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Home My WebLink AboutGW1--07399_Well Construction - GW1_20231117 • WEL • CONSTRUCTION-RECORD(GW-1) For Internal.Use Only: '- . - • • - : • 1:Well oritractor Information: • Ghri Kin .. . -. . � . .- 24.WATERZONES" '.. - t.'•,- ' Well Co4eector Name. ' ,' . FROM TO. DESCRIPTION Ne Well eontractot:CenifNation Number ' 15:OUTER CASING(for multi=eased wells)OR LiNER(If ap licable);_ Aqua Drill,Inc ' • . . FROM• ' TO -• -DIAMETER' • •THICKNESS ' MATERIAL • : 0' ft. D ft. l/ "In. PIZ 1 Company Nome: - f`j. �/' S-. �, .� i.l✓_? • 16.'iNNI R CASING OR TUBING(seotheimal.closed-loop),•- 2.Well onstrucnon Permit#:' S' d .� � V��J.I •FROM •TO -- • 1 DIAMETER• THICKNESS • MATERIAL ' • ' List ill aj licahlc ellronstruction pernuts(i.e.U/C Countit State,Variaute,etc:) :ff. ' ' ft- in-' - - 3.Well U irse(checkwell use) ' . . • - ' ' . . - .ft. Water Su I •Well: . •• ' : :.. . . . • , 17:SCREEN.. . A 'ct]tural 1' FROM. TO. DIAMETER SLOTSI7E_ �THICKNESS MATERIAL _ . : • •InMunicipaiiPublic .. : • 'ft: . • :ft.- - ' in,• - _.Geoth mial(Heating/Cooling$upply)- . $csidcntial Water:Supply•(singie)' . • ,••n•,:. . ft: . . :iii: Indust ial/Conuncrcial DResidcntial Water Supply(shared): " - lrriant�on - -. - -- ' ." . . ' - - EMPLACEMENT METHOD&AMOUNT r8R nR T TO' :MATERIAL ' - Non-Wa'tcr Supply:Welt,'" • ft. /� C) ft. �+ . -Monit tring .. _ - - ' .. Q . b .-- ' �Rccoycry ` -ft. . . ..Et.. . . • D el�e,�� ..�t�K • Injection Well; . . 11 -ft ft . AquiteY Recharge LJGroundwater Reniediation . • . • A uifeI.Story a and Recove i 19 SAND/GRAVEL PACK(if applicable) •; .q. g ry Ei$nlinityBarrier FROM•- TO'• ' MATF,RIAI. EMPLACEMENT METHOD . "1 Aquifei TestStortnwatecDrainage, ft. R. Expert rental Technology • 'OSubsidence Control • • • •- : ft ft, Geoth nral(Clo Lo sed op)' Q • Tracer - .20..DRILLING LOG(attach additional sheets if necessary)' ' FROM-- •TO DESCRIPTION(color,henloess,soitl pe rock t ,groin size,etc.) . Geothermei.(Heatmg/Cooling Return)• Otber"(explainunder#21•Remarks): . nQ 4:Date W¢I!(s)Coinpleted:�I��[ Wel!]t)# �i5 �.. . '��Ti t� ]r . - .::.i • ft tys it. w1.I Ric $a.:Well location: • LTC-7-tr, Jg�-.. . Go,IL . •• Le/MA;OA e . .-.. . . � Fa iliylOE•ncr.Name / Facility.tDO(if applicable) ft. ft.. : - .9 I O6 T S: ft. ft.• . • -•'T ,.: :• { Physical Alddnss:City.and Zip • : - . . . .• IL •. .. ',.,it• .'L, .a.:_ ".-. • v:�.I F- :C .. .. o , 1 c2� .. . County• . . PatccPldi:ptifiaation N).(PIN)" • _ :.21,REMARKS • • :5b..Latitude and'longitude in degrees/minutes/seconds or decimal degree's: • •• • • (ifweil lied,one tat/long is sufficient) • j • 22.Certification: : • • W . • 6.Is(are)the well(s) ermanent ' or [)Temporary • : :Signature of Certified Well Con eto . • •• De -. - : - ' •By signing'la's f, I beirhr c erl .;thug the ivy/I(.c),a as(were)ern Ira led in action dance ' . 7.Is this n repair to'an esistmg well Dyes: .or ONo. utlh 1SA.A'CAC 02C.0100 or LTA NCAC 02C.0206 hell Coaclraction Standus*L*and that a if Ibis is a Limit,Jill oat kiionn well.corestrtrclion itpbrntation and eaPlainthe nature oftlie .copy Wilds record hue hem prvrid.ed io.the it'd,owner: . . repair rind"e#21 renrurLi set•iign or on the hack cif this'fin,,,' ' :•. • . 23:Site diagram or additional well details:: - 8,For Gcoprobe/DPT er Closed-hoop Geothermal Wells having the same' You May use the back of this page to provide additional well site_details orwell:. construction:onlv.l OW=1 is needed. Indicate TOTAL NUMBER of wells. . . constriction details. You may also.attach additional pages if necessary: drilled: ( • SUBMITTAL INSTRUCTIONS. ii • • i 9.Total l'ell depth below land surface: / V • (ft.) 24a:For All•Wells: Submit this form within 30 days of completion of well I 'For piultip c im//s•/is:all depths tfdi/ferent(crumple-3(u)200•and•?(d100') : construction to the following/ ' • 10.Static water lei'el below top of casing: • 301. (ft.)• t of W Division aer Resources,Information P.rocessm If irate.Idi 1 is above easing use `+.•' g Uni t, 1617 Mail Service Center,Raleigh,iqC 27699-1617 . 11:Bore ole diameter: (7 (in.),J y 24b.For Injection Wells: In addition to sending the form to the address-in 24a 12.Well oristlaction Method: ► del 1• i above,'also submit one copy of this form within 30 days'of completion of well ' • ' • • (i.e:aubter • , otary,cable;direct push,crc.., - • conswctiomto the following:, • Division of Water Resources,Underground Injection,Control.Program, • . • FORM. ER SUPPLY./��'WELLS ONLY: • ' • • 1636 Mall Service Center,Raleigh,NC 27699-1636' 13a.Vie! (gprn) • l• •-Method of test: �. • 24c.For.Water Supply&iniecti1 n'Wells:•In addition to ending the form to. 5.i R -� _ J •the addresses) above, also submit one copy.of this form within 30 days of 13b.Disit fcetion toe: /7 ••i • Amount: 12-0�" .• •. completion of well Construction to'the county health department of the•county • - -, where constructed. Form GW- North,Carolina DeparFment ofEnvironnlental Quality-Division of Water Resources Rn vie nd 1-12-9niq GUILFORD 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:a-. . . Address.of Well 655. .i LATITUDE'3� Welt Permit Number: 25-O 7 "6:; j4 1 .. 0 O 3?9 LONGITUDE Well Contractor Coin an • �, . .:-A q uaDrill, Inc. -: . p y q Completion Date /i-e/ . Total Well Depth I SS . .ft. Well Yield: :30 : :gpm. . Static Water Level 5d:: ft.': :: .Outer.Casing : :Material:Pi ii i C :5 i7 z 2 .�: i � : � F Log Casin Diameter:. �ormation. � -S( ;in,. Casing Depth _S(3 :ft. . Depth � � Description. . Froth•• ft: •To ft l Line Cuing Material : From:.3 ft.'To `f S' ft .: 5�h1C' IZ C K Casin Diameter:.: : in:. Casing Depth. : : :ft: . From:gc-ft.To /rS.;:ft: fli;,e: Gr i �i Zi`ra P •From: ,ft:To:: ft: Grout . . . • .From: .ft. To:_. :., _ft.:.. Depth . Material Method': From:. ft::To: ft. From ft.To O:ft Cew� xi TR cK Fro gym: .ft..To: ft :.: From: ft..To::: : ft. From: .. . ..ft.To: ft. - ; � From` ft To: ft .From: ;ft To: . �'� ft : : . r .. :Water Production Zones Depth `17 ft.:.. : .. ft:. . ft -ft: ft : ft ft: . Yield; 2t gpiri gpm gpm . . gpm rri� gpzri gpm Metlios of.ftpair : •. : Method of Abandonment: ; :`., : : : : 1 I beret), certify that this well was constructed,repaired,or abandoned according to the'Guilford County Welt Rules i effect.on`this date and that a copy of thiS record has been provided to the-well owner:.. Chris King J./Well C ntractor. � � 2080-A � .1 4 Certification#:. . :bate: Record of Pump .Installation Pump stalIation Company:.:Ifrig.ill .'4144 .Z A , - Completion Date g1�141.3 Pump Depth: MO . : ft Static Water Level: 0 , ft. Pump rand:c' 'iie //D(/p . .Pum Size and Rating:H . _ : � P g ;� ��. ;hp LO . gpm Iherebycertify that this.pump.was installed and wellhead completed_accordiig to the Guilford County Well Rules i effect on:this date and that a copy of this record has been provided to the.well owner: : : Well C ntcactor: �. �/'� �P..�s'c'o � Certification#: � � GDate �� l( �3 . Revised:J nuaiy 1,2008