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HomeMy WebLinkAboutWELL-05-2021-150977.TIF 1/20/23,4:19 PM about:blank WPDT Report Area of Interest (AOI) Information Area : 3,134,508.72 ft2 Jan 20 2023 16:18:53 Eastern Standard Time if f • • 11-111 */* „fr v ,win vir" 1:4,514 Parcels(Polygons)-Parcels ". Projected Route 0 U 03 U 06 0.12 m 1 1 1 5 ti ti t Non.5ystem Roads — Other State Agency Route 0 0.06 0.1 0.2 km — Federal Route — Secondary Route Non-System Primarf Roads Otter System Roads — Interstate e. o+r t cra+eW.a roast to.w srd:a ar way Cihnva. OUT 4 Op.r911.00460 Mum* Evl MERE. O.nn 6s.GAan Ramps Rest Areas,Non•Mem4ne — US Route G.oT�v.oy«,Ire.WTtaysA,usos,CPA nos US c.a,�. s�.au USDA NGOOT GIS UNI Sancta EP, Moue DS USGS.NGA NASA — NC Route about:blank 1/2 1/20/23,4:19 PM about:blank 4059 JOE CROUSE RD, MAIDEN All North Carolina Department of Environmental Quality(NCDEQ)GIS data is expressly provided"AS IS"and"WITH ALL FAULTS".The NCDEQ makes no warranty of any kind,express or implied,concerning this information, including but not limited to any warranties of merchantability or witness for any particular purpose.The NCDEQ assumes no responsibility or legal liability concerning the Data's accuracy, reliability,completeness, timeliness,or usefulness.The data is not intended to constitute advice nor is it to be used as a substitute for specific advice from a professional. Users should not act(or refrain from acting)based upon information in the Data without independently verifying the information and obtaining any necessary professional advice. Users are solely responsible for ensuring the accuracy,currency and other qualities of any products derived from or in connection with the NCDEQ's Data.The Data is collected from various sources and may be modified over time without notice to improve spatial andattribute accuracy.The NCDEQ disclaims responsibility for the spatial accuracy and attribution of GIS features and makes no warranty concerning same. about:blank 2/2 • r •f'.'�{':ter ii7E;rf..k'd�1�3GY"y� WELL CONSTRUCTION RECORD (GW-1) Igor Internal Use Only: 1.4+eli Contractor Information: '1e i( un .'.'14.WATBRzONBS':::...•:':;`' ., A` ,;sni:,::;... • ,, . Weil Conte/mire.Yo�latcsclo Namev 0 n rscR1PflON ' ft, 11Sp ft. • sC/'i ''er it, . It. NC Well Contractor Cent tics tionNumber .15i'OU`TERCASIN[3(igrmalit=uuedivllll)OLLINII3R(tif<p ukaole);!.`,-.:=;:74.!,',i . Morgan Well&Pump, Inc. FROM TO DIAi1MTER _ THICKNESS MATERIAL +1 ft, '3 1L 8 i/8/ In' anal pro Company Name + lt�'IkNZRCsASINGORTIDUNd'{{tothViiiii'-1,ditd4uop)t.i•:; r'-=.`.i..: ' , 2,Well Construction Permit#t It""£ 0.S 2 U+4 " i S151?-7 FROM TO ' DIAMETER THICKNESS MATFPuI List all applicable wen mnmuctloe permits(1,e.U1C,County,State,Yarinnee,etc.). ft. ft In 3.WelI Use(check well use): it ft In '17fSCREEN :,._ c.'•r.s;•t;lj,,a:,.r:,l.x> ��<'. ,rr;•t':;_ 1..''1:<'i..: ''279 . Wat Supply Wen: • FROM TO DIAMETER SLOTSI2E THICKNxSS MATERIAL Wgricultural oMunlcipaVPublic ft. rt. tn. Geothermal(Heating/Cooling Supply) csidential Water Supply(single) - (II g/ g PPY) PPY( 81) ft. ft, la. aktdus4ial/Commercial °Residential Water Supply(shared) I,;18:ORODT:•� ..'.':-':,. C;.,.7. :!,`;!';;.M:.3=::; r;: ,P,.'i::r.`;a:;:�':y';'';;:'�;;i •lmgation r FROM TO MATERIAL EMPLACEMENT MKTTROD&AMOONT Non-Water Supply Well: o fa 70 n poured' bentonite poed Monitoring °Recovery • ft. n. Injection Well: • ft. H. jAquifer Recharge0 Groundwater Remediation r :::!.."1:,'-'' t,,;'tf ! .19:SANDIGRAVEL'PACK(r legiglicabl'ei'•.. t•::..t.,., Aquifer Storage and Recovery °Salinity liard RT et' FROM TO MATERIAL eLACGIIENT METHOD ' Aquifer Test QStormwater Drainage ft, ft. Raperlmental Technology °Subsidence Control n. ft. QOcothumel(Closed Loop) °Tracer 828,DRILLI:NQLOG'(itttieli addltion}I etiteti1f he'EasikS).4'.':'';; '-: 'S«'.:;; ice'.' I Oeothermal Calla Coolie Return) Othet'(explain under#21 Ramadts) FROM To DESCRIPTION(color,hardness,sett/rock typo,train elrq etc.) gc pft. zj fi. 42,4) p,t. r 4.Date Well(s)Completed: 42...5sz` Well ID# p vf• a it' •3 for `w�(�• 5a.WelILocation: u R' bbR' tit;✓4/-5Mr J' �'je4nit ft. ft �/6 U(1/4161 11lo�rt>;,S F ility/Owner Nome Pact ity ID;(if applicable) it. N. It. ft. Physical Address,City,and zip :71i1'RR1 AIRKs"r'x'a:�' .'Jr.: ...i., '.k;• ' :t's.- County Parcel Identification No.(PIN) .. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: - - (if well field,one to nons is sufficient) 1 11 22.Cer cation: /_ J 5i 51 1,5 r N e ' \.\\6 t i t W (/ J 6,Is(are)the wcll(s)16Permanent or °Temporary Signature of Certified Well Contractor Dot t By signing this form,I hereby certify that the well(s)was(were)corutructed in accordance 7.Is this a repair to an existing well: ©Yes or IA No with J3A NCAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and that a If this is a repair,fill au!knotty weft cons:,action infarnwtion and explain the nature of the copy of tit,record has bent provided to the well owner. repair under ti21 tamarks section or an the back gfthin form' 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 construction,only 1 GW-t is.n dcd. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary drilled: ,—- SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 40C (ft•) 24a.you All Wells: Submit this form within 30 days of completion of well For multiple twits list all depths I./different(example-3®200'and 2®l00') construction to the following: 10.Static water level below top of easing: d (ft.) Division of Water Resources,Information Processing Unit, (f water lerel is above casing,use'+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 6 (1n.1 24b.For Infection Wells: In addition to sending the form to the address in 24a ^{ ,) above,also submit one copy of this form within 30 days of completion of well 12.Well construction method: / , 1 t7 r 1_ construction to the following; (i.e,auger,rotary,cable,direct posh,etc.) V Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY LLS ONLY: 1636 Mall Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm)SUPPLY Method of tent: air pressure 24c.yor Water Supply&Inlection Wells.: In addition to sending the form to 1. n the address(es) above, also submit one copy of this form within 30 days of 13b.Disinfection type: r$rlt�� Amount: 0 ` completion of well construction to the county health department of the county where constructed. • Form OW-i North Cerollna Department et-Environmental Quality-Division of Water Resources Revised 2-21-2016 1 WELL CONSTRUCTION RECORD(GW-1) For Lmternal Use Only: • I:1i \ eliCon actOrinfot,nnNo�u:/J�CJ lw/����) l e!I ;14:WATER ZONES<'r.: �".;61:;�:::;�`,;:. WoIj,FOnUncl ern biFilO P. TO� ft. DESCRIPTION !F✓/~ SS �7U ft, rt. I NC Well Contactor Certification Number ,::,.,: INC licablo) :�i;�-i:'.,. ; .•...:,;!:. Morgan Well & Pump, I VC F hl To DIAMETER THICKNESS MATERIAL � • 1111, " 61/8 lit• sdr21 PVC Company Name `::::::............, ,y�.y / +�►,C +� '°16.1NNERCASINNG'OR TUBING?ieotherinaldoted-loop)'+,:: ;i:,..:;::.i,N...:*::`:,-,;:.:,::: . 2,Well Construction Permitii: !Veil"-OS~2Il SIN , r f FROM TO DIAMETER THICKNESS MATERIAL List all applicable well construction penults(i.e.U/C.County,State,Variance,ere.) ft. ft. In. 3.Well Use(check we/1 use): rt. ft. In. Ware Supply Well: 17.'SCREENs: ;"( icis;.;. :..a:...........a::.. <:: a;t {:;:_::;t:':r::.:.: rn y PROM TO DIAMETER SLOT SI Za THICKNESS MATERIAL griculturai ❑Manicipal/Public ft. n. Ia, ❑Geothermal(Healing/Coaling Supply) atesldenHel Water Supply(single) R, ft. In, Ulndwb'ial/Couhnterclal ❑Residential Water Supply(shared) ;?':.. :;.c(. ❑Irrigation ❑Wells>100,000 OPD FROM TO MATERIAL EMPLACE 1ENT METHOD&AMOUNT Non-Water Supply Well: 0 ft• 20 tt• bentonite poured °Monitoring °Recovery n, ft. Injection Well: • n, ft. ❑Aquifer Recharge °Groundwater Remediatiou :19.'SAND/GRAYELPACK0f rpptleabte) is:Ei a: ;: ?;;; 5_;•.' . :•.::;;':-.al:;:::t>`: r .: ' ,"t::':;a CI Aquifer Storage and Recovery ❑Salinity Barrier PROM TO MMATr,IUAL EMPLACEMENT METHOD ❑Aquifer Test ❑StormwaterDrainage ft. ft. ❑Experimental Technology ❑Subsidence Control ft, ft. ❑Geothermal(Closed Loop) ❑Truces' :20.DAIhLINGI;OG'anaeltYddlttouilsheetslf riecessa !=:::t'c:>. :: : FROM TO DESCIt ON color hardness,soUlrock type,grain the,etc.) ❑Geothermal(Heating/Cooling Return) ❑Other(explain under ti21 Re arks) O ft. /D R. n , ��� 4,Date Well(s)Completed: ��'l�'"'' Well DO 4 n. [ 0 ft. T' �,� to-1 I Sa.Well Location: 4 v ft. 30 ft, tuck__ frt C�o,; 4 vt'lo rf:5 j50 it. -7,s n. rc• ht:..J t[.aCi---- Facility/Owner Nat= Facility'IDS(if applicable) it. n. 0CeI ,d e. Cr .+Sty,_ ",74,ei a-r• it fl'. Physical Address,City,and Zip R. IL CO - ! k 1/- f oi, i et2,_) - ;21 REMARICs>` . .....rt:::g:,S t::: 'tti'i '.`•'}'`-(i". `;L;i,;;( County Parcel IdentificationNn•(PIN) Sb,Latitude and longitude ID degreeshninuteslsecwuls or decimal degrees: (if II field, lid/long I sufficient) � �.� � 22,Certiflc don; �,J� (�is N , t S `y 6.Is(are)the well(s): l 1Pertnanent or ❑Temporary Si a of n eel Won Contractor D e By signing this form,I hereby certify that the well(s)tress(here)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or CINo ISANCAC 01C,0100 at 1.1A NCAC 02C.0200 Well Construction Standards and that a copy Olds l:a repair,fill out knotty well construction Information and explain the ranrre of the of this record has been provided la the well owner. repair under till remarks seem or on the back of this form. 23.Site diagram or additional well details: 8.For Geoprohe/DPT or Closed-Loop Geothermal Wells having the same You may use Me back of this page to provide additional well construction into construction,only 1 GW-1 Deeded. Indicate TOTAL NUMBER of wells (add See Over'in Remarks Box).You may also attach additional pages if necessary. drilled:t Y 24.SUBMITTAL INSTRUCTIONS ?� 9.Total well depth below land surface (fl.) Submit ibis GW-1 within 30 days of well completion per the following: For multiple wells list all depths If d ferent(example-44700'and 143)1003 2 24a. For All Wells: Original form to Division of Water Resources (DWR), III Static water level below top of casing: (ft.) Infomhation Processing Unit,1617 MSC,Raleigh,NC 27699-1617 If enter levdf is above casing.use•''r" 624h.For Injection Wells:Copy to DWR,Underground Injection Control(IUC) 11,Borehole diameter: (hh,) Program,1636 MSC,Raleigh,NC 27699-1636 Rotary 24c•For Water Supply and Open-Loop Geothermal Return Wells:Copy to the 12.Well construction method: py (Le.auger,rotary,cables direct push,eta.) county environmental health department of the county where installed FOR WATER SUPPLY WELLS ONLY: 24d,Far Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA 13a.Yield(gpm) Method of test: air pressure Permit Program,1611 MSC,Raleigh,NC 27699-1611 : 13b,Disinfection type: 5 '1rl-i 4:r Amounts I Form OW-1 North Carolina Department of Eavlronrneotal Quality-Division of Water Resources Revised 6.6.2018