GW1--00509_Well Construction - GW1_20240118

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Bobby Allred II '
14 W,ATER��ONES '-�
Well Contractor Name FROM TO DESCRIPTION
ft. ft. 1 ;
2610-A ft. ft.
NC Well Contractor Certification Number 15.OUTER:CASING(for-tnulti-casedWe11s)OR-LINER(if ap licable). -_.
Charles R. Underwood Inc. FROM TO DIAMETER THICKNESS 1 MATERIAL
ft. ft. in.
Company Name
-16:;INNER CASING'OR.TUBING`{geotber'Mafclosed-loop) ,.
2.Well Construction Permit#: WSO6O1483 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) ft. ft. L ' in. See Attached
•
3.Well Use(check well use): ft. ft. '"'
•17i SCREEN•, `„, .::
Water Supply Well: FROM TO DIAMETER SLOT SIZE _ THICKNESS - MATERIAL
OAgricultural ❑MunicipaUPublic ft. ft. i". See Attached
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft in.
❑Industrial/Commercial ❑Residential Water Supply(shared) ;:18.'GROUT ? „"
❑Irrigation ❑Wells>100,000 GPD FROM TO , MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft• 3 ft• Neat Cement Pour
❑Monitoring DRecovery 3 ft• 50 ft• Bentonite Tremie/Pump
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
:-19:SAND/GRAVEI/PACW(ifapplicabl y,. ,?zry _,� g.x a to
❑Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 50 ft• 190 it #3 Southern Silica Tremie/Pump
❑Experimental Technology ❑Subsidence Control ft. ft.
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OGeothermal(Closed Loop) ❑Tracer 20.-DRILLING:LOG(attach"additionaliheets ifuecessariii .,- !)" .s
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soiUrock type,grain size,etc.)
ft. ft. See Attached
4.Date Well(s)Completed: 1/5/24Well ID# 16R ft. ft. •
5a.Well Location: ft. ft. V- r. i� ' •r: o-n N N-,a
Carmichael Farms LLC
ft. fL ���� �...•5.-.� �CY
Facility/Owner Name Facility tD#(if applicable) ft. ft J ,Iv 1 S 2024
Fairley Rd, Maxton, 28364 ft. ft. :7":":::-.;:
Physical Address,City,and Zip ft. ft. IG"` ' D�` ,Jn:� 1;;;::
Robeson 838423549700 ",21 RMARxs.,. ,., - -.. ,, t 3••.. 7' "a
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:
34.691212 N -79.391077 W U,a66 4/gLed WW 1/16/2024
6.Is(are)the well(s): I lPermanent or ❑Temporary Signature of Wified Well Contractor Date
By signing this form,1 hereby cert fy that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or l No 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under#21 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 construction info
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 184 (ft.) Submit this GW-1 within 30 days of well completionper the following:
For multiple wells list all depths if di erent(example-3@200'and 2Q100') y I p
19 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing,use"+"
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24b.For Injection Wells:Copy to!DWR,Underground Injection Control(IUC)
II.Borehole diameter: .7 5 (in.)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Mud Rotary
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
500
13a.Yield(gpm) Method of test: PUill
p Permit Program,1611 MSC,Raleigh'NC 27699-1611
13b.Disinfection type: HTH Amount: llb
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone:[phone]
Sanford,North Carolina 27330 Fax [phone]
Carmichael Farms
Frazier Farm
Well #16R
Formation Log
34.691212 N -79.391077 W
0-1' Black Top Soil
1'-5' Tan, Sandy
5'-11' White Sand&White Clay
11'-15' Pink&White Clay
15'-34' Orange&White Sandy Clay
34'-44' Grey, Sandy, Coarse&Clay,Wood ! '
44'-55' Light Grey Clay
55'-70' Med White Sand, Chatter
70'-78' Sandy Clay
78'-85' Med Coarse Sand,Chatter Wood
85'-95' Hard White Clay
95'-129' Med Sand w/Chatter Wood,Lenses of Fine Sand.&Grey&White Clay
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129'-151' Clay
151'-181' Fine to Med Sand, Chatter Wood, Colored
175' Lenses of Clay, Getting Coarse
181'-201' Grey&White Clay, Some Lenses of Sand
,

Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone:[phone]
Sanford,North Carolina 27330 Fax:[phone]
Carmichael Farms
Frazier Farm _
Well #16R
Casing & Screen Log
34.691212 N -79.391077 W
+2'-109' 8" SCH10 Stainless Steel Casing
109'-129' 8" Stainless Steel Screen .050 Slot
129'-151' 8" SCH10 Stainless Steel Casing
151'-181' 8" Stainless Steel Screen .050 Slot
181'-184' 8" SCH10 Stainless Steel Casing
184' 8" Stainless Steel Plate
Neat Cement 0'-3'
Grouted 3'-50
#3 Gravel 50'-190'
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