GW1-2022-09632_Well Construction - GW1_20221021

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WELL CONSTRUCTION RECORD For internal Use ONLY:
This form can be used for single or multiple wells
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1.Well Contractor Information:
Virgil Wilson '14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name - 11 ft. 25.5 ft. ` Wet
4473 ft. ft.
NC Well Contractor Certification Number -15.OUTER CASING for mulfi-cased.welis OR LINER if a livable
FROM TO DIAMETER - THICKINESS MATERIAL
Parratt-Wolff, Inc. ft. ft. I ! in.
Company Name 16.INNER CASING OR TUBING eotheernal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: 0 ft. 10.5 ft-- 2 ' 'n' sch40 pve
List all applicable well permits(i.e.County,State,Variance,Injection,etc.)
ft. ft. j in.
3.Well Use(check well use):
"1.7.SCREEN.'
Water Supply Well: .FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 10.5 ft' 25.5 it- 2 in. .010 sch40 pvc
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) '-18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑irrigation 0 er. 6.0 :ft. portland;ceril Tremie
-- - Non-Water-Supply Well: - - --- - --- - i _
Monitoring ❑Recovery
6 ft. 8 ft. Bentonite Chii Tremie
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if a' livable '
FROM TO MATERIAL; - EMPLACEMENT METHOD
El Aquifer Storage and Recovery ❑Salinity Barrier 8 fL 25.5 � ft- #1 Sand Tremie
❑Aquifer Test ❑Stormwater Drainage
ft. ft.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG(attach additional sheets if necessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness,soil/rock type,grain size,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks) ft. ft.
9-20-22 MH-48C ft. ft.
4.Date Well(s)Completed: Well ID#
ft. ft.. 6-
5a.Well Location: ft. ft.
Novozymes North Amehca, Inc. ft ft t_
Facility/Owner Name Facility ID#(if applicable) -
77 Perrys Chapel Church Road, Franklinton ft. t. ln ^fwlWj n Prk 11Ail
Physical Address,City,and Zip
21.REMARKS',
Franklin 8"FMC'in,24"BT pad
County Parcel Identification No.(PIN) !
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22fCtifiication:
f
(ifwell field,one tat/long is sufficient)
36.096594 N -78.410334 W
Signature of ified Well Contractor Date
6.Is(are)the well(s). OPermanent or ❑Temporary _
_ _ _ - By signing this farm,/hereby certify that the irel!(s)was(were)constructed in accordance
ivith I5A NCAC 02C.0100 or I5A NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or MNo copy ofthis record has been provided to the well owner.
If This•is a repair,fill oul knovn ti,ell construction information and explain the nature of the
repair under 921 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
S.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 file same construction,you can
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 25.5 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdifferent(example-3@200'and 2@100') construction to the following:
10.Static water level below top of casing 1 1 (ft.) Division of Water Resources,Information Processing Unit,
Ifiwater level is above casing,use" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8 (in.) 24b. For Iniection Wells ONLY: In addition to sending the form to the address in
4 1I4 HSA 24aabove, also submit a copy of tliis'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 Cen i ter,Raleigh,NC 27699-1636
Yield m Method of test 24c.For Water Supply&Injection Wells:
13a.
(gp ) 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.
Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013