GW1-2021-00574_Well Construction - GW1_20210224

WF.LL CONSTRUCTION RECORD �l v
1.\Tell Tontraclnr Informadon:
Virgil Wilson 14.WATER ZONES
FRtI\I 111 Il RIPE ION
Vl dl t'mm�f:nn�,;mc ft, ft.
4473 ft. ft.
\I \\dl l anu xdn;I'a Infi cans;; 111.:1 15.OLTER CASING(for!!0-'me d seeRS OR LINER i/• ' able
Hi TO 17011-IER TIII('K\Ftiti NIATFRIAI
Parratt-Wolff, Inc. ft. ft.
I ...... \;f;,... 16.INNER CASING OR TPBING eolheencal dored4ap
MOM In
DI\MFIT]t THI("KNF58 NI\TFRI\I
2.\\ell(m,lrudum Permit d: 0 D. 20 R. 2 tv sch40 PVC
r dhl; ;,OI. ...., v,,.f s..m. i.n dn.. .,� -
ft.
3.\Nell I leheck xell use): 17.SCREEN
\\Ater Supph\\'ell: FROM J to I DI\MISER SI.OT51/.1' 1'HICKNE' \1N1IIRIAI.
\_nculuu,d -\lum<Ipal Puhll; 20 a. 30 ft' 2 in. .010 SCh40 PVC
SupplN) -Rc,Idenu,d\\,u<r Supph la"ole) n. R.
-finnhcmral lllcurnc Ca,hm� t
n.
I11du9tnal C nrnmerrlal ❑ReslJenual\\Ater Supph (,hamd) 19.GROOT
FROM I TO M%TERIM. EMPLM'F.MF.NTMITHOD3.\\IOINT
-br,aa ton 0 R' 16 ft- Portland Cem Tremie
Non-\\'ate.Supph'\\'ell:
7Norrnonne ❑Rc...... 16 D. 18 f- Bentonfe Chil Tremle
Injection\\ell: ft. ft.
--\gmlici Recha al -1(iruendl,,w, Rrn\cdmtmn 19.SAND/GRAVEL PACK RA aN<
FRO\I TO \I\"RI%l FNIPI.\CF\IF\TMFTHOD
--Agwlir Stumpe and Reco,en -Sahna, Burner
18 R 20 m' #1 sand Tremie
->yuiier l cst -Snxmv,mrr I7ramacr
n. n.
I'Npcnmcnod lichnolo� r'SuhsiJcnu-C�ntrol
20.DRILLING LOG au ela
CGruhemal(Clu,rd LaOpl ClfuCrr FROM TO DFSCRIPI0% color.hArddnreas s.smLrvckrt e. ¢.)
=GeoLhennul l l lemurs Coollns Return t COther(eN I:un under R21 Remarks) ft. R.
O. ft.
4.Date\\'rills)Completed: Z-B-Z 1 Well IDN P-29
n. n.
5a.\\'ell Location: ft. R.
Granville County ft ft
Fv.Jn.(I„ncrAanl, Fnahn ID-1 t""I"ahl" ft. ft.
6584 Landfill Road, Oxford, NC 27565 D 4 L
Ph,a.al Wdfss.( ,I and Lp
21.REM ARKS
Granville
I-auorc Pmccl IdrnullLnn('n.o 1PI];
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 Certification:
ulndllieit I,Ln.long u>eHi ,,nu '
36.371349 N -78.616866
Yl (s✓C 10
S;enalrne.1 Ce;;Itc�0.el�l
6. Is(are)the%'ell(s): ILPermanenf m LAenlporan if, „enllfc 161, h,.ol. I hr..b, ,. Ot dnu Ih, „rllr,r, „. ..,.,III, ,d II ,.Jame
,,uf,IEI A; I; ICr' ('1"",,.1 1 A, I; If u]an 1Evll l,,,nvn✓cur TemJerl,.md Miele
7,Is this a repair to an eNisting x ell: ❑Yes or ?\o L"'; gnn,...,,.dhe.
U rho ,.I rrp,ur.l,if,nu A...... ,..II.,unrr...uenIsb.rmwnnl.unl,rpleul Ih,umore
.elwrvmJo heal,41hr,I„oII 23.Site diagram or additional%ell details:
)oa m;n Ilse the back of this page to pro,ide adds"nal well sic details of ,yell
R.\umber of%'ells constructed: 1 LOrIal cone detnll, You ma, also attach aJJmonal pages fl nrcc>san
I-,.mnlnplr npe.m,n ar n,ul eI.-. ,upp1, n eu,0M I'n Ih Ifm'mme:unstrucrinn.r,u,wn
nhm,n n;.I...... SI-R\IITT%L INSTCCTIO\S
9.Total well depth belim land surface: 30 (ft.) 24a. For All \Wells: Submit this form within al dv\s of eon lawn of well
I„rnu.1,4, "l,I",'did"W"I'd...-.cur naunlple-q a'I',I cad'a lou'l consttudfon to the lulloomc
III.Static%ater Incl bolo" top of rasing: None (R) Dnision of N'ater Resources.Information Processing l nit,
1,nm..I...I„uh,,........,...I„ 1617 Nail Senice Center,Raleigh,%'27699-1617
11.Borehole diameter: 2 (in.I 24b. For Injection NNell,0N1.A: In addfDun Ia scrdlne the tLtm m the add.... In
8 1�4 f'LSQ -sga aho,e- also subnla a cup, of all, totalv"thin 7o d", ni wnlocto n of wilt
we
ll ell construction method: cuneIlUelloo Iu the follos"n..
I, IUI_IT II v able 11u1:IPmh Lm
DiN ision of\Ware.Resources,I-ndergmmnd Injrcdon Control Program,
F(1R\\ \I R SI PPI.1'\\KI I S,ON I: 1636\fail Senice(enter,Raleigh.N(C 27699-1636
13T field(gp... Netbod of IeeL 24c. for\\ale.Supph S Injection NN ell,,:
VIsm whmlt one copv of tills lunn svlthm lU da,s of annplcuon of
13b.Disinfection n'pe: - AmnunL sell amsDuaiun to the countv health depalowent of the countv „here
cnnsttuctcd
I...... o't ono l"'I,l"d uuwl lie>,.uf ce.-Ufu>fon of AA.ne; R..oume. R"I"d Auuml_Ill:
it