GW1-2021-00259_Well Construction - GW1_20210125

WELL CONSTRUCTION RECORD
tie menra Be aA 1'
T6i,e,m,.aa Im Oren t Ia,n l„"hiplc..aua
I.\N ell Contractor Information:
Virgil Wilson 14.WATER7.ONES
FROM 10 DF_M'RIPIION
VAill t'nmrncn,r Axmc ft. ft.
4473 ft. ft.
V \\bll Cottraool t Timlcaw."\wobc] 15.OUTER CASING for mWR-aaud wells OR LINER if• 'fable
FROM TO DIl\IEl{R TIII(HSF55 \HTFRI\I.
Parratt-Wolff, Inc. 0 ft. 87.5 T'. 4 SCh40 I PVC
1- ".pan. same. 16.INNER CASING OR TUBING eothrrmal .,d4.vl
168-96-MW60-RW25 FTIOAI TH DI\METER Tru(I:NFSS %I\TERIU.
2.\\ell Cunxtrnctiun Permit M: 87.5 f'' 100 16 2 '" Seri pvc
.�.r,ill nppL.vblr hell pe non nnni.ir,nr-i mrtn,�..lnm.n.�n.u. ,
� ft. ft. in
3.IN ell I-se(check well use): 17.SCREEN
1\ater Supph, "ell: FROM 10 DI%METER SLOI'SI/f THICKNESS NI\1'ERI:\I.
\encultund ❑Municipal Pri 100 1i' 10 If 2 in. .010 SCh40 pVC
-Geothermal lllcult m,('oolm"Supph ❑Rcndcnual%Cate, Supph (amgla) " I ft. 2 in.
Industrml'(ommobal uReidenoal Ukrter Supple(shared) 13.GROUT
FROM 10 %1 ti FRI IL I'xaVF U 1>II'NT%IE1 HOD S.UIOI VT
-1 Imitation D f° 94 It. Portland Cam Pour
Non-\Water Supph,%Cell:
?M1lonuonna ❑Rccovcn 94 It. 97 fc Bentonite Ch Pour
Injection\Cell: ft. ft.
\quitet Recharge ❑Groundvcmet Rcmedmuon 19.SAND/GRACEL PACK if."he. e
FROM TO MATFRIU. FA.....'E]IFNT x..THOD
\quiet Storage and Rren ❑Rec... Sabn.I, Battle, 97 ft. 112.8 D' #1 Fine Sand Pour
=.-Ayotlir Test ❑Slornnmter Dmmvge
ft. ft.
-F,penmenlal I echnolo2, 7Suh1uer10 Control
20.DRILLING LOG I.Meh.defidomil theater if trcfearn
_Geodoctual(Closed I oopl OTracer FROM TO DESCRIPTION n'"lar.harJnessmibmck n- a esi. e.em.1
Gcothermat(I leaung/Cuohn_Retuml ❑011i ozsplam under 421 Remarks) ft. ft.
ft. It.
4.Date"'elfs)('ompleted: 12/4/20 Nt.eII ID4 DWI
n. a.
Sa.Bell Location: ft. ft.
Plantation Pipe Line Co 3571 n D
raaul'O...... m FLa6n ID-tit apple"NI)
2617 Quaker Landing Road, Greensboro, 27455 n
I'hcsmal Address-('a, and/q, 21.REMAR IRS
Guilford 7847837248
('aunty I'x,ccl L1cnm1'alo Vo WIN I
5b Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 (ertiRration:
T",I[fuld lati cuttiaenu
AN
s'ro'o le ofC"rood AAcll('onlreclur Dale
6. Is(are)the well(sg ri'Iaermanent m -ITemporars Hl ....... roe,h..... I knhi , ,un dim d" "'/U" n .,nonnoed m....ante....
vnll IfsA111 IPI OWN ear 131AI11 0'�- 11'09 tfoll, ,unvu.ua..Mesh-A and Ihula
7. Is this A repair to an existing well: ❑l es or TNo "t is « "'d lro.ha,o,pnmd.J n,rin ual ennlrr.
lIIho e. reap...-/ill....I k,n...I,..ell.a,n,n,no„n,I/')....moon a..I, pier...h, "'lure a/,he
rct.ur ender 'Ira"mrA,..-.Ie."„r'nIts.-h...k")'...term ((��ile diagram or Additional"ell details:
, You may use the back of this page to proy de additional .cell site details or well
8. Number of wells constructed 1 V ccas ru,non details You ntm also')ouch additional it a es it neccssan
I 11 11111111,141 ,nl. 11,111 1m-unnr„/•p(1 rll,n.vL)'iulh lhJ suite cufLYrrnd Teen
„h,..„ ",.1""' 71 StBNIITT:%L INSTI(TIONS
9.Total well depth belnwland surface: 112.8 (ft.) 24a. For All Ni Submit this L,rm mtHri 30 days of aompletmn of will
i... uul,"V,,u,It,b y ell Japlb.N J,ller.m le a...apt.- ;"'uN .wd'a l olr l c onsl mcu oo to the I oI l osA t n„
III.Stuff water level behlw lop ai leafing: Unknown (ft 1 1)iv Wit It of Paler Resort r('es.In to rena till"Pro ccs6mg t ni I,
/I„um ber)"ah.....m.... m. 1617 Nfail SerAice Censer,Raleigh,N( 27699-1617
11.Borehole diameter: t 2 5/8 (in.) 24b. Far Injection Wells ONIA In addition to sendme the loon to the add rev m
_a4u ahoce also submit a cups of III Gmn million !I' dacs of completion of"ell
L.\\'ell construction method:
Hollow Stem Auger I Air Hammer Core constmcilon to the lauo..mg
u v :niva-enure.vbk.Avcat pn.h.ale
Dirisinn of W'alrr Resources,IIIJerground Injection Cantrnl Program,
FOR NN V1 ER SI PPIA IN E.LIS ONLN 1636))ail Ser ire Center,Raleigh,NC'2%99-1636
13a.\ield(gptn) Clethud of it,t: 24c. Fit NA ater Supph,c4' Injection Wells:
VIso ,ithmrl one caps of this Won .,,dun 30 day n of c nit is l e do n of
13b.Disi tire c It mt is pe: knower: cell consuvcuon to the county health depnrtnunt of the counts .share
u,nvlrucicd
I"on(IAA-I Aon6CandmaUq,anmcm of I.....muucnnmd\mw al lk""r s-Univ..ontAAata Rcowcas RfvacdAn,aot"oJ