HomeMy WebLinkAboutWELL-07-2021-153606.TIF I,v.a Contractor Inf l
Robert Teague 14 WAWA ZOPtS
FROM TO DEKRITTION
well Coayscttr NUM r b ft. f t' ..f G��
2857•A a. n.
NC Well Cnnht,etot Certification Number iS.OUTER CASING for mold-cored web OR I,110.1 6 1. ' '
inazmiTO DIASETER TNICKN NATI/UAL
B K Well Drilling Inc D rt. �, ft. ft ire In, 6011.21 PVC
Coin petty Name 'IL INNER CASING OR TUBDIAINGMETeotlerfa i TH tiii L
FROM TO
2.Well Conetructlon Permit It: �� fL In, e
k»
Lot all q,pt,nbeflro rU AltCfumn..p ,n n r Ult..L n.np..cia;r I'oriart.r,arc ICKNESS1 In. i.
n. n.
3.Well Use(cheek%ill ule): 17.SCREEN
Water Sapph•Well: FROM TO
DIAMETER SLOT SILL TN ICA PI DA MATERIAL
Agricultural °MumcipalPublic ft. g, le.
Creothemtal(Nwung'Coohng Supply) rilRcsidenual 11'alr,Supply Isingle) fL n, in.
IndttctriaUCommatuil °Residential Water Supply(shared) iL.GROUT EMPLACEMENT METHOD l AMOUPrT
FROM TO MATERIAL
irrigationft, ft.
':Hon-Water Supply Weil:
Monitoring 0 Recovery rt. rt.
Infection Well: ft, fL
Aquifer Recharge °Groundwater Rcmcdiotion 19 SAAD1CRAyEL PACK If a anbk
Aquifer Storage and Recovery °Salinity Barrier FROM TO
MATERIAL EMPLACEMENT M[TROD
Aquifer Test °Siormwatcr Drainage ft. ft
Experimental Technology °Subsidence Control n, n'
Geotbemtal(Closed Loop) °Tracer X DRILLING LOG attach o CRd ssl IITION b as .w aduAca le mat 0,
'Rost TO
Geothermal(Hlating/Coolin)I Return) riOther)explain under 42I Remarks) ft •
.
4.Dace Well(s)Co aypLa D ' D( (-Welt ID# 3 n
S&WdiLoation: ao a g<
f
ae,1 �� _
ft. ft.
•
Faeillty+Owea Nutt i Facility iDa('f a licabk) .
ft. lb
Plinio)Addax,City,and Z.p 21 RE1HARK9
Comm Para)'denudation Na.(PIN)
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: • ' ^ �:..
22 C (i ,'s I
fif+etl fkt4 cox latllono k wiTiciunS ,;
V tiV ,.. r-,
s. 11.11�L Ly,;
Signature of Cc i(c cll Contractor Nag =-_ -
6.Ware)thewell(1) ?°Permanent or °Temporary
By ergo/rag thn form.1 hrrrbc m ta Mat at the t,e11(t1rout. (.err)cumerrechJ At acr,otdAee7
7.ii this a repair to AO cslsdat well: Yes oAft�o nrtl;1 Si NCAC 0.0 010t)tar 1SA NCA C t11C.0200 Well Corulrmchoe,Dattdrrdr and that o • , h
flAlt il e repair,jNl oW#no»e«dI corutruoa ctt ..tformatGloin rhr nature,I(hr cop)4lh/i rK"rd hai lrru prrnidrJ at the�e1f u.uer.
repair under tilt newts teak*or on the puck of this form 23.Site diagram or addiional well details: °•3+' rr -
C x
You may use the back of this page to pride additional well site dctatbt er w .;ei irk
zt
eT nor Geon.colt' pT or is n Closed-Loop I Geothermal TOTAL
NUMBER
Us g the wellssam construction details. You may also attach additional pages if nmsttr)r. , r,,;..
ouaattutxion,t)a}p Gylr.1 needed. indicate TOTAL of +�+
drilkel: ,SUUMITTAI.INSTRUCTIONS
9.Total wdidepth below lead"orrice: f)••CA (R•) 24a.For All Wei: Submit this Nun within 30 days of completion of Well
Foe nufr(pli wlL con ail drpkr if diy4rrw r'etmwplr..1•1100'oral 19107! construction to the following.
10.Statk water level below top of timing:40 (ft.) Division of Water Resources,information Pr ctsstng Units •
` 'fumy.le d1.above mug us...." 1617 Mall Service Center,Raleigh.INC 2769944/7 •,1
11 13trnbole diameter.6 I/O on.) 24b.For inlac(inn wrnit In addition to tending dto Point to she addles*in 24
Alf Rotary above also submit one copy of this tbrm within 30 days titteiMplction,orwell
1i'We9 ventilatba wan: consruction to the following' °
i O , t>.b4 dwq Ptah.nc.l t �"
' r motto of Water Resources,Underground Iojttepon Ciattroi frogrun.
I'4, ~.is !DVWL1d.S ONLY: 1636 i1UU Service Clete.Raleigh.NC;T4994636
r ! ricao` 4,0 Av.FIOW
Method*rust: 24c far 14'atrr Sim oh'ik_lnllisllon}YaiJ,tit,.to t +!1t+Qnt lhtf?WO t4
, the aildteaa(ta) abnC. also subunit vac copy 014%4 Arm wltLlo 30 d� or,
.,, AatouN: i VI Ise completion of we11 eonatructlptl to this mop/)Haltlt depastmint.of tbi county
t �; Ctlla Teba
t...ii.j's.? 13►IPII> »Aafacof►stn>,ttxi.
nt,, . .
si
A ,14 r s North Caroiw Depuotttwl at Ea+troetrn Qtal Inn r,pl+ a(11slat Rw,atct.;
, ct 1
t
- '?1.-