GW1-2022-06665_Well Construction - GW1_20220708

ME Form
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Bobby Lee Allred, I I 14,WATERZONES
Well Contractor Name FROM TO DESCRIPTION ,
2610-A fL fL
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ft. ft. V
NC Well Contractor Certification Number
15."OUTER CASING"(for mul6cssedwells OR LINER ifs' lica6le
Charles R. Underwood, Inc. FROM TO DL1b1ETER THICKNESS DUTERUL
�+O 462 ft. ft. i in.
Company Name 16.INNER CASING OR TUBING Ieothertnat closed-loop)
2.Well Construction Permit#:WS O V FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.111C,County,.late, l'armnce,etc.) +2 ft- 65 ft- 8 in. Sch 10 SS
3.Well Use(check well use): 115 ft- 120 ft- 8 in. SCh 10 SS
Water Supply Well: 17.SCREEN
FROM TO DL4METERi SLOT SIZE THICKNESS DIATERIAL
x Agricultural Municipal/Public 65 ft. 115 fr, 8 in. .050 SS
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ft ft in:'.
Industrial/Commercial Residential Water Supply(shared)
18.GROUT
Irrigation FROM TO MATERIAL ENIPLACENIENTMETHOD&AMOUNT
Non-Water Supply Well: 0 fry 3 ft. Neat Cement Tremie Pipe
Monitoring Recovero 3 f- 50 ft- Bentonite Tremie Pipe
Injection Well: fr. ft.
Aquifer Recharge E)Groundwater Remediation
19.SAND/GRAVEL PACK if a' licable
Aquifer Storage and Recovery [3Salinity Barrier FROM To 41ATERWL I E4IPLACEAIENTMETHOD
Aquifer Test DStormwater Drainage 50 ft• 120 ft• #3 Gravel Tremie Pipe
Experimental Technology Dsubsidence Control
Geothermal(Closed Loop) D-Fracer 20.DRILL(rIG LOG(attach addi6onal sheets ifnecessary)
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soil/rock e, min size,etc.)
- ft. ft- See Attached formation log
4.Date Wells Completed:6/29/22 Weu ID#Well #1 ft. ft. _
ft. ft. v,:�, e 1 IL a
5a.Well Location:
Riddle Farms, LLC f. ft.
Facility/Owner Name Facility ID9(if applicable) ft. ft.
7397 Riddle Road, St Pauls, NC 28384 ft. ft. ,:„
Physical Address.City.and Zip ft. ft. `'j'` '
Robeson 041001414100 21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field.one lat/long is sufficient) 22.Certification: f
34.50.25.74 N 78.53.13.65 NN,
7/1/22
6.Blare)the well(s)o Permanent or DTemporary, Signature ofC ved Well Contractor Date
)3v signtnR iris form,l hereby c•erttfy that the tell(s) was(u ere)constructed in accordance
7.Is this a repair to an existing well: QYes or E)No with l5A NC•AC 02C.0100 or 15A NC•AC 02C.0200 tVell C•onsiruction Standards and that a
/fdos is a repair.ill out knon n well construction iglorinatton and explatn the nature of the cony of this record has been provided is the tell otner.
repair under--21 remarks section or on the back o/'this j)rm.
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: 120 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
b itr untbtple tells hst all depths/jdifji•rear(esnniple-3t2t10'anc12�100') construction to the following:
10.Static water level below top of casing: 1 1 (ft.) Division of Water Resources,Information Processing Unit,
/fatter level is above casing,use -' 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 17 (in.) 24b. For Iniection 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) Method of test: 24c. For Water SuuDly& lnjection`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: i Amount: completion of well construction to ttie county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-DMsion of Water Resources Res ised 2-22-2016

Charles R. Underwood Inc.
Municipal Pump Sales&Service f
2000 Boone Trail Road Phone:[phone]
Sanford,North Carolina 27330 Fax: [phone]
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Riddle Farms, LLC
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Well #1
Casing Log
+2'—65' 8" sch 10 stainless steel well casing
65'—115' 8" stainless steel .050 slot screen
115'—120' 10" sch 10 stainless steel well casing
Neat Cement: 0'-3'
Bentonite Grout: 3'-50'
Gravel#3: 50' - 120'
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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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Riddle Farms, LLC
Well #1
Formation Log
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0-1 Black Top Soil
1-9 Light tan clay
9-18 Coarse sand,white
18-30 Clay,tan/white with some gravel mix
30-55 Sand with clay lenses
55-115 Sand,grey,chatter
115-122 Clay,grey
122-127 Sandy clay,grey
127-152 Clay, little sand mix,white/grey
152-168 Sand, little chatter, iron
168-182 Sandy clay,white
182-202 Clay, dark red
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