HomeMy WebLinkAboutWELL-12-2021-162774.TIF IPi ACI wet! k'BPf if- ?cat- 3Y2%
Catawba County Environmental Health
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Parcel: 367804625555, 3153 TIMBER RUN LN 1 in=40ft
MAIDEN, 28650
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the independent verification of any data contained on this map/report product by the user.The County of Catawba,Its employees,agents,and
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Copyright 2021 Catawba County NC
08/02/2022
"EiI (Q STRUCT-rp�RECORD(G%% 11 1 Fn:Internal lase Only-
I.Well Contractor I.formaaoo: I
Alfred Kiesling Sr I
Well Cotnnctt=Name FROM I TO , DEaCRRTM
2670-A n. /,7 rt. i /' i
,rt I��5 rt. p 5-'
NC we CnMnctnr Cmfiunon Vumtxr
B & K Well Drilling Inc `1,'"`T R�`Cgarm'�meet P 4!LLR > )
FROM In i 11..AMfrER TI(Ir-AvE.ry LMATf RIaL
eompanrlsine 1
0f_'! 15I• 161i4 10. 1SDR-21 'PVC 1
.�r,r
;16 f•1f.R CASING OR 1171NC_pew►eetLsal elan di.p) I
2.Well Construction Permit R: (.' 24 1 —t 6.27 1 ii 1vO4 to 1 DIME Rut 1 111lCk%GSJ 1 MAI ER1uL 4
14v n l appLcable l toiunuraow orewi.Li t t L'IC t:a,w:n Stnv 1 e^or;t e.; I ft ft I is I
I.Well Use(check well use):
ft ft I la. 1 I
Water Supply Well: 11 I1-SCRI N f
OA ultunl 1i O`l I TO DI�NETER (LOT Sill j TTteck%tcc I seOTERi.L i
�` �0M�uiliClpe Pcbltc i ft. ft re T 1 I
OGeothermal(Heatiiigi(ooi ig StpDlyl r74q:Cential Wate Supply(single
tr. ft. III. f 1
Ctudustnal'Conuuerclal CResidential Wee-Supply(shared) I 1
18 GROIT
Clnij;aion CWel)s>100.000GPD ' FROM To ; MATERL.L i EMLPLACEMENTMRUUDi•NUN? I
Nun Waeer SupplyWell: I '
0 " 120 f` IBentornte (Pour
Clfointonn1 ORcaoscry ft. i ft.
Injection Weil:
q I ftfr. 1 I 1
CA uiht Recharge O(rmuudwate,Rrnsadlation i
CAgwfer Storage mid Rex I Pi.SAMSGRaoT l P.aCX Fd roonbfe) ,
Recovery CSaltmty Barn 1 FROM , TO 1 MaTERIM. 1 fNPLACENf.YT Nfllilq I
CAquifer Tat OStormwater Dntaace ft.j ft. l
OExpenmental Technolog3 OSubside nce Control ft. 1 ft. 1 !
OGeo :Tracerul(Closed Loop) :Tracer 1
f m.DRILLING LOG(attach sidNi.edaiscb r.rcesve) -
C(ieotCtdTDal(Heatule/Coolln¢Return) OOthe!explain under=2I Remarlal ( ft. TO a. L— emus us a„etanz ekrape ._�
4.Date Well(s)Completed- ' d 3 74Well 1Drr fy
!S'tr. I} it . 0it, I
Sa.Well Location:.
I s ft. I !�,} it may!y 0
Yl e,14 vA LL L J I ft - /� �r /y—,
Faa TlttyOrsne•Name Fac,1•rs R):of tppl'cable' ft. ft f�---j
r h• tt f
315.3 n.6.,.� 3.1,..... f►LL - .C�:').N II
CPhyoc i Address.C,fvf.-a,d 2,p �rf Q�(L'/ �e C I ft. 1 ft
a C 1.�['a t� 364 { O i'J'7fI Y J Itl=.l. _IEmARk-s
C ouars . ?,.^cal Ickon!r ta,O No cPU.'1 I
(5b.Latitude and IoniNtk in degreeaJminateaisecundt or decimal degrees: t
Wren tick,one lei/long,a tuK,cicm! 22.Ccrtrfi Q� —
..4...
N
W
6.'stare)the wdl(s): )Per,oaaent or 'CTemporan b:±—a• offer:is Neal Coa xro: vSu e
.a.,r+;n•n.;'e.t10,,e 1 ile•ea•,r-rr,1'uet!Re.e;lyl rai 1.e^el.,.r!!:di'e..^.7,.t.•••..♦e .
7.Is this a repair to an taistiog well; C Yes or .!..No '.,4 VUC 02C 1/A'0r;5:%CAC 7,7C n.on RiR Col.•,u.7w.y.0141,43,;,.i:u•a",
If Mu It a repai,.1,/I nu,kno•r rill.oneir,n reran:n(onwa,.nu and',NO,Memiss,,.or,M. r(r^.:.'cce td hc,Min of•did in,h..re o„Rre.
'emu.ride*2,ee•n,rrkr mitt,0e on the bock of thu for..
1.Site diagram or addrtsoital well details:
S.For Geoprobc/DPT or Closed-Loop Geothermal Wells having the same You ma) use the back of this page:o provide addiTu veal well aons:rtet:on,nfo
construcr.on.only I GW-1 is needed, Indicate TOTAL NUMBER of cYII; (add'Sec O er in Remarks Box) You Ina,also anach a,Ltm:ni.a N.:" f-iaesacs
drilled
�n•//i 24.SUBMITTAL INSTRUCTIONS
9.Total weU depth below land surface: LlL 4.,r In.)
f.n eslnpn. ,ilia/us ed/Jepth,fir.,netrnr(,.ample-;,c;pe ;,air;c.'h) Submit this GW-I within 30 dais of well eompkiion Pet the follow mg
I0.Static water keel brio*top of cuing:40 21a. For UI W ells: On':nal torm to Pn isiox at N air I;c, e.' i;"N
er
:t.,er.tett(u.,r,•.e,nuRFwe • .) InforrarO Pr,v +s.nglauL:oltA1SC.Rrlelch.K(:'ow-.e:'
11.Borehole diameter:6 1/8 tin.) lib.for Inlabon_Wells:Coos to DWil Jnangnoma inin.'u.n l:nao. ,(:C,
P:oTam.Ie3o MSC,Ra,e t.Nt_'o99-loco
12.Well construction method.Air Rotary
Ise super•oav).cable.dnec•nu.n.etc I 24.Foe W ata Suppts and t pen-Loup Ceotbrrrrial Returw Urn, tau to:r.
_ Counts en, ,recent.,,fie.ilfh department o!�e:ounrs water m...lk.
FOR WATER SUPPLY WELLS ONLY:
7/� 24d._For\later%%ells produa_o..user 100.I itO GPO'C o %1;."4 `�, 1
13a.Yield is VGA Air Lift Pc''ril l'Ti.,aan.•Ink l\tom.RA'e.ght \l ' ..`.-I"..l
[RD )_ Method of test: _
Tb.D1aln1«naR t,�e, Chlor. Tabs Amount: 1 1/2 Lbs I
lFin in 1�1k•i 1J1411 rmmlam_'-Tani:w:a at L:n t04.no ti,,.ahr, I.,u a,a:w Li,.A'.....,.,. .. .