GW1-2021-00563_Well Construction - GW1_20210224

WELL CONSTRUCTION RECORD I,,,IIn„n,l I ,cU.I r
I hu III III can he uxd tin IIn__II I I,,,,III Ip I „III.
L N ell(on tractor Information:
Virgil Wilson 14.WATER ZONES
f RtIN Ttl Dh('RIPfION
\1 dl Cunv:wlor\one.. ft. ft.
4473 ft. I rt.
\, 15.OUTER CASING for nold-raudwe0s OR LINER Ka able
Rlllxl 'r0 DI\\I ETFa Tln('RNFtiS MxTFNl 11.
Parratt-Wolff, Inc. ft. ft.
r-unl pen. \a ILC I6.INNERCASINGORTUBINGIffe,theOn doredacam)
FROM TO DINIFTFR TIIIC6NF5S H.\TFRIM.
2.N ell Construction Permit 4: 0 rI. 50 ft. 2 in. sch40 PVC
.,elf rpplrrenle.yell pn,mr. ,. "n��n. tiem r✓n✓v.,.l,�I..r,.„� u..
D. I ft. I in.
3.N ell I se Ichecb well use): 17.SCREEN
M eter Suppl\Nell: FROM I III DIsMIFTFR SI.OTSIZF TmCANFSc M%TFRl%L
-\enR1nl12l -:Sfunlclpal Public 50 0' 60 ft- 2 in. .010 sch40 pVc
-Gcothonnal l lleutme CAadme supplvl 71tcsldcmialA6'.ncr Supp% l inee) ft. ft.
-lndustnul lbmmcraal Residential ASmcr Supply Ishuredl 18.GROUT
FROM TO MAI Fail:O. F.NPLN"FNFNI METHOD&dM01]T
lrnaau°° 0 ft qg D Portland Cem Tremie
Non-\Pater Suppy Nell:
�'1Lm uunne ❑R1-r'occn
46 D 48 Rt Bentonite Chij Tremie
Injection%\'ell: n. ft.
-Aquifer Recharge -Gmm.Jomcr Renr edmtion 19.SAND/GRAVEL PACK 1f
-Ayoltcr Sl e
FROM TTON{TFRI xI. Two M"FNIFNT MrTOt1D
mapc and Reco cen -Sallmtc Ramer
_ 48 ft 60 ft #1 sand Tremie
-:\ywfer l e9t -Smrm,suter Dralna�e
ft. ft.
[cpenmentul Technoloa, ❑SuhsWenee Control
FROM
DRILLING LOG 911aeb u14tl IPT ONjoishistift K.host......
.
-GfOlhcntro l(�uscd lAupl ❑TrYlCer FROM TO DFSCNIPflO\holm.haNnexc swLmoRn ¢.l
-Geothcrnra1111eutlna'Coolnv Rclurnl ❑0ther(eclum under Nil Remarks) ft. ft.
4.Date N'ellls)( 2-8-21 ompleteJ: Nell 111# P-30 D ft. rL
h. ft.
Sa.N\'ell Location: n. n.
Granville County D. +
Faaluc O,.nu Vamc Faalln Irl=ul uppbcahkl
6584 Landfill Road, Oxford, NC 27565
Pb,#cal \dd,... (lZ .and],p 21.REMARKS
Granville
t'owu. Par.d lJan1li nunAo II'IA,
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 (Ine ificalion:
Ili dl Iicid one[a,aonp a mliare,n
36.370767 N -78.616805 V C Z Ko -A
sonwwe (crluicd Roll l"t,..ia Un,n
6.Is fare)the we111s1: FPermanent or ❑Temporan /IT .,eon..rib,•h.rm.I h"h, , ron 'I drr , r.red.. . ,rderr.r
r .,.n, m
ulrh Ii:I\I.II 0 Olan ur IT I\I -II b', n/IU 11b11 r'ern,ru.uun 11.mdenl.end dnu e
?.Is(his a repair ID an existing well: 71 ex or ?No • (". 0 du•nu.n/tun Hero pr,n.,/,din drir cell mvmr
O,h....I.re...... l�,,,,Anm,n,.,U...... um,u»urruuunn.unl.-,piern rhr nnn....J,Ire
rep.ur..... JI rrmerk..au..n......I me nwk.,/rh,.n.rrn 23.Site diagram or additional well details.
Sou ma, use the hack of this page to pro%ice additional„ell site details or ,cell
R.\umber of wells constructed: 1 consnualon dctadz you mac also attach additional pages Ifnecessan
I-„r ¢duple urleonnr er........... v.pplr Bell.611 ram,"'oolufLm.)". ...
..
biro, SI'BNIITI %L INSTF CTIONS
9.Total well depth below land surface: 60 (ft.I 24a. For \II Wells: Submit this form wulun 3(1 days of completion of well
I-m nn Mph url6I...nil drp,InpAgl.....I.a,ny.le-1aCoo n111-,alurrl consOuctiun to the lollo,eme
10.Static water Inel below top#(casing: None Ifl) Ithimor,of N'ater Resources,Information Processing I nit.
I/nn1,.r 1I I,l.,onnrc I...n.. ,.•. 1617)tail Senice Center,Raleigh, 27699-1617
11.Borehole diameter: 2 (in.l 24b. For Iniecmin R%ells ON L1': In addition to sendlne the fill in to the address it
1_4a ubo,c. also sti a copv of this tono v thin 3u dacs of completion of,mlI
12.N'ell construction method: B 1/4 HSA with 2"spirt spoons wireline coring construction III the tollo,une
II. _ Iown.cable.duea pu.h.cm
Ilisisimt of N aRr Resources.I-nJergrnund Injection Control Program,
FOR N.ATI:R SI'PPIS NEI IS ONI-A: 1636%fail Senice(enter.Raleigh.AC 27699-1636
13a.Field Igpnd llethoJ of tbl: 24c.For Naler Supple& Injection Nells:
VIsu suhnut one copv of this Innn „Rhin ili da,.of cnmplction or
13b.Disinfection tripe: Amount: „ell cnn3ILLLvun to the count, heullh Jcpartnlcnt of the count, Were
_— cunstorctcd
full..(\1-I Aonh('alnbna Uq•vnn¢nl oil ncuonNenl andAmam Uivvo..n,N:va Roourcc. kcv.cJ Aupusl--ul;