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Home My WebLink AboutGW1--01591_Well Construction - GW1_20240308 WELL CONSTRUCTION'•RIECORD(GW-1): For Internal Use Only.- 1.Well Contractor Information: , . . '. ‘mmm17.F. "." i I.. - Chris.King. 14:.WATERZONES' • Well Coniractor Name FROM ' • 'TO'. • DESCRIPTION .. . .2080-A. 1 T i '•a'' 1 f.6 ft' .57:6) �e a'.1 ' . • .e. ' .ft..: . NC Well Contractor Cenitica[ion.Numbcr • •1S.•OUTER CASING(far multi-cased wells)OR LINER(if ap licable)' _ Aqua Drill,Inc.. FROM.' TO . . •DIAMETER .-.THICKNESS ' • 'MATERIAL / Company Nome. p�' • / , (� /}�• ' �06.INNER CASINGOR- 6,1(1BING Ierm'St7ial iZo2.l .'1"• •,�'i,li 2.Well Construction Permit J• ',�i V IZ• /{�'�J 'FROM TO DIAMETER' THICKNESS MATERIAL. Lc IY. tt tn.• • List all applicable well eonstnr:61ton permits tie.WC:.Cimino%State.,Variance;eta) 3.Well Use(check well use): • (t: R. la Water S6pply Wclli d7.SCREEN' • FROM' TO DIAMETER , SLOT SIZE .THICKNESS' MATERIAL ' Agricultural DMunicipal/Public tt• In.. Gcothennal(Hcating'Cooling:Supply), Residcntial.Waler.Supply(single). n iu IndustriaUCommcrcial -DRcsidcntial Water Supply(shared) .18:GROUT Irriga(ion' - . • • FROM TO- '.MATERIAL. :EMpLACEMEefrMETHOD&AMouNT i on-Water Supply.Well R, ..�� Monitorin � 2a �t1"YI°i'v',taJ"d' ' '/a't:•�Cg DRecovcry". tt:. R.jection Well• Aquifer.Recharge : OGroundwater:Remediation - :19.SAND/GRAVEL PACK(If applicable) Aquifer Storage and Recovery• •0Salinity Barrier FROM' . To ' :MATERIAL ,EMPLACEMENT METHOD Aquifer Test DIStonnwatcr.Drainage : • R • R Experimental Technology. ,Subsidence Control ft.' ft. Geothermal(Closed Loop), • Tracer . 20.DRILLING LOG(attach additional Sheets If necessary) . • Geothermal'(]leating/Cooling Return) ' f 1Other(explain under#21 Remarks). FROM To DF.SCRiPTtoN Wee;nordaau aoll/rock tape,cr.taats;etc.). - -IL bate Well(s).Completed: 24,-,A •Well ID#' r—E:it* '1.ST . 9. n• f j'6•' !t•. 511)1)a 1?0 cit. d`n t, G't• . • Ss.Well Locatlon: Al O- ft. 1S5..R•- 1 y'J[Jc 61 1/64C ft. tt: . •Facility:OwrcrMune ;Facility IDff,(if applicable): • - • n• �p6 3 Ra ;ertS: fr-�nl�i i.d .PIef4 Y4),.r4: . •• fr, . • • i7 ti—P• • • 'tL) . • -Physical Address.Ciiy,and Zip . Ya *�.C)1 BC .1!. n: . .ft. - AA .1 ; S. oTR./6.VI :Fazz.r .. 21.REMARKS . . , ` c7 County' Parcel Idcntitication No.(PIN) irteetPrtn:iinn Pr,,..o.:Arc 1 tit► . •Sb..L'atitude and longitude indegrees/minutes/seconds.ordecimal degrees: - D ' • . (if well field:one latilang'is sufficient) •22:Certification: ' 6.Is(are)tie�vel1(s ermanent - or Temporary Si lulu ofCortified Wcll'Coatr tor. Date_ . Ri signing thle;frrrn4'f hereht.ceilifi that the Ivc!!(s).war(were)cnns!,isted In uc nrdance • 7.IS:th;s is xep;:it to an existing well:: .Wes: or t��io' ' . :with 1SANC:IC.02C•0100 in 154 NCAC 02C 4200:Well Constrnctlan Standards and.that a •(f dais Is a repair,fill out known well ronstruetion hfiirmation'and a plalu.tite nature o ftue cops'of thli record lies been pranided to the well owner. repair under t:21 remarks Seetlan or on Ike hack of dsir•firm. • 23.:Site diagram or:additional welldetallst.' • • • ' S: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'.- constnrction.only 1 GW=1'is needed.'Indicate TOTAL NUMI3ER of wells- .construction details:.You may also.attach additional pages if necessary. drilled: 'SUBMITTALLNSTRUCTIONS 9.Total tell depth;below land'surface: • _ . (ft.)' :24a.For.All Wells:'.Submit this�form-within 30•days.ofcompletion.of well• 'For muiti'Fe wells list all depths(fd reur(example-3(W20D•rand 00')l(riw1 ' construction to the following: 10.Statc evatei level below top of casing:- . (.J. . .(ft.) -Division.of Water Resources;information Processing Unit, if water lercl is above(wing,yese._+'• . -1617 Mali Service Center,Raleigh;NC 27699-1617. 11:Borehole diameter: • :6; • . • ..(in.) .24b-:For infection Wellst 'Tn addition to sending the•form-to the-address in 24a- .above,elso'submit-One copy of.this form within 30 days.of completion Of well I2.5tiell construction method:' 14-)r e C... .(7 i'.i i . . • • construction to,the following: • '.(i.e.auger.rotary,cable,direct push.,et6.)- . - - - - • ' . -Division of Water Resources,U,ndcrgronnd Injection Control Program, ' FOR'iVA t ER:SUPPLY WELLS ONLY:: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a:.wield(ap;a) ).: . Method of test: i Cj lit. .24c.For Water Sutiph•&.infection Wells:.Tn addition:to•sending:the form to - �•- the address(es):Shove.'also submit one copy of this form within 30 days of: •136.Disinii::tion�ygc: N 74 - . Amount:1 6' OZ., completion of well construction to!the county health.department Of the county . where constructed. • Form G\V=1 'North Carolina Department of Environmental Quality-Division of Waiter Resources '.Revised 2-22-2016 1 GUILFORD COUNTY DEPARTMENT OF PUBLIC HEALTH Division of Environmental Health,Water Quality;Unit 400 W,Market St;guite:300, Greensboro,NC:27.401 Retoi4 Of COnstruktionff Repair or AbaNdotraMent 41a Weil Address of Well:(04;23 )?epii . PA/2:4 P(expiiin4 6in.C4n) . Well Permit Number 2.3 -.,) -e6,14-91.-oc:qe6. LONOITIME Well Contactor Company: tel Q0'.14 Do I Completion:Date:.2 Total Well Depth i gc ft. Well Yield I r .gpm Static Water Level! C0 ft. Ovargir:CSIstmg Material:- 5.12/Z1 I '0 Fteinglon Log Casing Diameter: 6 'Ai in. Casing Depth: 4357 .11. Depth Description From ( ft To ft• lied: (1hay EffirgST Ctigfill2g: Material . From:9 ft,To:I/0 ft. 5iflAirj laace d Casing Diameter: in. Casing Depth: ft. Rem:).1/3 ft:To:ltS.c—ft. 91u:6 6rieboa`. 'Prom: ft.TO:. ft. &dot From : ft.To:_ ft. Depth Material Method Froth: :ft.,To: . ft. Prom:Z_ft. To C) ft. "6 etvoitA3)- re0c( :From: ft.To: ft. :Rom; To: - From ft,To: ft. . Firm: : ft To_____ft. :From: ft.To: Water Production Zones Depth: ) c-ft. ft. . . ft. . . ft. ..ft: :ft. Yieid: Ls:gpm gpm gpm gpm gpm gpm gpm Method of Repair: IVIetliod of AbandOnnient: • i hereby certify that this well was constructed,repaired,or abandoned according to the Guilford County Well ]Ralea in-effect On.t.hig date and that copy of this record has been provided to the well owner; 'Well Conte:az' r: (Certification 0: ? gc_ -A: Date: 2 9 ROCOErd:of Punip EthistaleTtlap Pb.217..c Installation Company: : ‘ , Completion Date: at I. Plimlo Del*: 1 SO ft. Static Water Level: cRC) ft PriMp P1111113 Size and Rating: 3 Al hp: / D gpm- lhe7eby ceiti. y that this pump was installed and wellhead completed according to the Guilford County Well •Rules lit effect-on thi dath an that a copy of this record has been provided tO the Well:Owner. WO Contractor: , Certification 4-Q9 CtO 71-rate ez4:01C00-661 . • • ..:PioisGd:Januatij 1;200S 1 .