GW1-2022-09630_Well Construction - GW1_20221021

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
Virgil Wilson 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name 9 ff. 28.8 f" Wet
4473
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a licable
FROM TO DIAMETERTIIICKNESS M1LITERIAL
Parratt-Wolff, Inc. ft. I ft. I in.
Company Name 16.INNER CASING OR TUBING geothermal closed-log
FROM TO DIAMETER THICICNESS MATERIAL
2.Well Construction Permit#: 0 ft. 13.8 rt. 1 in- SCh40 pvc
List all applicable well permits(i.e.County,Slate,Variance,h jeclion,etc)
ft. ft. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 13.8 fr. 28.8 ft. 1 in. .010 Sch40 pvc
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. f`' tn'
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0
- --Non-Water-Supply Well: _ ft. 8.7 ft- Portland cem Tremie
8-7 rr.- 11.1 `fi Bentonite Chi Tremie
MMonitoring ❑Recovery
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVELPACK ifa licable
Mp
M1fATER1AL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier
f` #1 Sand Tremie
❑Aquifer Test ❑Stormwater Drainage ft.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,soil/rock type,grain sin,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks) ft. ft.
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4.Date Well(s)Completed: 9-21-22 Well ID# MH-49c ft. ft.
ft. ft. >A.. .
5a.Well Location: ft. ft. T
Novozymes North America, Inc. ft. ft.
Facility/Owner Name Facility ID#(if applicable)
ft. ft. ,
77 Perrys Chapel Church Road, Franklinton ft. ft. rnr;t�iil`
Physical Address,City,and Zip 21.REMARKS
Franklin
County Parcel Identification No.(PIN)
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5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. ertification
(ifwell field,one lat/long is sufficient)
36.096371 N -78.410242 N J 13L 16 •6 D
Signature Certified Well Contractor Date
6.is(are)the well(s): ©Permanent or ❑Temporary By signin this form,I hereby certify that the wells)was(here)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 ONo copy ofthis record has been provided to the well ou-ner.
lfthis is a repair,Jill out known well construction information and explain the nature of the
repair under�21 remarks section or on the back ofthis 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 narwater.supply wells ONLY with the sante construction,you can
submit one form. SUBMITTAL INSTUCTIONS
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9.Total well depth below land surface: 28.8 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For mndtiple wells list all depths tfdiJferent(example-3@200'and 2 n 100') construction to the following: iI
10.Static water level below top of casing: 9 (ft.) Division of Water Resourlces,Information Processing Unit,
1f water level is abore casing,use-�" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 (in.) 24b. For Injection Wells ONLY: Ini addition to sending the form to the address in
4 1/4 HSA 24a above, also submit a copy of this form A thin 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
m 13a.Yield
(gP ) Method of test: 24c.For Water Supply&Injection Wells:
,
Also submit one copy of this form within 30 days ofcompletion of
13b.Disinfection type: Amount: well construction to the county health department of the county where
constructed. I
Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013
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