilijectilon Control Program,:. . . :. 1 6 Moil Service•Cad r NC 27699-1636 (gp ) .- Method of test; (rite h 4`(,Me- 24e.for Water.Subniv&fnlectloti�iWells: In addition to sending the form to the addiess(es)aliovo,'also'submit`one copy'of this form-within 30 days.of 130,Disinfection type: l4114�(l0SC • AmaunC • (Ce®Z -. • - completion•of well construction to the county.;health department of the county- • .. - .. - h .- w here . • •Fornr.6 �1 NorthCarolinaD azhneetoflinvirom�nealQuauty..DivisionofWaterResontces !' Revised 22 2016 GUILFORD COUNTY DEPARTMENT OP PUBLIC HEALTH Division of Environmental Health,Water Quality Unit • St.,Suite 300, Greensboro;NC 27401 400 W.Marlcet ' Record of Construction, Repair, or Abandon n ent of:a Well Address of Weil.:. Do.'MC N; hu;a :Cep g (tkliliUi;jlai.A)C�??2+.1) LATITUDE 3 Wr.ft Permit Number Weil Contractor Company: Aim Trill int . le h Comp on Date 11 3 g,.1 Total Well Depth .:465 . ft. Well Yield: : 46 gpm, Static Water Level:: Lid : . ft. O Casing Material 'Pit: ;, • ' Forma'tion Log : . piing Diameter: G.as in. Casing Depth : 45._ ft. : Depth: . .' ' i . .' Description - Prom ft:To L ft. . Cott Inner.Casing :Material: From.' 1�.To ft. gior.0-an Casing Diameter: in. Casing Depth • ft . From::45 ft,To 30g:.ft. :`44ta• dsan;ip :. From: ' ft, To: ft: ' Grout :. • From:- : ft:.To . '_ ft. : . _ . .. . ro Depth . •.. : Material Method From. ft.To ft. . P 0 fl::.To:. f . ft. Cp•ma4. fi,►-t,344,1cuccFrom:. . . ft:TO: ' ft. Fro eft:To - :ft... From Frond. ft.To: ft. ft.To: ft, : : � _ _ . � � .. � .From. ft.To: ,�' ft.: . ' � .� _, _ . Water Pcodnction Zoned f Depth: :$qi ft. • fL, . ft. .. : : • - Yield: � . . ,---ft 56 gpm . gpmn • gpm: .. .,gpm :-gpm : m _ g : : • : - Method of Repair; :. • . I Method of Abandonment: - .. . - I here..y certify:that this well:was constructed,. E; � . • ,•. . . • repaired,�or abandoned according to;the Guilford County Well . . . Riles in effect*this date and that a copy of this record has:been provided.to the well owner: 1 Well Contractor. noiQli k • - :• : : Certification#: 4614-A : Date: II. .9,:RA Record of Pump Installation : Pump Installation an Compy: w-% 1\ 1 - :f 1L - • Completion Date: I 1 1.1.1_,-1.a- - 1 Pump Depth: . P.s't ft. Static Water Level: .. . 4 - Pump Brand: �.S \ Pump Size and Rating:; 1 5.hp. gpm 40 • • IherelyCertify that this pump was installed and wellhead completed accordingto the.Guilford County Well Rules n effect on iiiiiite an,, that a copy of th's record as:been provided to the well owner. . r Well Contractor: . i ' G c1atcp.M ,� �.. Certification#: � � i. • ,ate:'.1/1=f/?.3 Revised;Janudsy 1,2009