GW1-2021-00300_Well Construction - GW1_20210127

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
VINCE FEDERLE 14.WATER ZONES
FRONT! TO DESCR .ON
Well Contractor Name
A - 3552 rt. rc
n. D.
NC Well Contractor Certification Number 15.OUTER CASING for mull-rased welb OR LINER ift lira de
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
Company Nauru n.
16.INNER CASING OR TUBING _dhermal dosed-lao
2.Well Construction Permit#: FROM TO DIAMETER TIIICKNFSS MATERIAL
1.uv oil appmm�le urn rorvrrumm�permit,fir,-IN( ('uumy.6rare,rnrmnvr.rrr.l 0.0 fit. 5.0 ft. 1.0 i"' SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIANIUER SLOTSIZE I THICKNESS J MATERIAL
❑Agricultural ❑Municipal/Public 5.0 1E 15.0 fE 1.0 1O' .010 SCH40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single, ft. h. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrlalion ❑Wells> 100,000 GPD FRONT TO MATERIAL EMPLACEMENTNIETHOD&AMOUNT
Non-Water Supply Well: OD ft. 1.0 R' PomtMDUNTONnE SLURRY
EMonitoring ❑Recovery ft. ft.
Injection Well:
❑Aquiter Recharge ❑Groundeater Remediation
19.SAND/GRAVEL PACK ifs lieable
❑Aquifer Storage and Recoaery ❑Salinity Barrier FRONT TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test OStormeater Drainage 3.0 ft- 15.0 fL 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control D. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG artacbaddidonalsheeb ifmrena
❑Geothermal(Heabn Cooling Rehm) ❑Other(explain under 421 Remarks) FROM To DESCRIPTION mbr,M1nrdnm,soiVrvc4 tr vu.en.
0.0 R' 1.0 D, GRAVEL
4.Date Well(s)Completed: 01/06/21 Well ID# PZ-5 1.0 H, 15.0 11- GRAY CLAYEY SAND
Sa.Well Location: ft. IT.
INTERNATIONAL PAPER D. ft.
Facility+Owner Name Factin, 1D4(ifapplicable) H. ft.
1785 WEYERHAEUSER ROAD VANCEBORO 28586 ft. rL
Physical Address.City,and Zip
rt. rt.
CRAVEN 21.REMARKS
County Parcel Identification No.(PIN)
BENTONFrE SEAL- 1.0-3.0 FEET
56.Latitude and longitude in Degrees/minutes/seconds or Decimal degrees: "`PRE-PACK SCREEN"'
I ifwcll field,one Wiring is sufficient) 22.Certification:
350 13' 38.39" N 770 06' 27.73" W �(,�, y }„(,�,
1/15/2021
6.Blare)the well(s): IMPermanent or OTemporary Sipnamrc of Cenlfed Well Contractor Dale
He"gnmp I...fan, I hereby orn fb Jm101e well(/wm/verel ran.o a"'d tit ncomdmroe vuh
7.Is this a repair to an existing well: ❑Yes or IM:ND Intl.N'(.4'02( 0100 or/5d N('dr'02('11200 at//[......r...nan S)nrrdmd,an,I that o caps
I/drs ,o rapav,fill run brou a nett n....1,ra,an ul/oramaarr and explmn tlae oamre ul7he (!/In,,rrrord hn,heen porufed a,Inc u-ell ou n,,
repair under-21 remark%serum or on the hack ofornfi rm.
23.Site diagram or additional Mell details:
9.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add See Over`in Remarks Box) You may also attach additional pages if necessary
drilled. 15.0 4IJL rldlt.SUBMITTAL INSTRUCTIONS
AN `�
9.Total well depth below land surface: ( Submit this CW-1 within 30 days of well completion per the following:
hhr multiple car//.lhr all depth.Jdorrrem(e.raneple-3 rJ Ou'mul2(,7,lWI')
10.Static water level below top of casing: 7.0 (ft) 24a• For All Wells: Original form to Division of Water Resources (DWR),
It over leer)T.ohove cuing,um " Information Processing Unit, 1617 MSC,Raleigh,INC 27699-1617
11.Borehole diameter.
$,Q (in.) 24b. For Inection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh.NC 27699-1636
12.Well construction method: AUGER
21c.For Water Supply and Optn-Loo Geothermal R<lurn Wells:Copy to the
I i.e.auger,rotary,cable,direct push,etc count}'environmental health department o the county Nchere installed
FOR WATER SUPPLI'WELLS ONLY: 24d. For Water Wells producing aver 100,000 GPD:Copy to DWR.CC'PCU.A
Permit Program, 1611 MSC,Raleigh,NC 27699-1 6 1 1
13a.1 ield(gpm) Method of test:
13b.Disinfection type: Amount:
Fornr G W-I Nmrh Carolina Department of Envimmnental Quality-Division of Water Resources Rceiscd 6-6-101 S