GW1-2021-00301_Well Construction - GW1_20210127

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
VINCE FEDERLE 14.WATER ZONES
Nell Contractor Name FROM TO DESCRIPTION
A - 3552 fl. rl,
R. H.
NC Well Conoactor Cenification Number 15.OUTER CASING for mulfi<ued welb OR LINER ifa livable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS Ms
TF,RIAI.
ft. ft.
Company Name
16.INNER CASING OR TUBING eothermel close -to do
2.1Vell Construction Permit It: FROM TO DIA.NErOr THICKNESS I MATERIAL
/ea tr//uppbsthhe,renrx,n.1,ul.on pernnea 0.e. 11/(',('ou... Smrr. G,r"o,, u) 0.0 fe 7.0 fE 1.0 in. SCH 40 PVC
3.M'ell Use(check%ell use): R. ti, '
Vtaler Supply Well: 17.SCREEN
OAriRONI TO n1ASIFTER SLOTSIZE THICKNESS MATERIAL
ClGeot erniall ❑Msidenal/Public 70 fL 17.0 `f' 1.0 ' .010 SCH 40 PVC
❑Geothermal(Heating/CoolineNupply) ❑Residential Water Supply(single) D ft. in.
❑Industrial/C-ommercial ❑Residential Water Supply(shared) 18.GROUT
oftnication ❑Wells 1100,000 GPD FROM 'TO MATERIAL EMPLACEMENT MET110D&AMOUNT
Non-Water Supply Well: 0.0 fL 3.0 ff PoarrAuo BENTONITE SLURRY
OMonitoring ❑Recovery n. rt.
Injection Well:
n. R.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAV impeable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METII00
❑Aquifer Test ❑Stormssater Drainage 5.0 D' 17.0 `I' 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. D.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG an. h additional sheen if necessary)
❑Geothermal(Heatin Cooling Return) ElOther(explain under k21 Remarks) FROM TO DESCRIPTION hua.,hardue miVrochD re.ec.
0.0 It. 1.0 ft. GRAVEL
4.Date Well(s)Completed: 01/06/21 Well DIN PZ-1 1.0 ft- 17.0 ft- GRAY CLAYEY SAND
Sa.Well Location:
t. D.
INTERNATIONAL PAPER ft. ft.
Fanlip tOwncr name Faaila,lo'rfapprcnmc) ft. ft.
1785 WEYERHAEUSER ROAD VANCEBORO 28586 ft-
Ph}sical Address,Ca, it Zip ft. rL
CRAVEN 21.REMARKS
County Parcel Identification No (PIN) BENTONITE SEAL- 3.0-5.0 FEET
Sb.Latitude and longitude indegrees/minutes/seronds or decimal Degrees: "'PRE-PACK SCREEN"'
(ifuell field,one ladlong is sufficient) 22.Certification:
350 13' 38.39" N. 770 06' 27.73" W 1/15/2021
6.Is(ere)the w ell(s): 25Permanent or OTemporary, Signature of Ccnified Well Contractor Data
M'c.A y,d./ ll h� trTd tit /l(1 '(' ) ' i raed a acumlame i rzh
7 Is this a repair to an existing well ❑Yes or MNo �"r� i 75�I.K a( 02( 0/00 r b4 MA rt( 0200 0 11( .....r sr ndmd.nod that a mpr
a od N a<�tht cord ha. been prt ided it)the tell nt nee
lion, pr fit I k ell I Y ya,000 o / ,plum da h'm* I
treat v under :21 rt mnrb srnion ur un the bank JYhis Ihrnt_ J H
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 hell construction info
construction,only ) GW-1 is needed. Indicate TOTAL NUMBER ofwelis (add See Over'in Remarks Box).You may also attach additional pages it necessan
drilled 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 17.0 (ft.)
Far nru/tlplo yell,1lrlalldepdv rfdoh,ol(.......1,&-30),200'mu1214`100.) Submit this GW-1 within 30 days of well completion per the fallowing:
g.0 24a. For All Wells: Original form to Division of Water Resources (DWR)-
10.Sortie water level below top of casing: (ft') Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
//uvrta Inzl t,.n/Tore aavrrg,uce
11.Rorehole diameter: 8.0 (in.) 24b. For Injection Wells: Copy to DWR,Underground Injection Control (IUC)
Program. 1636 MSC,Raleigh,NC 27699-1636
12.\\'ell construction method: AUGER
24c,For N'ater Supply and depa Geothermal Return Wells::Copy to the
0e.auger.rmary,cable.direct push,em.1 count}environmental health department of the county where installed
FOR WATER SC PPLI'\\'ELLS ONIA: 24d. For 1\'ater Wells producing aver 100,000 GPD: Copy to DWR C'C PCUA
Us.}'field(gpm) Method of test: Permit Program, 1611 MSC-Raleigh,NC 2 7699-1 6 1 1
13b.Disinfection type: Amount:
Fonn GW-I Nonb Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018