GW1--05888_Well Construction - GW1_20230918

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
Jonathan Karnionka '� CWATEIVZONEs.9 M ._ . _, .; x , , r„=.
FROM TO DESCRIPTION
Well Contractor Name 201 ft• 231 ft• I 258-263
. 3465-A 284 ft• 324 ft.
:
NC Well Contractor Certification Number 'MI5;OUTER'CASING(for.malti.cased wells)'OR LINER(if ap"6cable).. 4; F
FROM TO DIAMETER THICKNESS MATERIAL
Bill's Well Drilling Co. o ft. 85 ft. 20 ' in. .375 steel
Company Name s 16.INNER CASING OR TUBING(GEOTNERNULL CLOSED LOOP( .1: e°'
FROM TO GIA6ILTER TNICKN Ss leaf:. MATERIAL
2.Well Construction Permit#: WSO$01069 - 31 FT 5
List all applicable well permits(i.e.County,State,Variance,Injection,etc) abb F* 0. t'o
- 414YFr Fr /o <t0 SS
3.Well Use(check well use): -� -
17.SCREEN sLGr ..`°vVb.,. „" ,. r -Ni'
ER TO DIAMETER 91ZE THICKNESS 7E ta1ESS MATERIAL
Water Supply Well: ph. F7 00❑Agricultural I]Municipal/Public �FT� ., -
-Fr FT L(ZtsZ
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) -FT-FT_
❑Industrial/Commercial ❑Residential Water Supply(shared) 1S GROUT::;.....s _:: ' .,,'.:a....... . ..... ^, - "
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 ft• 85 ft• neat cement pumped
Non-Water Supply Well:
❑Monitoring ❑Recovery 0 ft. 185 ft• neat cement pumped
Injection Well: 185 ft• 190 ft. bentonite tremmie
❑Aquifer Recharge ❑Groundwater Remediation 14SAND/GRAVEC,PACK(ifapphcable) ., .;A ;.._ , fir, , a,.
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery OSalinity Barrier
❑Aquifer Test ❑Stormwater Drainage
190 ft. 334 ft. I, ,#2 gravel tremmie
❑Experimental Technology OSubsidence Control it. ft.
ZO.DRIEEILIGiLOG(ittaikviilditionitilteetsifn"ecessary}'. '. ' . ;.. itAW:z
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,
ess,soil/rock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft. !: SEE ATTACHED
10-14-22 ft. ft. '' _
4.Date Well(s)Completed: Well ID# • f `"`. .
ft. ft. ``', ' k•.l 1...l'V L�L.
5a.Well Location: ft. ft.
Columbus Co Water District ft. ft. SAP I 2�
Facility/Owner Name Facility ID#(if applicable)
ft. ft. nfl r"' .w4::: Ur:A
In+"-a"�e'�
13979 James B White Hwy S, Tabor City, NC ft. ft. G*�`:'`art,,
Physical Address,City,and Zip `-21.REMARKS .Z_ _. , :;d.,:. .a6, :."a'iI ilfi.,e, iu,.. ..:_
Columbus FILLED WITH PORTLAND TO 270'DUE TO DIRTY WATER
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: 1
(if well field,one lat/long is sufficient)
N W 10-14-22
Signatiof ert Cohtractor Date
6.Is(are)the well(s): ©Permanent or ❑Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or DNo copy of this record has been provided to the well owner.
If this is a repair,fill out known well construction information and explain the nature of the
repair under#21.remarks section or on the back of this form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same construction,you can
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 334 (ft.) 24a. For All Wells: Subni'it this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@I00') construction to the following:I
10.Static water level below top of casing: 64.4 (ft) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
r
11.Borehole diameter: 20 (in.) 24b.For Injection Wells ONLY: In addition to sending the form to the address in
mud rota 24a above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: ry 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
I
13a.Yield(gpm) 390 Method of test: pumped 24c.For Water Supply&Injection Wells:
Also submit one copy of this form within 30 days of completion of
136.Disinfection type: HTH Amount: 5 lbS well construction to the county health department of the county where
constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013
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Columbus County
Water Sewer District IV
BILL'S WELL DRILLING CO.
Date: 10/14/2022
Drilling Log Lithology
Test Hole Site Columbus Co HS
Hwy 701
Tabor City, NC 28463
From To Formation Description
0 10 Orange&White clay
10 20 Gray sticky clay
20 30 Gray turning to orange clay
30 48 Orange fine& med sand w/clay float
48 58 Orange&gray clay
58 64 Gray Clay
64 67 Rock
67 73 Gray Clay
73 74 Rock
74 87 Hard Gray Clay
87 88 Rock
88 102 Gray Clay
102 104 Rock
104 128 Gray Clay
128 148 Gray clay w/small streaks of sand
148 168 Gray Clay
168 175 Clay
175 178 Med&fine sand
178 186 Gray Clay
186 189 Rock
189 195 Clay& rock Layers
195 196 Rock
196 223 Layers of fine sand mostly clay
223 256 clay
256 261 Sandy Clay
261 265 Clay
265 271 Sand&Clay layers
271 282 Clay
282 313 sand
313 319 Rock
319 322 Sand
322 334 Clay