GW1--04509_Well Construction - GW1_20240730

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells 513
1.Well Contractor Information:
Jonathan Kamionka 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name 193 ft- 248 ft.
3465-A ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if op Bcable)
FROM TO DIAMETER THICKNESS MATERIAL
Bill's Well Drilling Co. ft. ft. in.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
FROM TO DIAMETER THICKNESS _r MATERIAL
2.Well Construction Permit#: +2 ft. 180 ft• 6-1/4 i"• SDR21 PVC
List all applicable well permits(i.e.County,State,Variance,Injection,etc.) -
ISO.3 ft. a�•3 ft. 6-1/4 in- SDR17 PVC
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 193 ft. 248 ft- 6-1/4 r"• .032 SDR21 PVC
ft. ft. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(sin le)
❑Industrial/Commercial ❑Residential Water Supply(shared) 18 GUT
FROMRO TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 ft 180 ft. bentoite pumped
Non-Water Supply Well:
❑Monitoring ❑Recovery 180 ft. 185 ft• bentoite chips poured
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier
185 ft- 253 ft• #2 gravel poured
❑Aquifer Test ❑Stormwater Drainage
ft. 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 size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft• ft. SEE ATTACHED
11-7-23 ft. ft.
4.Date Well(s)Completed: Well ID#
ft. ft.
5a.Well Location: ft. ft.
Columbus Co Water District ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft
Old Lake Rd, Riegelwood, NC ft. - ft.
Physical Address,City,and Zip 21.REMARKS
Columbus TEST WELL
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Cert•frcation•
(if well field,one lat/long is sufficient)N w ..2bs"'
/4/`---1-(----'
11-7-23
f C
Signal oertified Wellractor Date
6.Is(are)the well(s): ©Permanent or ❑Temporary By signing this form,I hereby certify that the well(s)was(were)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 FINo copy of this record has been provided to the well owner.
If this is a repair,fill out known well construction information and explain the nature of the
repair under 421 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 the same construction,you can
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 253 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@100) construction to the following:
10.Static water level below top of casing: 54 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"r" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 12 (in.) 24b. For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
Mud Rotary
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
180 pumping 24c.For Water Supply&Injection Wells:
13a.Yield(gpm) Method of test:
Also submit one copy of this form within 30 days of completion of
13b.Disinfection type: HTH Amount: 2 lbs well construction to the county health department of the county where
constructed.
Form OW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013

Columbus County
Water Sewer District IV
BILL'S WELL DRILLING CO.
Date: 11/7/2023
Drilling Log Lithology
Test Well
Old Lake Rd, Riegelwood, NC
From To Formation Description
0 2 Topsoil
2 9 White&Tan Clay
9 19 Dark Gray Clay
19 29 Gray Clay
29 39 Gray Clay Some Shells
39 49 Gray Clay Some shells very hard
49 69 Very Hard Gray Clay
69 79 Gray clay some sand near bottom
79 85 Gray Clay some sand streaks
85 87 Hard Clay
87 89 Gray Clay
89 102 Gray Clay some sand streaks
102 107 Fine Gray sand
107 109 Gray Clay
109 121 Hard Gray Clay
121 122 Rock
122 129 Fine Sand shells rock layers
129 134 Sand &Rock Layers w/shells
134 139 Mostly Clay some rock layers
139 142 Clay
142 143 Rock
143 149 Sand &Clay Layers
149 162 Mostly Sand Medium&coarse w/clay layers
162 169 Dark Gray Clay
169 174 Clay& rock
174 183 Medium&fine sand
183 190 Clay
190 191 Rock
191 195 Clay turning to fine sand
195 204 Fine Sand
204 205 Rock
205 210 Fine Sand
210 211 Rock
211 235 Fine Gray Sand &Rock layers
235 240 Rock&Clay Layers
240 249 Rock& Fine Sand
249 251 Rock
251 253 Clay Some small sand