GW1-2021-06146_Well Construction - GW1_20211025

_ Pr.nt Form
ri WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
f
Charles M. McCaskill .Y4:WA`fER'Z0NESt
Well Contractor Name FROM ft. TO DESCRIPTION
2769-A & ft.
ft. ft.
NC Well Contractor Certification Number
15.OIiTEI CASING foc`inuld cas`ed:weM B_fL R"if a' ticable
Charles R. Underwood, Inc. FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name ,_ ,
WS06-01443 46.-INNERCASING'ORTUBING 6theematd&eil4 -t
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicahle well construction permits(i.e.II1C,County,State, Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
xI Agricultural Municipal/Public 77 ft' 118 f" 8 '"'' .050 Sch 10 SS
Geothermal(Heating/Cooling Supply) [ Residential Water Supply(single) 139 ft. 149 ft' 8 hi. .050 Sch 10 SS
Industrial/Commercial DResidential Water Supply(shared) .1g.GROUT _'s -. r'b
i Irrl ation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 e• 3 ft. Cement Poured
_i Monitoring DRecovery 3 ft. , 50 fr. Bentonite Tremie Pipe
Injection Well:
ft. ft.
Aquifer Recharge Groundwater Remediation �
19.-SAND/GRAVEL'PACK(ifa—livable} - st *
Aquifer Storage and Recovery DSalinity Barrier FROM TO MATERIAL I EMPLACENENT METHOD
Aquifer Test [)Stormwater Drainage 50 ft. 163 fL #4 Gravel Tremie pumped
Experimental Technology DSubsidence Control ft. ft.
Geothermal(Closed Loop) OTracer 20.DRIELtNG'LOG attach.additioiiilsheetiifn&essa
FROM TO DESCRIPTION(color,hardness,suiltrock type, rain size,etc.
CO Geothermal(Heating/Cooling Return) _j Other(explain under#21 Remarks) ft. ft.
See attached formation log
4.Date Well(s)Completed:9/1 0/2021 Well ID#Well # 1 ft. ft.
5a.Well Location: ft. ft.
Wakulla Land LLC f` f`
Facility/Owner Name Facility ID#(if applicable) ft. ft.
NC Hwy 71 & Oxendine School Road ft. ft. OCT
Physical Address,City,and Zip ft. ft. Unl4
Robeson 932843361800 2I.'REARhs�.<
County Parcel Identification No.(PiN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one]at/long is sufficient) 22.Certi
34*47'54.95" N 79*15'26.05" W
6.Is(are)the well(s)oPermanent or 13Temporary tgnature of Certified Well'C9Kactoff D
By signing this form,I hereby certify that the wells)was(were)constructed in accordance
7.Is this a repair to an existing well:, EJYes or E)No .ith 15,4 NC'AC 02C.0100 or I5A NCAC 02C.0200 Well Construction Siandardr and that a
If this is a repair,full out known well constriction information and explain the nature of the copy of this record has been provided to the well owner.
repair under=21 remarks section or on the hack of this 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 site details or well
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 155 (ft•) 24a. For All Wells: Submit this;form within 30 days of completion of well
For nmhiple,wells list all depths if different(example-3@200'and 2 a.100') construction to the following:
10.Static water level below top of casing: 13. (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"-" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 17 (in.) 24b. For Infection Wells: in addition to sending the form to the address in 24a
Mud Rotary above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
I
Division of Water Resources,Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c. For Water Suably & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to;the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources' Revised 2-22-2016
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Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone: [phone]
Sanford,North Carolina 27330 ° Fax: [phone]
Sam Parker—Wakulla Land LLC
Well No. 1
Oxendine School Road
Formation Log
0—0.5' Sandy topsoil
0.5'-10' Sandy red clay
10'-17' Very sandy clay
17'-22.5' Sand
22.5'-23' Clay
23'-26' Sand
26'-26.5' Clay
26.5'-3 F Sand
3F-32' Sandy clay lenses
32'-45' Sand
45'-46' Sand, wood
64'-64 .5' Clay
64 .5'-64.5' Sand
69.5'-70.5' Clay
70.5'-118' Sand, wood, a fine clay lens at 90'
118'-120' Sand clay lenses
120'-12F Clay
12l'-123' Sand
123'-137' Clay, gravel
137'-156' Sand
156'-160' Clay sand lenses
160'-160' Sandstone
160'-163' Clay sand lenses
III
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Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone: [phone]
Sanford,North Carolina 27330 Fax: [phone]
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Sam Parker—Wakulla Land LLC
Oxendine School Road
Well No. 1
Casing Log
(Casing Starts at 2' above grade)
21' 12-3/4" 8" Sch. 10 Stainless Steel Well Casing
21' 2-3/4" 8" Sch. 10 Stainless Steel Well Casing
21' 8" Sch. 10 Stainless Steel Well Casing;
167 3" 8" Sch. 10 Stainless Steel Well Casing;
10, 8" SS .050 Slot Screen
10, 8" SS .050 Slot Screen
10, 8" SS .050 Slot Screen
10, 8" SS .050 Slot Screen
21' 2-3/4" 8" Sch. 10 Stainless Steel Well Casing
10, 8" SS .050 Slot Screen
5' 8" Sch. 10 Stainless Steel Well Casing'
Cement: 0'-3'
Grouted: 3'-50'
#4 Gravel
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