GW1-2021-01320_Well Construction - GW1_20210329

WELL CONSTRUCTION RECORD uinil l .,n,Cl l
I n,Ilnnt cnn be rued lit,.rude or.....
I.Well Cmrtractor Informa lion:
Kevin White 14.WATER ZONES
YRtIM I Ttl I DES('RnTIOS
Icdl i lit ream\Ntnc 118 fr. 150 ft. wet
2973 ft. I ft.
\C ollk ontractur('ent G.naon nnlM10 15.OUTER CASING for multicased wells ORLINER if• Saable
fHtt\I TO DI-\\AFTER IOn KNESS I M%1ERIU-
Parratt-Wolff, Inc. ft.
1..nq... 16.INNER CASING OR TV G Olthermal dosed-too
FROM 'rn Ili M ETER TOO KSFSS \UTERI U.
2.\\ell(onstruction Permit a: (r. D. i
a ell.Ipplr.ehl,u,ll pert"".,. wont.Smin 14n-rtnr.: Gp,,m,n..I. I ft.. ft. On.
3.1\ell Ise(check well use): 17.SCREEN
NO Supply Hell: FROM I To Fl%MF7FR SLOTSIZE Jul(K]FSS M41HAU.
O.
-.NOT nculturul CMunlclpal Puhbc
-G,othermal l licaumg( uolm_e Suppl{) CResldenual Rater Supple lno0c) It. ft. t
n.
IndUSUldl Commcraal CRcmdcnualAA'amr Supph (shared) 18.GROUT
FROM TO \I{Tf:RI:\I. Y:\iPL.\('F\IF\T\I4]1101)5\MOI VT
=(rogation
N itn-Water Su pill N\'ell:
I Monironn CRecovm
Injection Hell:
-:Nymicr Recharge ❑(oouod,atct Rcmeddn,,n 19.SAND/GRAVEL PACK ifa ieaWe
FROM TO \UTFRIOF FNPI.\('FMF\-f MFTR(m
Nytutet Storage and Recoecn ❑sahnit{Rarncr ft. ft.
Aquae, list ❑S[OrmWatel Drainage
R. ft.
-1i\pennrentul Technologl ❑Subsidence Control
20.DRILLING LOG(. addfdmal aheeta ifeusecr a
-Geothermal(Closed l Oopl ❑Idc, FROM 'IU DFSCRIPTIOI\I talon LnrJneIs.fot6mcN ire e,etc.)
Gcoth tint ul(I feat I IiI Cooling Rcturn) ❑Other teq)Imn under H21 Remarks) ft. ft.
12/22-20 MW-65D ft.
Date H'eRls)Contpirted: Well IDH .. .
ft. ft.
5a.Well Location: R. ft.
Colonial Pipeline Company ft. AR 2 9 2021
F a.it its()..ncr VNittc I"".dirt 11); it npphcnhlcl ft. ft.
14511 Huntersville-Concord Road, Huntersville, NC 28078 n
phwlvel \ddrcss_(lt, and/ip 21.REMARKS
Mecklenburg Open rock hole
I bunt, Paid Id<nmiceuon Ao (PIN I
5h.1 ntitude anti longitude in degrees/minutes/seconds or decimal degrees. 22 (.ertiftcalion:
lit,,It field one 1,11 u m.uOlannil
35.412748 N -80.803857 YA. ��V L��uN l' 6,
'I"Ona" it('anilied 0.ell Cum to ctw Dele
6. Is(are)the wells): Id Permanent or ❑Temporan' lit ,Idol(¢mI,N..... I 0,,,rdnrw,
uah/sl Ai II W, 01011... III I, II ON 0,00IIr11 t)u1.I.ll.u,ul Iinnderd,errtl It I
7. Is this a repair to an eaisling well: Ell es or ?No .,apt,II IAA,m�,Inlnm hero prevJrd nl the,cell men;r.
Ir Ihn n e n7aur.lilt tart Aee��n hell On...I I.........mpneneuoa enJ sgdeui.iI. oaavr aI d"
rrywm nnJor ]I reln,Irk..n menu-,uI me ho,A"11hu"'1111 23.Site diagram or additional well details:
1 on ma{ use the hack of this page to pro{Ide additional Nell site details or well
S.Number of wells constructed: 1 construction details. You'I'd'also attach addlannal pages It ncccssan
I„r uuJuplr upmm....r m„F„err,upph vr11,0%L vnh III,'do"o"min..Iwo wu,en
�nnlwI,mV ,,"I SFBNIITT Oil INSTI,(I IONS
9.Total well depth below land surface: 40 (f1.) 24a. For All Wells: Submit this form Ivnlun 3o dms of vntplcuon of,vcll
l:vnn.h"'O,aril furell.lep14.4.11prc1r"01110 ll Ym "'Ili"I lo(''I emtstmcuun all the Cctllitvving
11).Static water level below top of casing: 118 Aft.) IN,ision of W'a ter Resources,Iitf)rum iion Processing I iti(I
11 l,rc/I,nh,n-„a�In,¢.I,., 1617 Hail Sen ice('enter,Raleigh,AC 27699-1617
11.Borehole diameter: 2 (in.) 24b. For Iniectinn Wells ONIA In addition to scrd,ng the lonn to the address In
A
<asnaa,n��.'as,e1-SA&4 Pl(-1 '-4dahuvc_ also subnla a copv tit this form Inthm 30 dacs nt complcuun of hill
I-.\\'rll construction methnJ:
gne„n n�„nmm� coneuuction to the III llo„mg
c ou._e r.ruwn_enhle.do«I push_ern 1
Uisision of Water Resources.I nJergraund Injection Control Program,
FOR W'A7 fR Sl-PP[]WFLLS ONIA 1636%fail Senice Center,Raleigh,N('27699-1636
13a.1'ielJ Igpml
\IethoJ of test: 24c. For IN mer Supp1F& Iniectinn Wells:
VIsn submit one cnpl tit[h Is ntrm IyRhln YU dmsol cuny,letum of
Hill Disinfection Ispe: Amount: hall construction to the cuunll heedlh dcpal'tment at the eoulm where
constructed
I.nn UAA-I Aunh('ai•ilma1)q-.wnwnt of l n,uonn,nl and 4noCd R...... Un...on,.I "mi Rcmnnecs Rclnvl Ad,l'01=