GW1-2021-07774_Well Construction - GW1_20211116

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/WELL CONSTRUCTION RECORD (GW-11 For Internal Use Only:
1.Well Contractor Information:
Bobby Lee Allred, 11 -14.WATER"ZONES r ,
FROM TO DESCRIPTION
Well Contractor Name
ft.
2610-A ft.
ft. ft.
NC Well Contractor Certification Number .15."OUTER CASING for iniilti=casod'wills OR LINER ifs" licable
Charles R. Underwood, Inc. FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name �16.'-INNER CASING OR T[IBING otheitnal`closed-lod ,� r
2.Well Construction Permit#:WS06-01451 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e. 11/C,County,State, Variance,etc) +2 rt. 80 ft. 8 in. Sch 10 SS
3.Well Use(check well use): 100-121 ft, 152-156 ft. 8 in. Sch 10 SS
W 17.SCREEN..,*;:,,
Water Supply Well: t.; P: .:,;;: r =•`
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
x Agricultural ®Municipal/Public 80 ft- 100 ft- 8 'n' .050 Sch 10 Ss
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) 121 fr• 152 rr• 8 in. .050 SCh 10 SS
Industrial/Commercial Residential Water Supply(shared) g.'GROUT . ,.`:•, x
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 fr• 3 fr• Cement Poured
Monitoring DRecovery 3 ft. 81 ft- Bentonite Tremie Pipe Pumped
Injection Well:
ft. ft.
Aquifer Recharge Groundwater Remediation
19.'SAND/GRAVELPACK'ife" livable
Aquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test [3Stormwater Drainage 81 fr• 157 R• #3 Gravel Tremie Pipe Pumped
Experimental Technology Subsidence Control
Geothermal(Closed Loop) 13Tracer 20.DRILLING LOG attaih`additiotialsheeisifeeces'sa `
Geothermal(Heating/Cooling Return) 00ther(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soil/mck type, rain size,etc.
ft. ft. See attached formation log
4.Date Well(s)Completed: 1 0/28/2021 Well ID#RL-9
5a.Well Location:
Patten Seed Company
Facility/Owner Name Facility ID#(if applicable) ft. ft. 2021
McGirt Gin Road, Maxton, NC
Physical Address.City,and Zip DWR t_ry
ION
Robeson 193090001007 21.REMARKS
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.Certification:
34.50.07 N 79.19.01 W
6.Is(are)the well(s)oPermanent or Temporary Si ature of iVified Well Contractor Date
By signing ihi.r form. I hereby certify that the wells)was(were)constructed in accordance
7.Is this a repair to an existing well: []Yes or x)No with I5A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
Lfthis•it a repair,fill out known well construction information and explain the nature of the copy of/his record has been provided to the well owner.
repair under 21 remarks section or on the back 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: 157 24a. For All Wells: Submit this form within 30 days of completion of well
Far nudnp/e+rolls list all depths ijdifferent(example-J a?00'and 2@100') construction to the following:
10.Static water level below to of casing: 16.2 ft.
p g: ( ) 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.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm)400 Method of test: Pump 24c. For Water Supply& 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: HTH Amount: 1 lb 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

Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone: [phone]
Sanford, North Carolina 27330 Fax: [phone]
Patten Seed Company
River Land Farm-RL-9
Robeson County
34.50.07 N 79. 19.01 W
Formation Log
0
0-1 Black Top Soil
1-10 Sandy Clay, tan/white
10-29 Cla , tan
29-46 Sand w/ clay lenses
46-80 Sand, chatter
80-81 Clay
81-91 Sand
91-104 Sand w/ Wood
104-115 Clay
115-116 Sand
116-124 Clay, light gre
124-158 Sand, chatter, wood
158-162 Clay
162-173 Sand with clay lenses
173-184 Clay, light grey
I
i

Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone: [phone]
Sanford, North Carolina 27330 Fax:[phone]
Patten Seed Company
p Y E
River Land Farm-RL-9
Robeson County
34.50.07 N 79. 19.01 W
Casing Log
+2' — 80' 8" Stainless Steel` Sch 10 Casing
80' — 100' 8" Stainless Steel' .050 Slot Screen
100' — 121' 8" Stainless Steep Sch 10 Casing
121' — 152' 8" Stainless Steel' .050 Slot Screen
152' — 156' 8" Stainless Steel Sch 10 Casin
0'-3': Cement
3'-81': Bentonite Grout
8 V-157': #3 Well Gravel