WS0801043_Report Well 2_20191021

WELL CONSTRUCTION RECORD For Internal Use ONLY: c A (,11
This form can be used for single or multiple wells V (r
1. Well Contractor Information:
Jonathan Kamionka RECEIVE01i4mc NRmwn
I
FROM
mom
ZZONES
TO
I DESCRIPTION
Well Contractor Name ,
3465-A
NCWcll Connector Ceaificaaon Nmnbe, OCT 2 1 2%
Bill's Well Drilling Co. Water
265 &
285 ft.
30o h•
320 ft.
IS. OUTER CASING Ifer
multi -cued wells) OR LINER Ile noble
FROM
TO
DIMIEfER THICKNESS M1IATERML
D 1
ao It•
12 a schaa PVC
Company Name OperatQ o ACC g ar
WS080I ftw CD6a ectlon
2. Well Construction Permit N: J V �i17� eVU _ nal Offirr
List all applicable ii,all perans (t.c. Caary, State, Pm hinen hijeetimr, etc.)
3. Well Use (check well use):
16. INNER
CASING OR TUBING
cothermalelosedl
FROM
TO
DIAMETER
THICKNESS
M1IATERLIL
+3 Ir'
1265 ff•
6 i°'
.188
Steel
ar - ft,
300
a R.
1
In.
6
.188
Steel
17. SCREEN
Water Supply Well:
ClAgricultural OMunicipal/Public
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply (single)
Catndustrial/Commercial OResidential Water Supply (shared)
Obligation
FROM
TO DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
265 16
285 r4 6
'"'
.032
S.S.
300 R•
320 1- 16
'"'
1 .032
S.S.
18. GROUT
FROM
TO
MATERIAL
EMP"CEMENTMEfHOD&MIOUNr
D R.
250 ft.
bentonite
pumped
Non -Water Supply Well:
❑Monitoring ORecovery
Injection Well:
OAquifer Recharge OGmundwater Remediation
❑Aquifer Storage and Recovery OSnrnBarrier
❑Aquifer Test OStotonnw ater Drainage
El Experimental Technology OSubsidence Control
❑Geothermal (Closed Loop) OTraC¢f
OGeothermal (Heating/Cooling Return) ❑Other (explain under 021 Remarks)
R
fe
19. SAND/GRAVEL
PACK
If mar, Ifeablet
FROM
MATERIAL
EbIPLAcem METHOD
ENT
250 ft-
325TO le
#3 gravel
poured
u.
ft.
20. DRILLING
LOG suacb
addluonalebanifneceua
FROM
I TO
IDESCRIPTION colon hardness. soiVrocx rain sise.eu.
ft.
IL
See Attached
4. Date Well9-5-19 s) Completed: Well IDN WELL #2
So. Well Location:
US Cold Storage Inc.
Facility/Owner Name Facility [DO (if applicable)
240 Bruce Costin Road Warsaw, NC 28398
ft.
rt.
ft
ft
ft.
(L
ft.
ft.
ft
ft
rt
rt
Physical Address, City, and Zip
Duplin 01-366
County Parcel Identification No. (PIN)
21. REMARKS
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
22. Certification:
(ifevell field, one lot/long is sufficient)
35.015417 -78.113225
�� 9-5.19
N%Y
SignaluteofCerti6c Well Contractor Data
6. Is (are) the well(s): OPermanent or OTempte ary
By matting this form. I hereby cerr/fy than da Well(s) Wos (mere) cotu0uclif h, accordance
Wllh ISA NCAC 02C .0100 or 15A NCAC 02C .0200 Well Coralruedou Standards and that a
7. Is this a repair to an existing well: OYes or IUNo
ropy ofOds record has been proilded to 16s Well oImor.
Ifthis is a repair, fill out known yell eonsmation h forniatlou and esploo, the nourr •• of the
repair carder 921 remarks section or on the back ofthis form.
23. Site diagram or additional well details:
'
1
You may use the back of this page to provide additional well site details or well
-
S. Number wells constructed:
construction details. You may also attach additional pages if necessary.
ateed:
For mulOple o0enias or oao-nnttr apply welh ONhY u•!Ih drc seats ao"slruarlt��y'o aan
nj
.ntb..in ane form. /.. L % I P
SUBMITTAL INSTUCTIONS
e32`5 -
9. Total well depth below land surface: (fl.)
E4 J or AI ells: Submit this form within 30 days of completion of well
Far auhiplenelh I,,Ialidepflrs lfdgerent(example-3@200'rttd 2@10(Y) t`
construction to the following:
10. Static water level below top of casing: 54((f,)�,,
•Division of Water Resources, Information Processing Unit,
Ifwaler level is above cas... g, rise "-"
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameler: 12 (in.)
24b. For Inieclian Well ONLY: In addition to sending the form to the address in
Mud Rota ry
24a above, also submit a copy of this farm 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) 300 Method of test: pumping
24c. For Water Supply & In)ecton Wells:
HTH
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: 1 Cup
well construction to the county health department of the county where
constructed. -
Fo.n GW-1 North Carolina Department of Environment mid Natural Resources- Division of Water Resources Revised Augus12Di3

Bill's Well Drilling Co Pumping Test - US Cold Storage Well 2
800 McArthur Rd, Fayetteville, NC 28311
US Cold Storage - Pumping Test Record Well #2
Test Conducted by: Jonathan Kamionka Well Construction Permit #: WS0801043; CU3328
1. WELL LOCATION: Nearest town: Warsaw County: Duplin
240 Bruce Costin Road Warsaw, NC 28398 Quadrangle #:
2. OWNER:
VV �JJ US Cold Storage Inc.
3. USE OF WELL:
_Domestic _Public X Industrial
_ Irrigation _Other:
4. WELL DEPTH: 325
CASING DIAMETER: 6
IN. CASING TYPE: steel
5. DRILLING CONTRACTOR:
Bill's Well Drilling Co.
Was Casing Grouted? yes
6. STATIC WATER LEVEL:
54 FT. above x below
top of casing.
Date measured:
_
9/11/2019 Casing is 3
ft. above land surface.
c
7. WELL YIELD: 300
GPM SPECIFIC CAPACITY:
4.68 GPM/FT.-DD.
N
8. PUMPING WATER LEVEL: 118 FT. AFTER 24
9. CHLORINATION: TYPE:
10. TIME AND DATE: PUMP STARTED:
11. WATER LEVEL MEASURING DEVICE:
12. TEST PUMP: Type Submersible
Capacity: 300 gpm at
HTH
10:05 AM 9-11-19
HOURS AT 300 GPM
AMOUNT: 1 cup
PUMP STOPPED: 10:05 AM 9-12-19
Probe FLOW MEASURING DEVICE: Meter
Make Grundfos Horse Power 20
200 T D H Intake depth 147 ft.
Jonathan Kamionka - 3465-A Page 1 of 3
E

Bill's Well Drilling Co
800 McArthur Rd, Fayetteville, NC 28311
Pumping Test - US Cold Storage Well 2
Date
Time
Water Level
Pumping
g
Remarks
9/11/2019
10:05:55
54.0
0
9/11/2019
10:10:55
117.2
300
9/11/2019
10:15: 55
117.6
9/11/2019
10:20:55
117.6
9/11/2019
10:25:55
117.9
9/11/2019
10: 30: 55
117.7
9/11/2019
10:35:55
117.8
9/11/2019
10:40:55
117.5
9/11/2019
10:45:55
117.6
9/11/2019
10:50:55
117.9
9/11/2019
10:55:55
118.2
9/11/2019
11:00:55
117.6
9/11/2019
11: 05: 55
117.9
9/11/2019
11: 35: 55
118.0
9/11/2019
12:05:55
117.8
9/11/2019
13:05:55
118.1
9/11/2019
14:05:55
118.0
9/11/2019
15:05: 55
118.3
9/11/2019
16:05:55
118;0
9/11/2019
17:05:55
118.1
9/11/2019
18:05:55
118.1
9/11/2019
19:05:55
118.1
9/11/2019
20:05:55
118.2
9/11/2019
21:05:55
118.4
9/11/2019
22:05:55
118.0
9/11/2019
23:05:55
118.2
9/12/2019
0:05:55
118.6
9/12/2019
1:05:55
118.3
9/12/2019
2:05:55
118.4
9/12/2019
3:05:55
118.4
9/12/2019
4:05:55
118.2
9/12/2019
5:05:55
118.2
9/12/2019
6:05:55
117.8
9/12/2019
7:05:55
118.2
9/12/2019
8:05:55
117.9
9/12/2019
9:05:55
118.0
9/12/2019
10:05:55
118.1
9/12/2019
10:20:55
118.1
Test Stop
9/12/2019
10:25:55
59.2
9/12/2019
10:30:55
58.4
Jonathan Kamionka - 3465-A Page 2 of 3
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