HomeMy WebLinkAboutWELL-08-2023-203215.TIF Catawba County Environmental Health
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Copyright 2023 Catawba County NC
08/18/2023
WELL CONS'VRUCTION RECORD(I;W-I) TnI Titlrrun )It.�..._,.._.....__..
el
trfInt —
I.Well(bntnctot Infnrnutiont
Robert Teague .....
Well Comrwsrta Nana YI drat UI p)►i iP II1
IS ail ,�
2857•A 'I ° y''�
NC Writ l'nntisetm Ce'Uflcalion Numb et
W oh
8&K Well Drilling Inc P C ! t ) " ,i A., 4 .
Comma'',Name O n, n rM I". non Jt Pvr
2.Well Compunction Permit.a.0.1*ab,....._..._.._.....:.... .... u000 ,„Olt li't .. ..!art'.
Lb(dl Applicable well;wun welkin pNieutarir IOC,I'uuntr,Sir. I'II Will..en) h. ft. in.
3.Well Ilse(chock well useu n. n, in.
'Water Supply Well; t,1 b4N$IL'
nor4.... Pi _ .... ".,It rem ! JfU. yf'! ."r 'tcs;
ill A cultural [0Municipal(Public ft, n, In.
•("irothet nal(Heating/Cooling Supply) ®Rvaulennnl Wine'Supply(sing* ` " it, n,, In _ " ' <_. w. . _._,
•Irlduatrla1/C,`omttiorclal OResidenlial Wale'Supply(shined) a ^1 °^^ .- " '""""°"`"'"" « ' "'°'°" '
irrigation (
''. :-.21,L----_. 3161164C:,11
Ntui•Water Supply Welk -
n, ft.
■Monitoring ..,.-....�. ...«, ..
njerifon Well; IDRecooery n. - ._ft
■Aquifor Wargo ft. it. .
Dig umdwatoi Itcnicdialiun
■Aquifer Storage and Recovery t g y ❑Salinity Battier ick, )t�, � (kbSif A�),.•.,«. f
•Aquifer Tent �!itutrtiwatrr I)inlnngt• II, «fi,
t::xperinirntal Technology OSuhtulence Coiniol b. It,
•(itothrrmal(Cloom)Loop) [Tracer n (fit tN �1G utat aII I4I a h, ►
•(ialthermal Ileniltt.Conlin: I(etuni •tidier ex dent tinder 971 Rentatita I n'r'r,.r- i - - °!a' twr :.,,tie r h niV u jeC t!1".. "•.) ,
/.Date Well(s)Completed:t 1 j`•t ')%1 Well IUN t�n' (t:iss n (,(,(A r)ct.-11/6- - ,_OS'. cd'„'
..�7..al .Q; .+y 1..�1-p} »•'
Si.Well locations 5,h_. .a�S tr )i y 1 f`_-ti ....... ...
PacilstyfOwner Name yFacilny Iiie firapplicahlcl n. ft. __. ..... �«.,.�. . M_..
0 3 .1 . c.7 V.C1J-c_.
Physi.al Addreaaa,Cay,and lip n, h.
c.� bGs (���'�L� L Y> 21. . A _ �w
Couniy I'sicdfdcuHnraitnnNu il'ir. _...._..... .,. . .,«..,.. —..... 1
Sb.Latitude and longitude lu degretalndnutea/secalds or decimal degrees:(if wall field.one IaVbna is aufflclenU 22.G 4en. Inn: "-•1
6.Ware)the well(a)0Pernaanent or °'Temporary Iaaa147a of I Lfllncil Well Contractor ly.i.
h?!(going thi,Imes.I he'r6i rr70'that ihr+41f0 nal(erne/runrliniled In anvrdua.:•
7.b thle a repair to an existing well: Yea or No AIM I)A Ne,ec etc.0100 or 1),i WAG'OK 0100 11411 Cantmtuton Standard'and ih,t a
lfMu U a repair,flit out*moan soli eonsnlieitnn mfwinallun o .Blip'the*Mae id the "'Pr r'I"'"I'd Stu Bern p"'nk1k4 is rhr..it rn.nvr
wall whit,ell normal s.CIlan or on the back of this form
13.Site diagram or additional well details:
8.For GroprobelDPT or Closed-Loop Geothermal Wells having the some You rosy ute the back of this page to provide additional well site details or well
construction,only LGW-1 Is needed indicate TOTAL NUMf3F.R of wells cunsuvnion detail!. You may also attach additlortal pages ift>ecsnaary
drilled: SUIIVtirf SPl[I111jy+S
9.Total well depth below lend surface' (fi) 24m. j(u.AIj„WeI(Y: Submit this form within 30 days of completion of well
Foe'multiple Melt LIM all depths(f Jeerer',r.ianple•)yj-lee'and 191007 cortattuction to the following.
10.Static water level below lop of csshtgt 40 (ft.) UhWon of Water Resources,Information Processing Unit,
tfamrr Gwl In ebony<a,,..s am"✓' 1617 hall Service Center,Raleigh,NC 27699.1017
II.Borehole diameters 6 1/8 (in,) 24b.yor 1Nertiult Web: In addition to acndiug the form to the sddreu to 144
Air Rotary abate,also submit one copy of this fonn within 30 days of completion of Neil
12.WeU construction method: _ construction to the h'llowiog
0,e.eupr,rotary,cable.dole:push,etc)
Division of W'nter Resources,Uudarground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1036?fall Service('enter,Raleigh,NC 27699.1636
13a.Yield(gpm) Li. Method or lest: Air Flow 2.1c.j'or Water sr/WI is lntestlon Welij: In addition to'eliding the rune to
the addrcas(es) above. also subunit one copy of this fhnn within 30 days of
13b,Disinfection type; Chlar Tabs Amount: I Ill Lb. completion of wall construction to the county health department of the Wilily where constructed
Farr GWI South Catotirn Ucpamrpint of hotiromncnul Quakily-Donlon of Willer Resnwcca 0evoed 2-21•Jpio