GW1--06630_Well Construction - GW1_20241108

WELL eiNSIIRIICTIONRECORD(GW 1) For Internal y:alUseooi - ..
I.Well Contractor Informatioei:
Ganj Thompson •
•
•ttiw�sRzttr>es:: :. - .
Nall CanrmamrNo® soot m- • nt�raire , i -
. 4418-A •• - S. EL (NO EL Fra►Ltor ! .:30 (rpm
f NC waueaeheeteeee,tt&eetianrFoabm IOS a Igo- a F•r actor ' So • .&P M - •
. - 16:011TERCASINGObr�fnd .iceRO RLINER"Of_"-&alde): ._::.:
Aqua Drill, Inc.o .. ROM 70 55 nuadl MATERIAL
Compsny Nome• 0 iz bt(y III SDR ai PV c
2.Well ConstractiomParmi & 24-06'w mile-.0063r1 m To n ASING Gmmsfficm° '�elesetlatal``'iA. -'-:,
Lesta1l opprreabreuaDaomauaranpannes(it wen always Sate.Vertanee ate) ft. _ ft. Ia.
3.Well Use(check well use): ft. fr. in - -
-
• Water SupplyWeY: •II 17'SCREBN_.
Ageitatittual �M�ieipalt�eb>is sn0Ma TO intaisims., citrus,= -iiiniraiss mum.-
111 Geothetenal Mealiag/Cooliog SPAY) .`II lte4identiel WatecSupply(single) fo• eL in.
I. i Guoeoercted [ResideagalwaterSnpply(sh�) :.1�GRotIT... s. :-- . :; . _�'•.'; •--• •-
FROM TO ara einu.i mitiarrtreteoo&mote=7-
Non-Water Supply Well;. , 6 ELa0 a Cones-C Canatt4c ryaW.
RIR *Romany a it:-
fnjeclionWell:
it• , "RechargeDGroondwatcrRancdiatioa • • _ rt.
•
gue&rStorageend Recovery °Soli*Hamer seto Atvn! vBLP�iCB�TRRIAL ---.. : • --
ecomacsatmernteratto •
• I Aquifer Test
Stoan+vaterDrab,age3 a. a
ae 4 mental Technology DSubsidence Control ft. E8 '
IGemheunol(Closed Loop) OT ccr. "20.DRILL.tNGLOG(attieLmedtbaileheersifnesiam)- -
Geattemml austingiceplinsReatm)- f OHteeromptamunder 2I Ramadts) FROM To ossaUtonna ee®;eaaaea,,oam+ncvmemraemaet
R it;
4.Date wdi(s)Q:omptete4: 10-ag-aLl wen mg S $ s O 1a: R c k,r
dn..Well laeattoat � � _ r^( Sandy So;I !
So SS Bloc 6erdtae-it
He-i4o.g e H o+nnes. SS a I LIS$ g l 4res clot r • �,,
Rtailityltle nee- tuce 'RialtoITINifap_limhte) R 1 ,T i 'R-<; �� ;t •�
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02S Kwekke Noose Ra Wh.�seit NC aria49 a a .
Rostra!Addrar..City.aad2"ip a f NOV 0 o 2024
Gut%ore a1:Y
Cam' PuaalidaedfieafenNo. IG .z:z•, , . --z4-,'.v-.., -..
• Sb.Laetadeand longitudeindegreestroinntestreconds or decimal degreem
(Wwcll fold.a m istRong&sabreot) 22.�rcatione - •
36°5'.18.4; N 11°�" 34' 44.e w
trri----' 1 I h-2.11S-34 .
6.Ware)the weil(A 'er�nmt or DTemparary. Signsiu of • Well Data
9.is this n 4v thtsfaan,!hereby mini&az the villa)um COae)a nsetteedtn aavrdame,
repair �gwdh Dorn or No altoISANCACD2C.O/DDor LTA NC6CO2C.D200lTd Ca S'tmntm+$and that a,- •
• ( a t ire+epao-jplamlwosmnrll rh�amtatlaa eipfalnrhetmtunoldie coNtelkitartrdharbemploal&dratfrsvaaeuer.
taper=fera?)teaa.&raetIaaorwdar ttftdsfata
L Site diagram oraddre nalwelldrn
. B.ForGeoprobglDPTOrcosal;Loop Geothermal Wells having the same Yon ffiy use the back ofthis page to pmvkle adder sell site details or well
construction,only LGW-1is needed.Indie e TOTALNUMBER ofwells• coastruedondetails. You may also attach additional pag necessary.•.
drilled; SUBN11RTAL tNS1RUCT1ON$ • .
'ATofai well depth below land surface: 14 S (a ) 7Aa.Far All Wets Submit this fame within 30 days ForemlGplaua►/;Sod 1 depths faPifocar fp'g(028p�� Dp) construction to thefollOwing: �c0 tefion of wail
- la Static water level hdotivtop easing: 40 (�) Divisfonof WaterRescoraes,fafo:motion Promising
nk
ljmaterferr!ls�aveeostbgate'+ 1617Matl Service Center',Ra[etgTt,NC27699.1617
IL Borehole Camden on.) i.24b.For Waft fal eus In aetdeltaee m sen�dbtgthe form m the addross is 24a a
- A Well eaasteaegoa method: Ro 4ar.( A:r - above.aLso�submit of Sun;Within 30 days of comptation of well
corisourai(wesa many,abb.dheotrash te) I ,
FOR WATER SUPPLY WELLS ONLY: Diatsroa of Wafer Resoneees,Undetgca8 Naceon Control program,
1636 Mall Service `aleigigh,NC27699-19E6 r).
-13a.1tield(gpm) 60 Method DItesP Got I * I ii0r►C• 24e.For Water Sunder&Infection Wells:;In adllon to sending the form to
- o ou the adtiress(es)above,also submit One copy of tiffs Sum within 30 days of
.13b.Dlstiteetion-type: 'N� %-10 �o Amount: I. 16 at. completion of null construction to dee county health department of the county •
1
where constructed.
Ron GW 1 Ranh t otmaEngrnommtofEnvmemmialQuotes-DivisionoiWVaterRemurcu Retitedb022016 -

GU.FORD COUNTY DEPARTMENT OF PUBLIC t iAL
TH
Division of Environmental Health,Water 4,,
ality�Jnyt
400 W.Market St.,Suite 300, Greensboro,NC 274101
+2Z.� 1 .; F C®nstrra Cony Repair', or Abandonment ®f
Address of Well: 6$a$ :vekke souse 24 wr,,,AszkieN e a-Dagq @A`PiTUDE SliL S' 1 to4
Well Permit Number 24-06-WiVHR-0061'1 6ONCI4ME Ince 341 Oct, ��•
Well Contractor Company: Niue. Or 11 In c
Completion Date: IC)-a8-at-1
Total Well Depth: ILI S ft. Well Yield: 60 gpm Static Water Level:- Q ft.
Outer Casing material: PVC SpRa1 Amu& Log
Casing Diameter. 6'/41 in. Casing Depth: SS ft.
Depth Description
i m iu@�CasingFrom:O it.To: 1_5ft. Red h,r f
Material: From: IS ft.To: SO ft. rockl Setr+dy So;Casing Diameter.®in. Casing Depth:-ft. From: ft.To: SS ft. g lu c
From:SS ft.To: Iys ft. h I u c Gret n rf f
Grout From:. ft.To: ft.
Depth Material Method From: ft.To: ft.
From: 0 ft.To: aO ft. Goncctie Co frcic lsuc,C From: ft.To:
Fiore: ft.To: ft,
_ From: ft.To: ft.ft
From: ft.To: ft. From: ft.To: ft.
Water Production&MS
Depth: 8S ft. JOS ft. ft. 0 ft.
Meld:, �,fPm 30 m ."�ft. ft. ft.gp gpm ®gpm t __gpm t pm
Method of Repair:
Method of Abandonment:
•
hereby certify that this well was constructed,
Rules in effect on this date and that a coppthisis record oras been provided to the welloned according to owner.er County Well
•
ell Contractor...41.etAz2A2, ...._ Certification#: 1_ Date: 10-ag-ay
':"7�" lBt'X�PZS+xF 'y?:1.:F.:h„Cee'AC�_yWicE67fJ3iViEirJ=�'��wrn� y.��_.-". _ � _ . —
74.
_ _ -
i1%2]Record of PumpE sta ati nt
Pump Installation Company: u ; i --
Completion Date:_capipy_
Pump Depth: ai ft. Static Water Level:;_,ft.
Pump Brand:_ �ii,s�
Pump Size and Rating: Z hp _gpm
I hereby certify that '• pump was installed and wellhead completed according toithe Guilford County Well
Rules in effect on `r . .t: - an that a copy of thi: word has been provided to the well owner.
Well Contractor ,•. . � ;'
4I Certification :
# Date: /I 0
• 2906_,4
•
Revised:January 1,2009