GW1-2021-00110_Well Construction - GW1_20210526

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WELL CONSTRUCTION RE •RD ,
NORTH CAROLINA
EnWronmental Quullty
•rm GW­1 Well Construdon Electronic •
North Carolina Department of En\Aronmental Quality
April 1,2021
Page 1
Submission ID#
GW 1-2021-00110
CONTACT INFORMATION
........ ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ...
Email Address*
Contact Name* rconrad@universalengineering.c
Randy Conrad om
Is this a revision to the form you have previously submitted?
r Yes r No
WELL CONSTRUCTION INFORMATION
..................................................................................................................................................................................................................... ................................................................................................................................................................................................................. ..........
1.Who is installing these wells?*
r Owner r Well Contractor
1.Well Contractor Information:
Certiticate# Cert Level First Name Last Name Company Name
4501 A RANDY CONRAD GFA INTERNATIONAL, INC
2.Well Construction Permit#:
List all applicable well construction permits(i.e.Ivbnitoring Wells,UIC,County,CCPCUA etc.)
What type of well is this?* r Injection Well r Non-Water Supply Well
r Water Supply Well(includes irrigation wells)
3. Injection Well* r Aquifer Recharge C Aquifer Storage and Recovery
r Aquifer Test C Experimental Technology
r Geothermal(Closed Loop) C Geothermal(Heating/Cooling Return)
r Groundwater Remediation C Salinity Barrier
r Stormwater Drainage C Subsidence Control
r Tracer r Other
4. Date well was completed and ID#

Date Well Completed* Well ID# Well Yield
5/4/2021 N/A
(gallons per minute)"

Page 2
5.Well Location
Facility/Owne r Name*
Cintas Facility ID#
(Required) (If applicable)
County* Parcel Identification No.(PIN)
Alamance
Physical Address* Street Address
610 Woody Drive
Address Line 2
City State/Province/Region
Graham NC
Postal/ZZp Code Country
27253 United States
Latitude* 36.0585200000 Longitud09.3850800000
Decimal degrees Decimal degrees
6. Is(are)the well(s):* r Permanent r Temporary
7. Is this a repair to an existing well:* r Yes r No
If this is a repair,fill out known well construction information and a)plain the nature of the
repair under#21 remarks section or on the back of this form.
For multiple Geoprobe/DPT or Closed-Loop Geothermal Wells having the same construction,only 1 GW-1 is needed.
8a. Indicate TOTAL NUMBER of wells drilled: 1
9.Total well depth below land surface:(ft.) 9a.What is the depth of the casing from ground
235 surface?
For multiple wells Iistall depths if different 175
(example-3 a200'and 2@100') in feet
10.Static water level below top of casing:(ft.) 11. Borehole diameter:
17 6"
If water level is above casing,use"+" in inches
12.Well construction method:
r Auger r Air Rotary r Cable Tool
r Direct Push r Mud Rotary r Rotosonic
r Other
horizontal drilling

Page 3
14.WATER BEARING/FRACTURE ZONES
From To Description
33 17 overburden rock interface
in feet in feet
15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
From To Diameter Thickness Material
in feet in feet in inches
17.SCREEN
From To Diameter Thickness Material
235.00 175.00 3.00
in feet in feet in inches
18.GROUT
From To Material Emplacment Method &Amount
60.00 0.00 portland w/5%bentonite Tremie
in feet in feet
19.SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
0.00 0.00 Nonw
in feet in feet
20.DRILLING LOG
From To Description (color, hardness,soil/rock type,grain size,etc.)
0.00 235.00 installed along the top of rock
in feet in feet
21.Remarks
See attached well drawing for air sparge well
22.Site diagram or additional well details:
You may upload additional well construction information here.
Ellingson DTD-AECOM-Graham NC-Cintas Facility Pilot
199.06KB
Well-As Built.pdf
pdf only
*rJ By signing this form, I hereby certify that the well(s)was(were)constructed in accordance with 15A NCAC 02C
.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of this record has been provided to
the well owner.

23.Certification*
Signature of Certified Well Contractor
Submittal Date 5/26/2021

Client Name: AECOM
Job Name: Cintas Facility Pilot Well
Location: Graham, NC
Well ID: AS-1
Drill Rig: Ditch Witch JT30 All Terrain
Drill bit: 5 TCI RockmasterAssembly
Well Screen: 3 inch DR11 HDPE .025 inch slots
Well Casing: 3 inch DR 11 HDPE
Length of Drill Rods:
Length of Borehole:
Length of Well:
Entry Casing Length:
Screen Length:
Exit Casing Length
ft
232 ft (Horizontal Distance)
235 ft
175 ft
60 ft
NA ft
ELLINGS
Rig Entry Angl
Elevation at Point of Entry
Station at Point of Entry
Horz distance from Transmitter to Point of Entry
Height of Transmitter above Point of Entry
-18
-2.5
0
0
degrees
ft
station
ft
ft
Rod
Rod Distance from Vices
(ft)
Station
(#+#4t)
Description
Bore Elevation Relative to
Building Floor
(ft)
Percent
Slope
(%)
Vertical
Angle
(degrees)
Horizontal
Distance
(cumulative ft)
Calculated Depth
(ft below entry)
Point of Entry
0
+
Entry @ STA 00+00
-2.5
-32.5 %
-18.0
0.0
0.0
1
9.3
+9
-5.4
-32.5 %
-18.0
8.8
2.9
2
18.6
+18
-8.1
-28.7 %
-16.0
17.7
5.6
3
27.9
+27
-10.6
-26.6 %
-14.9
26.7
8.1
4
37.2
+36
-13.0
-27.2 %
-15.2
35.7
10.5
5
46.5
+45
-15.4
-27.0 %
-15.1
44.7
12.9
6
55.8
+54
-17.8
-25.5 %
-14.3
53.7
15.3
7
65.1
+63
-20.1
-25.1 %
-14.1
62.7
17.6
8
74.4
+72
-22.2
-23.1 %
-13.0
71.7
19.7
9
83.7
+81
-24.2
-20.2 %
-11.4
80.8
21.7
10
93
+90
-26.0
-18.2 %
-10.3
89.9
23.5
11
102.3
+99
-27.5
-15.8 %
-9.0
99.1
25.0
12
111.6
1+08
-28.8
-12.8 %
-7.3
108.3
26.3
13
120.9
1+18
-29.9
-11.2 %
-6.4
117.5
27.4
14
130.2
1+27
-30.8
-7.3 %
-4.2
126.8
28.3
15
139.5
1+36
-31.3
-4.0 %
-2.3
136.1
28.8
16
148.8
1+45
-31.5
0.0 %
0.0
145.4
29.0
17
158.1
1+55
-31.5
-0.2 %
-0.1
154.7
29.0
18
167.4
1+64
-31.5
0.3 %
0.2
164.0
29.0
19
176.7
1+73
Start of Screen @ STA 01+71
-31.5
0.7 %
0.4
173.3
29.0
20
186
1+83
-31.5
-0.7 %
-0.4
182.6
29.0
21
195.3
1+92
-31.5
0.2 %
0.1
191.9
29.0
22
204.6
2+01
-31.5
0.2 %
0.1
201.2
29.0
23
213.9
2+10
-31.5
-0.2 %
-0.1
210.5
29.0
24
223.2
2+20
-31.4
0.9 %
0.5
219.8
28.9
25
232.5
2+29
-31.3
1.2 %
0.7
229.1
28.8
25.3
235.29
2+32
End of Well @ STA 02+32
-31.3
0.3 %
0.2
231.9
28.8

5
m
L
H • 5
L
0
0
LL -10
bO
c
-a -15
° -20
v
4-
f6 -25
v
m
o -30
cc
°2 • -35
—2X Vertical Exaggeration
Air Sparge Well AS-1
Cintas Uniform Services Facility
Graham, NC
Prepared by Ellingson-DTD for AECOM
25
50
75 100 125
Station
BORE NOTES:
Well Length: 235'
Horizontal Length: 232'
Riser Length: 175'
Screen Lenght: 75'
Well Material: 3-inch DR11 HDPE
Screen Spec: One 0.025"x1.3" slot per foot (60 slots total)
150 175 200 225 250
Approximate Ground Surface
Building Floor
Casing
Screen
Approximate Location of Grout Seal