WS0801059_Report_20210519

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
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#: WS0801059
List all applicable mall permits its. Cnlmty, Slam, Variance, lnjeclion, ale.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrlal/Commercial
Non -Water Supply Well:
❑Municipal/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
❑Aquifer Recharge
DGroundwater Remediation
❑Aquifer Storage and Recovery
DSalinity Barrier
❑Aquifer Test
DStonnwater Drainage
DExperimental Technology
OSubsidence Control
❑Geothermal (Closed Loop)
DTracer
❑Geothermal (Heating/Cooling Return)
DOther (explain under 421 Re
4. Date Well(s) Completed: 5-13-2021 Well ID# Davis Farm
5a. Well Location:
Goodson & Wells Farms, Inc.
Facility/Owner Namc Facility IDN (ifapplicable)
Jim Best Rd, Mt Olive, NC 28365
Physical Address, City, and Zip
Duplin
County
350000681185
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one let/long is sufficient)
35.139842 in -77.971677 L
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: OYes or ONo
if ilus is a repair, fill out known well construction Information and explain the nature ofthe
repair under #21 remarks section or on Ibe bock ofthis form.
S. Number of wells constructed: 1
For nndtiple injection or con -water supply wells ONLY wilh the same construction, you can
submit oneform.
9. Total well depth below land surface: 356
For manic , wells list all deplbs ifdierem (example. 3©200' and 2Q100)
10. Static water level below top of casing: 40.6
ffivater level is abore casing, use '•+"
For Interval Use ONLY:
- ft. Alto- ft.
O fL 1 4 7 a. 120
1' 1 .375 Steel
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rnala TIC DEMETER TXICXXEEE
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FROM �T-O PIRM EM ERE TXICXNEEE METE3IICL IESS MATERIAL
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leS R�Rf_,F 2 Ld3a.
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10 1" 147 fl. I Neat cement I numned I
0 D•
100
ft.
benotite
pumped
ft.
fL
19. SAND/GRAVEL
PACK
f Ifca6le
FROM
TO
MATERAL
EMPLACEMEWMETROD
10o IT.
355
D.
#3 Gravel
poured
ft.
1
ft.
fr. ft. See attached
ft. ft.
D. ft.
ft. I ft.
22. Certification:
4 `. 1,/ �— 5-13-2021
SignaisficofCertified Well Contractor Data
By signing this farts, f hereby certify that the ,Oil(s) ums (here) e..,,acted in accordance
with /SA NCAC 02C.0100 or 15A NCAC 02C .0200 Well Conslrac0an Standards and that a
copy ofthis record has been provided to the mall mvaer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft) Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 20 (in.) 24b. For Infection Wells ONLY: In addition to sending the form to the address in
Air &Mud Rotary 24a above, also submit a copy of this forth 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
m 650 Method of test; pumping 24c. For Water Supply& Injection Wells:
13a. Yield (gp ) Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: HTH Amount: 4 cups well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Department ofEnvimnment and Natural Resources- Division of Water Resources Revised August 2013

BMUS WELT. DRILLING CO.
800 McArthur Road
Fayetteville, North Carolina 28311
Office [phone]
[e-mail] www.biUswelldrilling.com
Date: 5/13/2021
Goodson & Wells Farms
Drilling Log Lithology
Davis Farm -Jim Best Rd, Mt Olive, NC Duplin Co
From
To
Formation Description
0
5
Orange Sand & clay
5
11
Mixed Sand
11
16
Orange Sand
16
17
Gray Silty Clay
17
37
Gray Clay w/streaks of fine sand, large
gravel, glaucanite & wood
37
47
Silty Gray Clay
47
55
Hard Gray clay
55
ill
Fine Sand & Clay, Glaucanite & wood
ill
117
Mostly Dark Gray Clay & wood
117
137
Mostly Clay w/small streaks gray sand
137
165
Sand & Clay streaks w/Gray medium sand
165
175
Clay
175
177
Soft Rock Sandstone
177
182
Salt & Pepper Sand
182
192
Solid Gray Clay
192
197
Streaks fine Sand & Clay
197
222
Dark Gray Clay
222
237
Light Gray Clay Softer clay w/some sand
237
265
Light Gray Clay turning to darker Gray
265
277
Streaks of Sand w/some clay
277
284
Clay
284
290
Streaks of Coarse sand mostly clay
290
297
Clay
297
356
Small streaks fine sand & some clay
Bills
WE
DRI G
Jonathan Kamionka
3465-A