GW1-2021-06145_Well Construction - GW1_20211025

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Charles M. McCaskill
Well Contractor Name FROM TO DESCRIPTION
2769-A ft. ft.
ft. ft.
NC Well Contractor Certification Number
1'S:.OUTER'CASIlVG`fo�mulh�ased'wells INER'"it' hcable".
Charles R. Underwood, Inc. FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name
S 0 A 16.40NER CASING OR TUBING``6theitmil closed 3r
2.Well Construction Permit#:W V 6OG— `' 4 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable ivell construction permits(i.e.UIC.County,State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
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Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
x Agricultural Municipal/Public 82.5 ft- 111 f" 8 in-j .050 Sch 10 SS
:]Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) 120 ft- 140 ft' 8 in.j .050 SCh 10 $$
Industrial/Commercial Residential Water Supply(shared) 1gCROYIT
J1 Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 3 ft. Cement Poured
Monitoring _.Recovery _ 3 ft- 50 ft- Bentonite Tremie Pipe
Injection Well:
Aquifer Recharge Groundwater Remediation
19.SAND/GRAVEL PACK`(if a 'licable *•> " ? •`
Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test [)Stormwater Drainage 50 ft. 155 ft- #4 Gravel Tremie pumped
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) OTracer 20.iDR1LLING BOG attach additioirmf heetsifnecessa
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
Geothermal(Heating/Cooling Return) 0 0ther(explain under#21 Remarks) ft. ft.
See attached formation log
4.Date Well(s)Completed:9/14/2021 WeII ID#WeII # 2
ft. ft.
5a.Well Location:
Wakulla Land LLC ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft.
NC Hwy 71 & Oxendine School Road ft. ft.
Physical Address,City,and Zip ft. ft.
Robeson 932843361800 21;REMARKS
County Parcel Identification No.(PIN) ' pWR Section
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one hit/long is sufficient) 22.Certif ti
34*47'56.40" N 79*150.70" W
6.Is(are)the well(s)ox Permanent or OTemporary ature of Certified ell Contractor Dat
By signing this.fonn,!herehv certifv that the well(V)was(were)constructed in accordance
-7.Is this a repair-to an existing well: ElYes—or ONo with 15 MCAC-02C-0100 or 15A NCAC o2C.020o Well Construction Standards and that a
ffthis is a repair,fill out known we!/construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under"21 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 back of this page{to provide additional well site details or well
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
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9.Total well depth below land surface: 145 (ft•) 241. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths fI'dierent(example-3@200'and 2@100') construction to the following:
10.Static water level below top of casing: 13. (ft,) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"-" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 17 (in.) 24b. For Infection Wells: In addition to sending the form to the address in 24a
Mud Rotary above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.) `
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c. For Water SunDly&Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to`the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

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Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone: [phone]
Sanford,North Carolina 27330 Fax: [phone]
Sam Parker—Wakulla Land LLC
Well No. 2
Oxendine School Road
Formation Log
P,
0—1' Topsoil
1'-11, Sandy clay
11'-22' Sand, few clay lenses
22'-25 ' Clay
25'-34' Sand
34'-34'4 Clay
34'4"-39' Sand
39'-45' Very Sandy clay
45'-100' Sand
100'-100'4" Clay
100'4"-111' Sand
111'-119, Clay
119'-120' Sand
120'-120'4" Clay
120'4"-140' Sand
140'-143' Clay, sand lenses, not much sand
143'-145' Clay, sand lenses
145'-147' Sand
147'-16F Sand clay lenses, big lenses of each
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Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone: [phone]
Sanford,North Carolina 27330 'Fax: [phone]
Sam Parker—Wakulla Land LLC
Oxendine School Road
Well No. 2
Casing Log
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(Casing Starts at 2' above grade)
+2'-82.5' 8" Sch. 10 Stainless Steel Well Casing
82.5'-111' 8" SS .050 Slot Screen
111'-120' 8" Sch. 10 Stainless Steel Well Casing
120'-140' 8" SS .050 Slot Screen
140'-145' 8" Sch. 10 Stainless Steel Well Casing-';Tail
Cement: 0'-3'
Grouted: 3'-50'
#4 Gravel
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