GW1-2022-01933_Well Construction - GW1_20220224

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells ��
1.Well Contractor Information:
Jonathan Kamionka F4.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name 1 170 ft. •14230 ft.
3465-A aab%o ft. i 5o fr. u, Pit0:'11
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells ORLINER'ifa licable
FROM TO DIAMETER THICICIVESS MATERIAL
Bill's Well Drilling Co. o ft. 4 7 ft- 20 is .375 Steel
1E.INNER CASING OR TUBING)GEOTHERMAL CLOSED LOOP)
Company Name FROM p_ DIAMETER THICKNESS MATERIAL MATERIAL
WS0801059FT -'
2.Well Construction Permit#: FT ;r F
00
List all applicable well permits(i.e.County,Slate,Variance,Injection,etc.) W FT
147
3.Well Use(check well use): --
17.SCREEN SLOT
Water Supply Well: FROMFT_&DIAM rER SIZE THICKNESS MAT_edewL WSS MATERIAL
❑Agricultural ❑Municipal/Public .2+^%"3�.11FQ/rFT 4c W-V.j�t���. ���
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) FTl.TLC.FT_t�i
FT-FT- -
❑IndustriaUCommercial ❑Residential Water Supply(shared) Ia:GROUT
FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
123hrigation 0 ft. 47 ft. Neat cement pumped
Non-Water Supply Well:
0 rt. 100 ft benotite pumped
❑Monitoring ❑Recovery
Injection Well: tt. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier
FROM TO ft MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stortnwater Drainage 100 ft• 355 #3 Gravel poured
ft. ft.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG'attach additional Sheets if
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hsranes soillrock type,grain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft. See attached
ft. R.
4.Date Well(s)Completed: 5-13-2021 Well ID# Davis Farm
ft. ft.
5a.Well Location: ft. ft
Goodson &Wells Farms, Inc. ft ft
Facility/Owner Name Facility ID#(if applicable)
ft. ft.
Jim Best Rd, Mt Olive, NC 28365 ft. ft.
Physical Address,City,and Zip 21.REMARKS
Duplin 350000681185
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one lat/long is sufficient)
35.139842 N -77.971677 W 0' � 5-13-2021
Signs of Certified Well Contractor Date
6.Is(are)the well(s): [OPermanent or ❑Temporary By signing this form,I hereby certify that the mvell(s)was(were)constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or E]No copy oflhis record has been provided to the well owner.
Ifthis is a repair,fill out known well construction information and explain the nature of the
repair under#21 remarks section or on the back of this form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also,attach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same construction,you can
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 356 (ft.) 24s. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths rf different(example-3@200'and 2@100') construction to the following:
10.Static water level below top of casing: 40.6 (ft) Division of Water Resources,Information Processing Unit,
Ifmvater level is above casing,use'•+ 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 20 (in.) 24b. For Infection Wells ONLY:I In addition to sending the form to the address in
Air& Mud Rotary 24aabove, also submit a 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
24c.For Water Supply&Injection Wells:
13a.Yield(gpm) 650 Method of test: pumping Also submit one copy of this form within 30 days of completion of
13b.Disinfection type: HTH Amount: 4 cups well construction to the county health department of the county where
constructed.
Foram GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013

BILL'S WELL DRILLING CO.
800 McArthur Road BI LINO
Fayetteville,North Carolina 28311 E
Office [phone] WE
[e-mail] www.biRsweUdfiUing.com
Date: 5/13/2021
Goodson&Wells Farms
Drilling Log Lithology
Davis Farm-Jim Best Rd,Mt Olive, NC Duplin Co
From To Formation Description
0 5 Orange Sand&clay
5 11 Mixed Sand
11 16 Orange Sand
16 17 Gray Silty Clay
17 37 Gray Clay w/streaks of fine sand,large
gravel,glaucanite&wood
37 47 Silty Gray Clay
47 55 Hard Gray clay
55 111 Fine Sand&Clay,Glaucanite&wood
111 117 Mostly Dark Gray Clay&wood
117 137 Mostly Clay w/small streaks gray sand
137 165 Sand&Clay streaks w/Gray medium sand
165 175 Clay
175 177 Soft Rock Sandstone
177 182 Salt&Pepper Sand
182 192 Solid Gray Clay
192 197 Streaks fine Sand&Clay
197 222 Dark Gray Clay
222 237 Light Gray Clay Softer clay w/some sand
237 265 Light Gray Clay turning to darker Gray
265 277 Streaks of Sand w/some clay
277 284 Clay
284 290 Streaks of Coarse sand mostly clay
290 297 Clay
297 356 Small streaks fine sand&some clay
Jonathan Kamionka
3465-A

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