GW1-2022-06666_Well Construction - GW1_20220708

VRP �eForm:,
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Bobby Lee Allred, 11 14.WATER ZONES'
Well Contractor Name FROM TO DESCRIPTION
2610-A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for tnniti-cased wells OR LINER if a 7icahle
Charles R. Underwood, Inc. FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name
WS0601461 16.INNER CASING ORTUBING 'eothermalclosed-loo
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERLAL
List all applicable it construetum permits 0.e.UlC.C ouniv.State. Variance.etc.) +2 ft. 64 .ft' 8 in. SCh 10 SS
3.Well Use(check well use): 84-90 ft. 100-105 ft. 8 in- SCh 10 sS
Water Supply Well: 17.SCREEN .:
FROM TO DIAMETER I SLOTSIZEI THICKNESS I MATERIAL
Agricultural []Municipal/Public 64 ft. 84 ft. 8 inj .050 Iss
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) 90 R. 100 ft' 8 in!
I .050 ISS
x Industrial/Commercial OResidential Water Supply(shared) 18.GROUT
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft• 50 fr• Bentonite Tremie Pipe
Monitoring QRecovery ft. ft.
Injection��'ell: ft. ft.
Aquifer Recharge E)Groundw'ater Remediation
19.SAND/G RAVEL PACK rifa licahle
Aquifer Storage and Recovery Salinity Barrier FROM To MATERL4L EMPLACEMENT METHOD
Aquifer Test DStormwater Drainage 50 ft• 105 ft- 1#4 Gravel Tremie Pipe
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) Tracer 20.DRILLING LOG attach additional'sheets ifnecessa "
Geothermal(Heating/Cooling Return) 00ther(explain under 921 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
ft. ft. See Attached formation log
4. Date Well(s)Completed:6/27/22 Well ID#Well #3 ft. ft.
ft. ft.
Sa.1Ve11 Location:
Autry Grading ,S.=.
,t�
Facility/Owner Name Facility IDS(if applicable)
ft. ft.
1830 Davis Bridge Road ft. fL JUL 0 8 2022
Physical Address.City.and Zip ft. ft.
Robeson 948289181300 21•REMARKS Ilya/ t �
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field.one lat.long is sufficient) 22.Certification:
34.56.15.04 79.02.00.99 W
I 6/30/22
6.Is(are)the well(S)�Ix Permanent or OTemporary Signituri0tertifled Wel ontrac r Date
By signing this n-ni, l herehv cerl!1v drat the it ell(+)was(sere)constructed in accordance
7.Is this a repair to an existing well: FIYes or x©No trap 15.4 NC'AC i/2C'.0/00 or/;.a NC'A( 02C'.0200 bIL!/('nnstrucnnn S'iandcrrcG aodiliai a
(/this is a repair.fill out known ti ell construction alformatimi and explain the nature of the copy of this record has been provided to the Ire//attner.
repair under=1 remarks section or on the hack 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
9.Total well depth below land surface: 105 (ft-) 24a. For All Wells: Submit this!form within 30 days of completion of well
lbrnndnpleit ells hsi all depths fd1Jje rent(example-J6@10t1'and1n/00')
construction to the following:
10.Static water level below to of 20'0 ft.
P g� ( ) Division of Water Resources,Information Processing Unit,
(/water level is above casinz,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 SuoDiv& Infection Wells: In addition to sending the form to
the address(es) above, also submitione 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
6
f

Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone:[phone]
Sanford, North Carolina 27330 Fax:[phone]
F
Autry Grading
3rd Generation Ventures, LLC
Well #3
C
CASING LOG
+2'-64' 8" SS sch 10 Well casing
64'—84' 8" Stainless Steel .050 slot Screen
84'-90' 8 SS sch 10 Well casing
90'-100' 8" Stainless Steel .050 slot Screen
100'-105' S' tail
Screens:
64'-84'
90'-100,
Grouted to 50'
#4 Gravel 50'—105'
i;
0

` Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Rd. Phone: [phone]
Sanford,North Carolina 27330 ; Fax: [phone]
'r
Autry Grading
3rd Generation Ventures, LLC
Well #3
Formation Log
I
0' — 1' Black Top Soil
1' —6' Yellow Sand
6' — 10' Orange sandy Clay
10' — 11, Orange and White Clay
I — 12' Orange sandy Clay
12' — 16' White and Orangey Sandy clay
16' —21' White and Pink sandy Clay
21' —22' Coarse Sand
22' —29' Grey Clay
29' —31' Red clay
31' —37' Grey clay
37' —50' Pink and Brown sand
50' —56' Grey clay
56' —58' Sand
58' —61' White sandy clay
61' —84' Pink and white sand, course
84' Some wood and grey sand
84' —90' Light grey clay
90' —99, Chatter, white sand lenses of white clay
99' — 112' White sandy clay
6
112' — 117' White and orange sandy Clay
117' — 142' Reddish brown tight sandy clay E
s
III
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