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Home My WebLink AboutGW1--07398_Well Construction - GW1_20231117 • • • WELL.CONSTRUCTION RECORD(GW-1) . For Internal Use Only: 1 _ I.We I Contractor Informations.. Chas King. • - .. • '" • - '14.WATER20NES ,:i Well Contractor Naine FROM -. TO DESCRIPTION • 2080-A 6.2*6 • 2 V it • S a l I1Cf.We I Contractor Certification Number • 5.OU CASI roulh-eif edavells)ORLINER:(ifhp licable) Aqu brill, Inc, • FROM TER" NG fo TO' DIAMETER . • THICKNESS MATERIAL :. Company Na•me • • n• I 7(� /� in; �b ^�(� r�f /_ • • • 16:•INNER'CASING OR TUBING:-'(geothermal closed-loop)> • • 2.Wel Construction Permit#_L -/. ..6 .-7Wf iJ . JZ D 298 -FROM • . •TO DIAMETER -THICKNESS' _ MATERIAL List all applicable Well construction permits(i•.e.U/C County.State,Vai ranee,elc.' ,I•' ft. : io: • 3:Wel Use;(check well use):. . n:. . ft., in. Water SuppliP Well; - ..• . 17.SCREEN FROM . TO DIAMETER ! SLOT SIZE•• •TH►CKNESS -_MATERIAL AO ultural .. , DMunicipallPublic' • ft ft. . • ' in. ' Gent cimai(Heating/Cooling Supply)• 'graksidentitilsWater Supply(single) ' ft. tt. in:. )ndti trial/Commercial . "DRcsidcntial Water S upply(shared) • 18.'GROUT " . lirig�ion . , •• . .. . .- -FROM . TO' - MATERIAL EMPLACEMENT METHOD drAaIOUNT. Non Water Supply Well: • • • C) ft. d ft. Mont oring . . Rccovc " • • • D' ".. .. . ft. it,. m prd� �h it C� Injech n Well • Aqut er Recharge Groundwater•Reniediation tt ft. • Aqm er Storage and Recovery O Salini Barrier -19.SAND/GRAVEL PACK(lf applicable)- -:... f. _ . tY " .` :Aquifer Test ' . DStoi'mwater Drainage'.• : a :• ft CE - FROM. �TO MATERIAL • • 'FM11PI AMF1\T METHODExperimental.Technology Subsidence Control -ft.: .ft. .- Geothermal(Closed Loop) : ' "• ;OTracer. - ' ' ' '. •20:.DRILLING LOG(attach additional sheets if necessary).vc Geothermal(Heating/Cooling Retum). Other(explain under#21 Remarks) G ftc. r FROh! TO DESCRIPTION(eolar,hardness,sai0rock bps,arnto size.et )• • 4,Date Well(s)Completed://f�- _ -. Well iD#" ft •�� tt: .$4 1 oC•iiC . 5a.:Weti Location: .. ft. Facility/ wncrMimc • - FacilitylDtt(ifapplicable) - - ��°�8_ 0R iL ft. . j R c5-:- . • - -. " . lam- ' :y r. f ., •3 Physical ddress,City;and Zip ' • _ .: iL. gym_ t "L'�IZ` - .REMARKS' f tCounty , .�^ : LOU Z1: i l' Parcel Identification No.(PIN) • ' " ( J Sb.Lath'ude and longitude in degrees/minutes/seconds:or'deciinal degreest; tt:�i"'` „• (if well'tiield,one lat!long is sufficient) • " ' •'' • 2 2 .Certification: •N �V ..2) • • j ��9 6.Is are the ,` r ! _ 7'`$ ( ( $� ermanent or QTem ora Signature ofCerti cd We Contras r IJ'. P tyDate' B1'signing this,lori,, l hereby(erg.that Ute url/(,c)urns(reerel:constructed in-accordance 7 Is this a rapatt••to au existing well QYes or•6j.'o •iri/h 1SA NCAC 0?C.0100 or 15ANCACO2C:0200 licl/Ccinsienctian Sianilards`andthat a. If this is a rcpai fill oat kitmiii reel/constru t/nn lnfarntalinn and erli/ain the nature nfthe ctiO1'of 1h1 s record lice been proildal to the Well onmer. . repair tau•r ii21 remark%scctinn or an Ilre.hpck cf thisforar. : • • - ' 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 site details or well - constntct on;only 1 OW-1 is needed. h)dicate TOTAL NUMBER of wells • construction details: You may.also attach additional pages if necessary, drilled:. ' SUBMITTAL INSTRUCTIONS ' 9.-Tota) •ell depth below land surface: - • • (ft,) 24a. For Al Wells: Submit this form within 30 days of completion of well Fornnrhip c Wails list all depths7fd event(example-.W,200'and 2(0100'): construction to the following:. 10.Stati water level below top of casing: -" (ft.) If,iatei le,el is'ahoy a casing,'ase• +~. Division of Water Resources,Information Processing Unit, •1617 Mail Service Center,Raleigh,NC 27699.=1617 Ir.Bore)ole diameter,:••• • ' 6 (in.) 24b..For Injection Wells: In addition to sending the foini to the address in 24a 12:�i'ell onstruction method: ! �Z,[. -' above,'also submit'one copy of this form within 30 days of completion of well (i.e;auger, dairy,cable,direct push,etc.) ' ' ' - -- constriction to the following: • FOR WATER SUPPL 5'WELLS ONLY: Division of Water Resources,Underground Injection:Control Program, 1636 Mail Service Center,Raleigh,NC 27699 1636 lie.Ytcic'(l pm) .T.. ' !' . Method of test: S(itkyv> 24c.For'Water Supply&Iniecti In•Wells: In addition to sending the form to the address(es) above, also submit one Copy of this form within 30 days of 13b.Disii feetion t3'pe: ) t$ Amount: /4 0'2- •" completion'of well construction to the county health department of the county •• where constructed. Form GW,1+ North Carolina Department of Environmental Quality=Division of Waier Resources 12...4..A 1 o,,n. is -GUILFOI2D COUNTY DEPARTMENT OF PUBLIC HEALTH - Division of:Environmental.Health,Water Quality Unit ' ' 400 W:iVlarket St:,Suite 34{}; Greensboro;lVC:27401 Record of Construction, Repair or Abandonment of a .Well Ad ress of Well, 5-26 k_ //15.2, Age_s • f. . Weill Permit Number .-Q 6 . -. �l tNc)P2 q' � LONGITUDE Wel Contractor Company Aqua Drill,.Ine . . .. Completion Date:_ ? -Z 3 . . Total WeII De th - ,2 S`.. . :. , . p ft. Well Yield: :57. • :. gpm . Static Water Level: C O', . Out r Casing Material Pl,� d. �S 0 tZ Z 1•. .. .. .. , Formation Log - Casa g Diameter:; �r�_ in: Casing Depth:. �?, ft De th . . - P : Description . .- From ft.To &i ft. Red_ . .ei - Inner Casing .Material ) W Y' CasingDiameter:. � � .in. Casin Depth:: : . �� From � ft:'To ?.,� .ft:. 5�nr:� 1'2• c To:' 5ft o u . -'. . . . � �. g P • � ft 'From ?�.ft. _ ':From: ft.To ft; . : Grout - � � - From ft. To � . $ Depth Material Method: From ft:To 1, ft. ' , . • From O : ft.To: 2 d ft. 4 enm P411 io c-IC : .• From: ' : :ft.To:: ft: From ft.To:: . . :ft. : From: ... ft:To: . _ From • . . � . . ._ ft. _ .. . ft:To .ft: . . From: • ft..TO:: ' , .. :ft:' • -Water Production Zones . bep :. �dit: � - Sf ft.. . . : .. . - � . Yield ' . 'ft .. . gpm gpm gp gp ,7 . : : : ': � ft: -: ft. :ft. Meth d of Repair.: - - ;. : - Method of Abandonment ..- - I hereb :certify that this well was constructed,repaired,or abandoned:according to the:Guilford County Well Rules in effect,on•this date and that a copy of this record has been provided to the well owner:' Wellcli ontractor . • Chris King. . �. . owner': certification#: 200-A Date:// . 7:- ��j� Record of Pump.Installation ' Pump ListalIationCoin-'an : ' (N5).. .c-.4 ` f � . 'P y , `J -i UI . J- .C,._ •• Completion Date: t i f 3I-1, Pump Depth: :--0 - ft. Static Water Level: . ft. Pum rand: tD f :Pump Size and Ratm' g ( ' :hp gpm: at uI hereb certify that this p as instahed'and wellhead completed according to the Guilford County Well Rules in effect on this date and that a copy of this record has been provided to the well owner: Well C ntractor: ,f'7- :0 �1 .,,' ? Date:// /S 3� L Certification#:. 1 Revised:J nuary 1,2009