GW1-2022-06668_Well Construction - GW1_20220708

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Bobby Lee Allred, II 14.WATERZONES i—
Well Contractor Name FROM TO DESCRIPTION
2610-A ft 1
ft. ft.
NC Well Contractor Certification Number
15.OUTER CASING for multi-cased wells OR LINER if a Gcable
Charles R. Underwood, Inc. FROM TO DIAMETER THICIGN ESS N.ATERIAL
�+ A ft. ft. in.
Company Name WS O V O 46 16.INNER CASING OR TUBING `eothermal dosed-loop)
2.Well Construction Permit#: FROM TO DIAMETER I THICKNESS 7 MATERUL
List all applicable,tell c•ansiraction pennils(i.e.UIC',('noon•.SYoie, t'ariance,etc.) +2 fL 82 ft. 4 in. PVC
3.Well Use(check well use): 87 ft- 90 ft- 4 in. PVC
Water Supply Well: FROCIREE TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural Municipal/Public 82 ft. 87 1" 4 in.
050 SS
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single)
x Industrial/Commercial PP (shared)
Residential Water Su Supply4
EJ18.GROUT.. 'i
Irrigation FROM TO MATERIAL EJIPLACENIENTAIETHOD&ANOINT
Non-Water Supply well: 0 ft- 50 ft- Benttinite Tremie Pipe
Monitoring DRecovery ft. ft.
Injection Yell:
ft. fr.
Aquifer Recharge Groundwater Remediation
` 19.SAND/GRAVEL PACK if applicable)
Aquifer Storage and Recovery Dsalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test DSton-nNvater Drainage 50 ft- 90 ft- #4 Gravel Trerrie Pipe
Experimental Technology Dsubsidence Control ft. ft.
Geothermal(Closed Loop) DITracer 20.DRILLING LOG attach additional sheets if necessary)
- FROM TO DESCRIPTION color,hsvdness,soil/rock e, rain size,etc.)
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) ft. ft-
See Attached formation log
a.Date Well(s)Completed:6/23/22 WeII ID#WeII #1
fr. fc.
Sa.Well Location: !
Autry Grading
r K yaw -1� •v. .. i_ r
Facility/Owner Name Facility lD°(ifapplicable) ft. ft.
1830 Davis Bridge Road ft. ft. JiJL
ft.
Physical Address.City.and Zip ft. .1.�.;-rn
Robeson 948289181300 21.REMARKS _ 1,
County Parcel Identification No.(PIN)
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field.one latilong is sufficient) 22.Certification:
34.56.12.25 N 79.01 .52.56 `N, i
6/30/22
6.Is(are)the well(s)OPermanent or IDTemporary Signature of ified Well Contractor ! Date
)iv stgnmg this ornr, I hereby certfi that the uell(,y t+•rts(were)c•anstrucied in accordance
7.Is this a repair to an existing well: DYes or x)No troh 15.4 NIAC•02C'.0100 or 15A MAC 02C'.0 00 We//('nu.,'Irtrction,l'Inndcrrd,'anc(Ihut a
if tlris is it repair,fill out known a ell construction io?lbroraium and explain the nature of the cop}of this record has been provided to the ire//otrner.
repair under=1/remarks section or on the hack ref Ihi.s 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: 90 (fL) 24a, For All Wells: Submit this form within 30 days of completion of well
lur nrnhrple ire/Lc list all cleptlr.r ijchfJ�•renl(e.raorple-9 tt?llll'and 1.(t lIlll') construction to the following:
10.Static water level below top of casing: 20.1 i(ft.) Division of Water Resources,Information Processing Unit,
/f traterleve/is above casing.tLse••- 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 10 (in.)
24b. For Iniection 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 & Iniection 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: i completion of well construction to the county health department of the county j
where constructed.
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone: [phone]
r
Sanford, North Carolina 27330 Fax:[phone]
i
Autry Grading
3rd Generation Ventures, LLC
Well#1
F
CASING LOG
+2'-82' 4" PVC Well casing
82'—87' 4" Stainless Steel .050 slot Screen
87'-90' 3'tail
F
Screen:
82'-87'
Grouted to 50'
#4 Gravel 50'—90'
4
I
6
f

Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Rd. Phone: [phone]
Sanford,North Carolina 27330 Fax: [phone]
i
I
Autry Grading
3rd Generation Ventures, LLC
Well #1
Formation Log
0' —2' Brown Sand
2' — 11' Pink White Clay
I — 14' Orange Sandy Clay
14' — 17' Tan Clay and fine sand
17' —22' Pink Sandy Clay
22' —34' Sand, getting iron
34' —37' Pink and white Clay
37' —56' Gray Clay
56' —61' Grey clay, sandy
61' —71' Grey Clay
71' —79' Pink clay and Sand
79' —81' Clay, white and grey
81' —87' Some chatter
87' — 105' Clay, light grey
105' — 114' Sand
114' — 170' Clay, grey,fine tight sand,dirty
170' — 179' A little tight chatter
179' One foot of good chatter
179' — 197' Clay with fine sand lenses
I:
a