GW1-2021-00657_Well Construction - GW1_20210203

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
VINCE FEDERLE it WATER ZONES
Well Commissar Name FROM TO DESCRIPTION
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A - 3552
n. a
NC Well Convector Cenifieaoon Number 13.OUTER CASING law mald-eaxdwelb OR LINER ifa Rubk
GEOLOGIC EXPLORATION FROM TO DIAME f:R THICKNESS MATERIAL
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Company Name 16.INNER CASING OR TUBING eot6ersoal clmed-ko
2.Well Construction Permit#: FROM ro DLAMEI'ER TNICKNFSS %IATERLAL
List all applicable well construction pennies(i.e.ULC Count',Slaw.Yorimrce,etc.) QO R 4.0 fL 1.0 in. SCH 40 PVC
3.Well Use(check well use): R fL 1a
Water Supply Well: 17.SCREEN
FROM I TO DIAMETER SLOTSIZF THICKNESS MATERIAL
OAgriculwral ❑MunicipaVPublic 4.0 fL 14.0 fL 1.0 'n .010 SCH 40 PVC
EGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL fL in.
❑Industrial/Commercial ❑Residential Water Supply(shared) Ill.GROUT
Ofingation ❑Wells>100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD A AmOI NI
Non-Water Supply Well: 0.0 fL 1.0 fL aORTIND eENTONnE SLURRY
fJMonilaring DRecovery n. R.
Injection Well:
x. h.
OAquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ifa timbre
OAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERAL EMPLACEMENT ME-IIfOD
❑Aquifer Test ❑StormwaterDminage 2.0 rL 14.0 fL 20-40 FINE$ILICASAND
❑Experimental Technology OSubsidence Control fL D
OGeothermal(Closed Loop) DTraccr 20.DRILLING LOG Oiftsch additional.hee s Bnectasa
OGeothermal(Heating/Cooling Return) oOOler(explain under#21 Remarks) MoM I To I DF RIPTION mows,hasammu si/riea sue,n..
0.0 f. 1.0 IL GRAVEL
4.Date Well(s)Completed: 01/06/21 Well ID# PZ-4 1.0 m 14.0 rt GRAY CLAYEY SAND
St.Well Location: D. fe
INTERNATIONAL PAPER R. fL
Facility/Owner Name Facility lDs(if applicable) R. fL
1785 WEYERHAEUSER ROAD VANCEBORO 28586 R R
Physical Address,City,and Zip fL H'
CRAVEN n.REMARKS
Comity Parcel Identification No.(PIN) BENTONITE SEAL- 1.0-2.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: m`*PRE-PACK SCREEN"'
(if we]]field,one IaUlong is sufficient) 22.Certification:
350 13' 38.39" N 770 06' 27.73" \/...1 'A }„&A-
r/ � 1/15/2021
6.lattice)the well(s): MPerment or OTempors'yA C6 (s J Signtme ofCettified Well Contractor Doe
ap
Byngning this form,l herehy cen fy that the well(sl was(were/cmutructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo l5A NCAC 02C'.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy
If this of a repair,fill out known well construction information and"plain the nature of the of this record has been provided to the well owner.
repair under 421 remarks section or on the back of this form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the hack of this page to provide additional well construction info
constitution,Only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 14.0 (ft)
For multiple wells list all depthsifdilfirrem(example-3@200'mdl@100') Submit this GW-1 within 30 days of well completion per the following:
6.0 24a. For AN Wells: Original form to Division of Water Resources (DWR),
If rer/ever is above casing,use Static water level below top of casing: (fL) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If fee
11.Borehole diameter: 8.0 (in.) 24b. For Infection Well :Copy to OWN,Underground Injection Control(IUC)
AUGER Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: 24c.For Water Supply and O D-Lao GLOthermtiI Return Wells:Copy to the
(i.e.auger,artery,cstilt,direct push,era.) county environmentalT [ epartrnent o the county"ere installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producinE over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-I Noah Carolina Depamnent of Environmental Quality-Division of Water Resources Revised 6-6-2018

2040 Swage Road SOIL BORING 7 MONITORING WELL ID:
® Engineering LLc ChffMtDn,SC 29407 Pz-04
a Member of The GEL Group,Inc. [phone] Fax(843)7W7397
ENMRONWNTAI I ENGINEERING I SURVEYING wepir9al.coN PAGE 1 OF 1
problem solved PERMIT NO: PERMIT DATE:
CLIENT: International Paper-New Bem PROJECT NAME: Landfill monitoring
PROJECT NO.: inpa00720 PROJECT LOCATION: International Paper-New Bem,NC
DATE STARTED: 1172021 COMPLETED: 1172021 BOREHOLE DIAMETER: 8-in.
DRILLER: Geologic Exploration CERT.NO.: NC CWDN3552 GROUND SURFACE ELEVATION:
DRILLING METHOD: DPTMSA NORTHING: 538,568.336
LOGGED BY: BPB APPROVED BY: GAD EASTING: 2,565,638.265
NOTES: TOC Elevation=4.33 GROUNDWATER LEVEL(24 Ng 1.79 feet from top of casing
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91 n > ? Tests t Lithology Description m Well Construction
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0 Sandy Clay:Black,moist, 15% 0
medium and 15%fine sand,70% Grout
day
Bentonite
0.1 CL V diam.PVC
Gravel with clay and sand:Black,
,0� mdst, 10%coarse,20%medium,
0 and 10%fine sand,60%day
5 0.3 GP 4O* -5
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.
.T T T Silty Sand:Black,saturated,30%
T T T medium and 30%fine sand,wood
T. T.T.
TiT and organics(d 8-10'
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T.T.T.
TTT
'.T.' .T. Sand Pack
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T T T 1'Diam.SIDtted
T T T Silty Sand:Bromv,saturated,50% PVC Susan
T T'r medium and 50%fine sand
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4:.T T.
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