GW1-2022-01945_Well Construction - GW1_20220224

WELL CONSTRUCTION RECORD fGW-11 For Internal Use Only:
1.:Wel l[Cantraetor;Infarmatiow
Jonathan'Katnionka14vcTERzoas
Well Contmetor Narne _ROM TO DESCRIPTION
-160 ft• 220 ft• mamas
3465-A rt R
NCWdl Contractor Certification Number jFI3 OUTERCiISIN foemd Wa I"1%,,01tM MER Ill fa c b" ]* ;1
Bill's Well Drilling FROM TO DIAMETER TIHCMEss MATERIAL.
ft IL
Compnoy Nacre. /n /� f
2.Well Construction Permit#;
.. i'V�S:6 ( 6 .I FROM TO DIAMETER� a1THICtQ�rF�55..: I MA7ERULL ... ". .
List ak applicable Wit construction permits(I.e.UIG County State,11ariauce,ere.) *t R ta4 ft. 6 l SOWwe
3.Well Use(check well use): 23o ft 1225 fL 8 `SRotr pyC
Watersuppiy'Wellr1?lSCRE
FROM I TO i DIAMETER J SLOT SIZE I THICKNM MATERIAL
rc Agricultural 0municipal/Putilie 184 It' f. a: fn I :03z• SS
Geothenmt:(Heating/Cooling Supply) 13Residential Water Supply(single) Its, rt, in
lndustrial/Commeicial Residtxttial Water Supply(shared)
g OROu7 r .. t
) u.<
1tTi...tion 5FROM
TO MATEKGL. EMPLACEMENTMETHOO&AMOUNT.
Non=Water Supply Well: 140 it, eentontte rump
Monitoring Recovery 150 ft• Bentanite Pour
Injection Well: ft. to
Aglfer Recharge Groundwater Remediation 1
RAY1 P VK1 lffa c tiFe.
Aquifer Storage and Recovery [}Salinity Barrier TO MATERIAL ENPL:ACEMENT METHOD
Aquifer test., QStormwaierDrainage 160 f4 225 ft 02 hour
ExPerimentaltechnology DSubsidence"Control, ft tt
GeothemLal.(CiosedLoop) 13Trilete 0MVIULL11±tG i+iiafUf;dilitiooat hesl�ituaesis
Geoihennal Heatin Coon Rbtuiit Otlter("`"lain under:#21 Retrta`rtrs FROM TO ESCRIPTION ealor had all/mc� rate sia CIL)
fL eve Attached
4.:Date Weli(s)Completed:2/3/2022 Well DD#
Sa_Well Locations ft. it.
Johnson Nufsery fr. ft.
FSoility/OwtxiName FacilityIM'(ifapplidable) ft. f6
�tJ 5 ,JO('I e1 s-gr,, XAt—SP P:/'Aid,.l ;11At'l�x.?9y?5. ft. ff. � 1'1
Physical Address,City,and Zip
PeAdef
2IREafAR[cs � � �E
County 'Parcel tdentificationNo:(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,On*IM6ng is sufficicat) 22.Certification:
.N
6.Is(are)the'welt(s)�}x Permanent or Temporary SigdV&ofCetti6e'Well Contactor Date
0y signing this Lorna I.hereby ceri(fy dial the trelfrIj tear(were)constructed in accordance
7.1s this a repair to an 6i btizig,well: ©Yes or jNo tvflh lJA't4C4CO2C.0100`or,l5A NCAC 62e.0200 WY llComl?weti6n k,r,daK*dnd thet a
Ifrhis is d repatr fr!!auRkiioiimlvell.consirirctloa info rmafton and ciplain Ike nature of he 'cOM ofthis record has-been provided to the uill otuner.
repair undei 921,rejwrh.'section or odihe back ofd n fart. - � - '-
23.Site,diagram or additional well'defails:.
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-t is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages,if necessary•
dolled:,' SUBMIT fAL INSTRUCTIONS i
225:
9.Total well depth below land surface: (R) 249. For Ali'Weily: Submit this fomi within 30-.days of completion of well
For mOVp ivellr.lat all de*lo if.#ffe ent(exaivie-3@200'and 2@100'j cunshue idri tothe following:
10.Static water level below top of raving=4 UP Division of Water Resources,Information P,rocescing Unit,
If imter lerel'is abore casing,rue '1617 Mail Service Center,Raleigh,NC 27699-4611
1 t,Borehole diameter: 16 (in.) 24b.For Infection!?yeller 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 wett
12'Well cgnstructioa.method: construction to the following
(le-auger,rotmy,ea61e,diraet push,ere.')
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY.- 1636 Mail Service Center,Raleigh,NC 276994636'
13a.Yield(gpm)300 Method ottest: pump 24c.For Water.Sunnlw Bi.Iniectllon Wdts; In addition to sendiagthe'form to
the address(al)above,also submit one copy of this form within30 days of
13b.Disinfection typei HTH Amount. 3 G1tp complexion of well consuit6tion to the county health department of the county
where tdnstructed.
FotmGWi North Carolin Department entalQuality-1ivisionof4aterResouncesi; Rmised232-2016.

BILL'S WELL DRILLING CO.
800 McArthur Road
Fayetteville,North Carolina 28311
Office [phone]
[e-mail] BI IS
www.biUsweUdfilhng.com
RI ING
Date: 2/1/2022
Drilling Log Lithology
Johnson Nursery
985 Johnson Nursery Rd,Willard, NC
From To Formation Description
0 12 Black&Orange Hard clay
12 20 Fine gray sand
20 30 gray sand and clay layers silty
30 36 clay
36 36 Shells hard spot
37 57 hard dark gray clay small layers of sand
57 97 Black hard clay small layers of sandstone
97 107 Gray clay
107 117 Rock&sand Layers
117 120 Sand&sea shells
120 138 Dark Gray clay and sea shells small streaks of sand
138 140 Fine Gray Sand w/clay
140 141 rock
141 146 Gray clay
146 148 Fine Gray sand
148 149 Rock
149 156 Find Gray sand
156 157 Rock
157 158 Sand
158 164 Sand and shells
164 165 rock
165 178 Clay&fine fray sand
178 198 Tight fine fray sand w/clay
198 214 shells
214 215 rock
215 239 clay
239 251 Silly gray clay
251 253 Sand layer
253 260 Silty clay
Jonathan Kamionka
3465-A