GW1-2022-06667_Well Construction - GW1_20220708

• Pmnt Form
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well.Contractor Information:
Bobby Lee Allred, ll 14.WATERZONE5 )'
FROM TO DESCRIPTION
Well Contractor Name
ft. ft.
2610-A
fr. ft.
NC Well Contractor Certification Number 15.OUTER CASING Ifor hwlti-eased wells OR LINER if a Gcable '
Charles R. Underwood, Inc. FROM TO DIAMETER THICKNESS MATERIAL
fr. ft. in.
Company Name
W G 16.INNER CASING OR TUBING' eothermal closed-loo
2.Well Construction Permit#: S0 UO ` 6 FROM To DIAMETER THICKNESS MATERIAL
List all applicable,cell constnrclion permits(i.e. U/C.C'on it,v,State, toriance.etc..) +2 ft. 62 ft. 8 nn. Sch 10 SS
3.Well Use(check well use): 82-93 ft. 103-108 ft. 8 in. Sch 10 $$
Water Supply Well: ..17.SCREEN.
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
Agricultural QMunicipal/Public 62 ft- 82 ft. 8 i .050 SS
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) 93 ft. 103 ft' 8 tj' 050 $$
x Industrial/Commercial Residential Water Supply(shared) 18:GROUT r..
Irrl ation FROM TO MATERIAL EMPLACE��IENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft• 50 ft• Bentonite Tremie Pipe
Monitoring Recovery
Injection Well:
Aquifer Recharge QGroundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery QlSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test ` DStormwater Drainage 50 ft. 108 ft. #4 Gravel Tremie Pipe
Experimental Technology OSubsidence Control ft. ft.
Geothermal(Closed Loop) DTracer 20.'DRILLING LOG attach additional sheets ifnecessa
FROM TO DESCRIPTION(color,hardness,soillrocA e,grnin size,etc.)
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) rr tr
See:Attached formation log
4.Date Well(s)Completed:6/24/22 Well ID#WeII #2
o
Sa.Well Location:
Autry Grading ft. ft.
Facility/Owner Name Facility ID (if applicable) ft. ft.
1830 Davis Bridge Road fc. rt. tni�r,,,z i�nrPr;� P�;ttg
Phvsical Address.Citv.and Zip ft. fC
Robeson 948289181300 21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field.one latilong is sufficient) 22.Certification:
34.56.10.99 N 79.02.06.35 W
6/30/22
6.Is(are)the well(s)�x Permanent or Temporary Signature rtitied Wel Conti ctoi Dare
41 signing thrs.ftnn, /herehv cergA-that the vellGJ it (sere)constructed in accordance
7.Is this a repair to an existing well: DN'es or X)No ,rich 15A NC'AC 02U.0100 or 15A NC'AC 02C.0?00 H ell Construction btandardr and that a
l(das is a repair,Jill out know it,Cell consvntction information and explain the nature oJ'the copy cJthts record has been provided to the,cell ou ner.
repair tuncter=21 remarks section or on the back of this f tan.
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: 108 (ft-) 24a. For All Wells: Submit this form within 30 days of completion of well
/irr mu/lip/e,re//x h.ct a//depths njchffreni(example-3.tb'200'and 2Q/00') construction to the following:
10.Static water level below to 20.4
p of casin g: (ft.) Division of Water Resources,Information Processing Unit,
/j,rani/e,r/is whore casing use••- 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 17 (in.) 24b. For Infection Wells: In auddition 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 Resource's,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
r
13a.Yield(gpm) Method of test: 24c. For Water SuDDIv& 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. j
Form GW-I North Carolina Department of Em ironmental 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]
Autry Grading
3rd Generation Ventures, LLC
Well #2
CASING LOG
+2'- 62' 8" Sch 10 Well casing
62'-82' 8" Stainless Steel .050 Slot Screen
82'-93' 8" Sch 10 Well casing
93'-103' 8" Stainless Steel .050 Slot Screen
103'-108' 5' Tail
Screens:
62'-82'
93'-103'
1
Grouted to 50'
#4 Gravel 50' — 108'
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Y Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Rd. Phone: [phone]
Sanford,North Carolina 27330 I Fax: [phone]
Autry Grading
3rd Generation Ventures, LLC
Well #2
Formation Log
f
0' —3' Brown Sand
3' —8' Orange and Red sand Clay
8' — 14' Red and white Clay with streaks of sand
14' —27' White Clay and fine sand
27' —33' Tan and White Clay
33' —44' Sand, Brown and Red
44' —47' Gray Clay
47' —59' Softer Gray Clay
59' —62' Fine Grey sand
62' —81' White sand with lenses of grey clay
81' —94' Light grey clay
94' — 101' A little chatter, grey sand
101' — 102' Light grey clay
102' — 112' Sandy grey Clay
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112' — 114' Grey clay +
114' — 128' Pink Clay
128' — 156' Light grey clay, sandy
156' — 158' Little chatter
158' — 177' Blue Green sandy Clay
177' — 182' Hard ��
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