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Home My WebLink AboutGW1--07933_Well Construction - GW1_20231208 . WELL CONSTRUCTION RECORD(GAY-1) . For Internal Use Only;. • • • • I.Well Contractor information: Chris King ; • • • - .. . .. ONES ,14r WATER Z ; ' • V.eil.Contractor Maine • • • • FROM. TO DESCRIPTION 2030-A - -. ' •• NC Well ContractorCeniticatiun Ndmlier I• 15.OUTER CASING(for multi-cased wells)ORLINER(if ap licable)• Aqua Drill; Inc.,' • ' - - • FROM • ' .TO - -DIAMETER :-THICKNESS MATERIAL '• _- - • COrli }•.Naatc • .. . _ ft. ft.: I in: .54,1z..2/ a y / N b1� 16:INNER CASING OR TUBING-(geothermal closed-loop) - 2.Well t onstruction Permit#;u3..7.o 7, i =-�a3,3 g .FROM -' •TO' DIAMETER • • •THICKNESS' MATERIAL • • List:d/ape/itahle ir:/1 cnnetruclion permit (i e;Ula Countc'State;Variance,etc.) ', . .ft.' - 'ft. - in. --:3:Well Use(check well use): •. . Water Supply Well;• • 17:SCREEN. ii . . I • . ler S u�a:hi' . FROM TO DIAIIICTER SLOT'SIZE• THICKNESS ' .[IfATER1AL.' OMunicipal/Public ft.'. ft.. • in." Geo:'l--m• il(Heating/Cooling Supply).cHAesidential Water Supply(single). -ft. tin.lustaiaiConunercial . . - :QRcsidcntialWater Supply(shared). . • 1 to-.t o FROGROUT"TO ' ' MATERIAL EMP ENEMY METHOD&A1iOUNT I<a. W tc: Sui)ply Well: • ; `Iv t• 'd't. , ft.. •� IMonitonis .• ' • •. � . . •. . . � -' . . : Rccodcry ft. ' .. 'ft. Injection Veell: • . .. . F.gniferRecharge ' . . . lL4GroundwaterRemediatioo • -• •ft.: ir. : r Aqu"rc:atoraga and Recovery I $alini Barrier .19.SAND/GRAVEL PACK(if applicable)_--. • -: ry .. 'FROM. .TO - ' - -_I .MATERIAL F.MPLACF.MFNT METHOD ' - Aq�if;:r:cst j. Stonnwater Drainage : - ft • :ft:• : . . - : lL".Qeril>t,;tal Technology • OSubsidence Control : -ft I- ft.; (,comer -Id illlased Loop) i Tracer • : I • 20:DRILLING s._OG.(attach'additional heets if necessary)-• ••- -' (ieOCi.r'"1::i',iisating/Cooling Retum)' • ilOther(explain under#21 Remarks) FROM -• 1 TO - • ° iciness,soivreck•••pe,"rain size,ctc:1 - ' FSCRiPTION(color;b - - . - - . ° :fr. ft. t, . •. • • (3 .- - 0 r'i -� ^.Date 1'ell{s)Completed:1� -"� 7Wcll iD# • 1 _ I ' 53.Weil 617C. .'.(]uR: t1 - , CCF:.6!!"•; n , :\j..,.i,: - 1;�,0{ l� -Faciliti.IDi(if applicable) • • ft I ft; • • •_ ° ?fl:•„: t:{. ''{ ;-- cz2 ct • I2 o eiz c /c/ii, '1. d- ft. I ft. . . L'P.�.•. u .8.?ln/3 (�j� ti . Pity liini:Uldrais.C'itj,.and Zip • • • • it. ft: ' V if` ,:d • - - • 21.REMARKS .::. .- :n ti -i2t..i',A . . _ :Coal-ay • . Parcel Identification No.-(PIN) - -. • : - . ' • • . • - • . . - _ • Sb..Latiaide aitd longitude;in degrees/minutes/seconds'or decimal degrees ' ' (ii wcli Auld:-one ladloni iostiffcicnt) '22.Certification:' • • 1N - W G.istare)the svell(s rmanent. .or '},Tein art Signature of Certified ell Contra r •W P 17Date -Bi•.elgnhig ihle•ftrtn,I hekihj•certifp that the ivell(s)no.(nvercl commaied in ac.ordauce . .• 7.IS this a'repair to an existing welt: • DYes-.or ,o 'with 15A•A'C4C 02C:0100 or 15A NC.4C 02C.0200 Ire!!Ctinstrtrriirin Stande dc.and that a. 1f Ihi.•,ic.a repair,.lill oat knn'wn well ctincn•tte11011101a,,nai,on and eyda.in,the natare girlie ' top oft/ii..•Ittcord/ia.heeu ptitridcd in lbe i.e!/oiwter. rrpmlr tinder 42Premarks•sdr•lin,tn:on the back o%hicftrot. ' . .. ' . - • 23:Site diagram or additional well details: •S.For Geopriibe/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 construction:only 1 OW-1 is needed. Indicate TOTAL NUMBER of wells construction details.-You,may.also attach additional pages if necessary.• drilled: - SUB1V[YTTAL INSTRUCTIONS • 9.Total well depth below land•surface:. �•�. • (ft) _24a. For•All.`�'ellsh Submit this form within 30 days of completion of well For f al pie ireldr!lst all deptGs/1 dleren!(e camp/e-3(d)200•an_d 2(ri)l00'). construction to the following: r 10.Static Water level below top of casing: 0 . . • • -- ..Ift:p (f.) Division of Water Resources,Information Processing Unit, ter'(et el is above easing,use 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borcdiole diasisetcr; IP`. (in:) 6 0 24b.For Iniection Wells: In addition to sending the,'form to the address in 24a • 1,2.Well Construction method: A//Z. •.this* •i•I. • above,also submit one copy of this form within 30 days of completion of well • (i.e.auger.rotary.cable,direct pubis,etc.) construction to the following: FOR.WATER SUPPLY WELLS ONLY: Division of Water Resources,Underground Injection Control Program; < 1636 Mail Service Center;Raleigh,NC 27699.1636. 13a.;'lcld(yprn) .J. . Method of test:. s i�' �4 _ 24c •Fm•:Water Supply&Injection Wells: In addition to sending the-form to )13b. _e: 14 the address(es) above, also submit one copy of this form within 30 days of .0 C •completion of well construction to th Dislnfrction type: I7 Amount: e county health department of the county - .. . ivhere constructed. For,:,C'd•-i North Carolina l)rnartmrnt,.f Fn.,ir...........,..t n.._c... ,.----.• r... - GUILFORD COUNTY DEPARTMENT OF PUBLIC:HEALTH Division of Environmntale Health,Water Quality Unit 400 W:Market St:,Suite_300,.Greensboro,NC 27401: Record Of Construction, Repair, or Abandonment.of a Well. - :Address of Well: -2 L/ gp9.e f 5 94A4.: 17d_ , LAT1TuDE:3� :. ___ ______ Well Permit Number 2 3.'TO 7_ 033 . Well Contractor Company: Aaua.DnII.Inc. - • . Completion Date �� /� �.�� Total Well Depth )g$` -ft.: :: Well.Yield. gPm Static Water Level. : _._ .ft.:. . :. Outer Casing. aterial TZ�s 2 I -A r/fc : Formation Log :Citing Diameter 6 Ai: in. Cas4ig.Depth ��(I. ft. - . . . - Depth. "- Description. - From O ft.To 5 ft. 01124 . " Inner•-Casing. � � - Material: ... . From ft To:7S� ft:: Si9)ud Ire Cit:. . -: :. Casing Diameter:: - in,- Casing Depth :. i4l1314 Z ft. To: �' rom �5"ft. ft.. Moe:: ��Z • :From . ff:To: ft. . Grout .-. . . : . - . From ft.To ft Depth� : � � - Material .: Method. From • ft. To ft.. :From:(. ft:To 20 ft . : ( -ieit 4, . IIC From: ;'ft."To:- : f, - . . From ft,:To :ft.. : . From . ;`ft. To ft •• - :: From:.. - ft.To: :: ft. •- . . . : . ; From: - . . ft. To • Water Production Zones Depth ft. . - ft.: ft. ft. : ft. Yield :. .. - gPm _. .gpin -. gprn _ gpiYi gP� . .gPm "'gPm, Method of Repair :.. - : . Method:of Abandonment:-..' "' - I hereby 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 - Well Contractor: - -: - . - • : Certification#: .. 2080=A: Date:/-J-%' 2 q ' : . Record of Pump installation - Purrip Installation Company: ;Pt.--; l , r2 ' - : Depth: � Completion- Date: ��L�.y) - Pump • Depth: :_ I C ft.. Static.Water Level:.. .c C. . ft. - PumpBr .d c�VC; =-.7 `arY . -P100 Y - . . P f mp Size and Ratrng . o� hp. �� gpm : Ihereby rtify teat pump was installed'and wellhead to com leted accordin� P g the Guilford County Well.. Rules in effect on this date d that a,co y t •s record has been provided to the. well owner. 6-) "Well Contractor: CertificatiZT 'f? 1 i).;"t \-):::-'5 : Revised:January 1,20ne