GW1-2021-00255_Well Construction - GW1_20210125

WELL CONSTRUCTION RECORD mlcmal 1 ,�nyLv
nu.Iimnl can be a.eA ht ainglc Ili nvihiplc ,If,
I.%Nell(untrue her Information:
Virgil Wilson IJ.WATER ZONES
FROM 111 DES(:RIMION
%k,11,nt„et„rya1IIe 45 It 57 n. wet
4473 n 0.
M \\dl( ,MOi, ,,l'cmli.en„,\II... IS.OUTER CASING for mWli-ruM sells OR LINER ifs 'cable
FNtIM "rrl DI\METER Till(ENF.SS xIxTERI\L
Parratt-Wolff, Inc.
-„.„..,tip \.nnc 16.INNER CASING ORTUBING eothermalclmed-los
168-96-MW60-RW25 F""" T(' DI\METER THI('RSESS TFRIM
2.ll ell Construction Permit 11: p ft 42 ft 2 SCh40 pvC
r,I.dl.,pphn,hle hell pe.nlm �_ rz,ni.tiunr. Ibrmne hr,ew."�_.mt
3.%Veil I (cheekwell use): 17.SCREEN
1\titer Supply R ell: FROM 1 TO DI\MI:TF:R I SL(FTSI/.F: llll(RNES Mdl'IRlal.
-\xnculat'll Iti111m.Iral Puhhc 42 0 157 ft 2 in .010 SOh40 i PVC
-(imuthennullilcuums C ooh ma SupPle) -IRcslJcnu,Il Rk,w, Supple tsmglcl It. II f` 2 in .010 SCh40 pVC
hldustnal!I ommercial -IRcsidenoal%Cater Supplc(sha,ed) 18.GROUT
FROM TO %1 kTF"RI\I. FNPI..%('EMENT NF.THOI)& %Mm NT
-bngml"a 0 n' 38 It. Portland Cem Pour
Non-11'ater Supple 1Vell:
?,btuiutonna -Rccovcn 38 O. 40 ft. Bentonite Ch Pour
Injection(fell: n. n.
--%quite,Recharge -IGnoundlsmcr Rcmcdiation 19.SAND/GRAVELPACK if ' able
FROM TO xUTERI>I. F\IPIA(F\IENT NI Erin1D
-lywterSmrage andRmxcn ❑Sahnin tiarncr
40 ft. 57 ft #1 Fine Sand Pour
=Ayuitcr Test CSmrmouter Uramuge
ft. ft.
-1 penmcntal Technolusl ❑Subsidence Control
20.DRILUNG LOG nuenth addiRonal ebeeb if necev
-Geothermal(Closed Loop) -Tracer FROM TO Dr5(ItIPTION mnmr.n.rdn�sniF.n.l.n �. �a .um.
-.(reothermal(fleating/Coolin_Return) ❑Other Kctlam under 421 Remarks)
12/11/20 2W-26
J.Dale N'ell(s)Completed: Well IDH
ft. ft.
5a.Well Location: ft ft
Plantation Pipe Line Co 3571 ft. ft.
Faedu�ut,n.. l0=nhppbca6lo ft. ft.
2617 Quaker Landing Road, Greensboro, 27455 ft. I ft.
Pln sisal Udrev_(II¢nrld/ip
21.REMARKS
Guilford 7847837248
I\mnp Ilmcd ldcnulicnuwi\u (PINI
56.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.(ertifica on:
ui itch lidd.o."IuiI... u.ulTuenu
36.146603 -79.851074
.s,tauueof(anled Reif Lonna.... Um.
6. Is(are(the well(s): 61 Permanent or ❑Temporan eI ..e,onc no,ro.... l hen-h, e ,Io IIreI It, hello) „,.�,,. rJ.. ,moor
n ul LI I VI dl'0-'I' 11100... I`J %,,1. ", Oj....)fell I�u...I,la n"o,Am..th"I end Ihnl e
7. Is this a repair to an existing well: ❑Ves or Z'No ,:spi ,,,du,ra era ha.hrrn prnrnbJ rn the nvll.nonr.
It tlrn I,„,rpm,./ill urrl I ll,»mvucllm,utlo.meunu end e-(pion ore nnuva of Ihr
.ryv,.a„der 'I run...4, n,n:...,n me h,nk.c rho pII,n 23.Site diagram or additional well details:
1'no mac use the hack ul this page to provide additional vcell site details of Ivdl
8.Number of wells constructed: 1 consuu von details Vuu mn) also attach additional pages it necessan
I-e.rvulupla uyruunl nr moo omer vlppll nvll,O N1.1, inlh the.time cuawn,to. I..rz,een
'sh,n„,,,I,I„.... SI-FIND T T%L INSTFCTION S
9.Total well depth below land surface: 57 (ft.1 24e. For .UI Wells: Submit this Ginn within 30 dais of completion of well
1—nmh,ple ael6 0,I ell Jep14,"'I'll.....mmmplu-i 1,2110 emI2 d Hs,I q 'l tnlenon to the lollovvng
III.Static water level below nip of casing: 45 I\F� {J((f.l ll Division W'll'ater Resources,Information Processing I nit,
//,,,,,,,.1,",.I„„I.....e„qcr,,,, 1617%fail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8 1/4 (in.) 24b. For In iection 11'ells ONI.V: In add it,on to sending the loon to the address tit
Hollow Stem Auger -aaahave also ..bout a cope of this limn within 30 dacs of completion of vsell
12.11'ell construction method: consructon to the t'ollowmg
i e nicer.,man:cable direct pu.h.cic
Division of Water Resources.I-nderground Injection('ontrol Program,
FOR W.\TER St PPLI-KELLS ON11 1636%fail Sees ice I enter,Raleigh.N( 27699-1636
13a.It (gpm) Method of lest: 24c. For NA titer Supplx IS, infection Wells:
%Iso submit one cap% of Ihi, furor within 1,11 down(completion of
136.Disinfection n'pe: Amount Nell consovuuon to the count, health department of the count\ where
- _ _ ConslruelCd
I"onilA1-1 No III(-amlum DO,N.... iu.d l ulannmaa.ulJ Aauu+l R<snwcc,a Uh u.on..IAknet Resources Raised lnuo Nil;