WS0801053_GW-1_20200428

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jonathan Kamionka
Well Contractor Name
3465-A
NC Well Contractor Certification Number
Bill's Well Drilling Co
Company Name
2. Well Construction Permit#: CU3340/W50801053
List all applicable well construction permits (i.e. I/IC, County, State, Varionce, arc.)
3. Well Use (check well use):
OAgricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
01ndustrial/Commercial DResidential Water Supply (shared)
DAquifer Recharge
❑Aquifer Storage and Recovery
DAquifer Test
OExperimental Technology
❑Geothermal (Closed Loop)
M Wells > 100.000 GPD
❑Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
OTracer
under#21
4. Date Well(s) Completed: 4-15-2020 Well [DO Mr. John's Farm
59. Well Location:
Goodson & Wells Farms, Inc.
Facility/Owner Name Facility ID# (if applicable)
359 White Flash Rd, Mt Olive, NC 28365
Physical Address, City, and Zip
Duplin 35200137138
County Pascal Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/secands or decimal degrees:
(ifwell field one la/long is sufficient)
35.124611 N-77.923278 W,
6. Is(are) the well(s): OPermanent or OTemporary
For Internal Use Only:
W. WATER
ZONES
PROM
TO
DESCRIPTION
IfdS ft
O It.
1
ft
15. OUTER CASING for melfi-cased wells OR LINER if a Htabk
FROM
TO DIAMETER TtlIC.. MATERIAL
0 it. 147
it. 120 in. I I Steel
16. INNER
CASING OR TUBINGETER eodrermal
clmed-too
FROM
TO DIAM
THICIQJE55
I MATERIAL
ti-noR.
d-O Sft- 10
SDR17
JPVC
d Op R.
3a5o n- 10 In'
3
SDR17
PVC
17. SCREEN
FROM TO
DIAMETER
SLOTS¢E
THICKNESS
MATERIAL
1 00 Is- 3 Sp rL 10
I
i"'
.032
SS
2Soft. 13aS D' 110
in.
.032
Iss
18, GROUT
FROM
TO
MATERIAL
EMPLACEMENTMETROD&AMOUNT
0 rL
47 f6
Cement Grout
Pumped
0 it.
155 n-
Bentonite Grout
Pumped
a.
ft.
19. SAND/GRAVEL
PACK
a tic e
FROM
TO
MATERIAL1
EMPLACEMENTMETHOD
155 f.
330 0-
#2 gravel
Poured
ft.
ft.
20. DRILL
LOG attach
additional sheets ifnecesse
FROM
TO
DESCRIPTION color, hardnessrod/rock type, enda.radi.)
D.
fL
SEE ATTACHED
ft.
ft.
D.
ft.
D.
ft.
ft.
ft.
rt.
ft.
ft.
ft.
21. REMARKS
22. Cera
.
4/15/2020
Sign roof Canifie ell Contractor Data
Bysigningthis form, I hereby cert6 that the rvell(s) was ([rare) corulructed in accordance with
7. Is this a repair to an existing well: ❑Yes or ONo
15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Sl mdards and that a copy
If this is a repair fill out knmvn well construction information and explain the nature fthe
f this record has been provided ro the well corner.
repair under 421 remarks section or on the back ofthis form.
23. Site diagram or additional well details:
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
You may use the back of this page to provide additional well construction info
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
330
9. Total well depth below land surface: (ft.)
For multiple wells list all depths ifdii fercnt (example- 3Q200' and2Q100�
Submit this GW-1 within 30 days of well completion per the following:
10 Static water level below to of casin • 45.4 111)
24a. For All Wells: Original form to Division of Water Resources (DWR),
P g•
Ifwarer /eve/ is above casing, are 't "
II. Borehole diameter: 20
(in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Iuiection Wells: Copy to DWR, Underground injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
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
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
13a. Yield (guns) 635 Method of test: Pumped
13b. Disinfection type: HTH Amount: 4 Ibs
Form GW-I North Carolina Department of Environmental Quality - Division of Water Resources Revised 6-6-2018

BILL'S WELL DRILIdNG CO.
800 McArthur Road
Fayetteville, North Carolina 28311
Office [phone]
[e-mail] www.billswelldrMing.com
Date: 4/15/2020
Goodson & Wells Farms
Drilling Log Lithology
MrJohn's Farm - White Flash Rd, Mt Olive, NC - Duplin County
From
To
Formation Description
0
52
Tan Sand w/streaks white clay
52
58
Gray & Tan clay w/sand streaks
58
74
Gray & White Clay w/fine sand
74
78
Gray Clay
78
98
Silty Clay w/Fine Gray & White sand
98
207
Fine Sand "Float"
207
218
Gray Clay w/Sand streaks
218
234
Gray Silty clay
234
238
Fine Sand & clay
238
253
Layers of Sand & Clay
253
270
Clay
270
278
Clay w/small streaks of fine sand
278
298
Streaks of sand w/ clay & coarse sand
298
318
Sand w/small streaks of clay
318
330
Clay w/small streaks of sand
BI
WE
DRI LG
Jonathan Kamionka
3465-A