GW1--00510_Well Construction - GW1_20240118

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
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1.Well Contractor Information: I ,
Bobby Allred II 14.;WATERZONEs `
Well Contractor Name FROM TO DESCRIPTION
ft. ft. i ii
2610-A
ft. ft.
NC Well Contractor Certification Number 1.5.OUTER CASING(for mold=cased wells).OR LINER(if op`Gcable)-- ..
Charles R. Underwood Inc. FROM TO DIAMETER THICKNESS MATERIAL
H. ft. ; in.
Company Name
A6..1NNE&CASING ORTUBING:{peuthermalclosed-lo - ,., -i,,: b=.
2.Well Construction Permit#: WSO6O 1481 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,Counry,State,Variance,etc.) +2 ft. 160 ft. 4 in' SCH10 Stainless Steel
3.Well Use(check well use): 180 ft. 185 ft• 4 , I". SCH10 Stainless Steel
;17.SCREEN . ,r. , r )t '',.:
Water Supply Well: FROM TO DIAMETER,�-SLOT SIZE THICKNESS MATERIAL
OAgricultural ❑MunicipaUPublic 160 ft- 180 it 4 in.; .050 Stainless Steel
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft• 160 it i".i
❑Industrial/Commercial ❑Residential Water Supply(shared) =,18.GROUT ,,,: _
❑Irrigation ❑Wells>100,000GPD FROM . TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft• 3 ft' Neat Cement Pour
❑Monitoring ❑Recovery 3 ft. 55 ft• Bentonite Pump/Tremie
Injection Well: -
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19 SAND/GRAV,EL PACK(Itapplicable)
0 Aquifer Storage and Recovery 0 Salinity Barrier FROM _ TO MATERIAL EMPLACEMENT METHOD `
❑Aquifer Test ❑StormwaterDrainage 55 ft• 190 fa #3 Southern Silica Pump/Tremie
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) OTracer 20.DRILLiNG LOG(attach addition ..nafi;heets<if necessary)" , -
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain sue,etc.)
ft. it See Attached
4,Date Well(s)Completed: 12/22/23 Well ID# 1 ft. ft '
5a.Well Location: ft. ft
Walter Kay McGirt ft. ft. T,` _ < ,r,
Facility/Owner Name Facility ID#(if applicable) ft. ft. ir-%,, A,,,1'E,;,,% V 0:,..:_:. i
1492 Mckinnon Pate Rd, Rowland, 28383 ft. ft. 7024
Physical Address,City,and Zip ft. ft.
Robeson 19110100103 .0:2L.REMARKS .. ;. .x ......4._ lr,.. .., r ztl1_ r. ,. ,Okix:cl,...
DWCV,30G
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:
34.537422 N -79.272622 W . U& t 4r d� 1/16/2024
6.Is(are)the well(s): OPermanent or OTemporary Signature of C died Well Contractor Date
By signing this form,I hereby cert fy that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or it No ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction.Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under 1121 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 construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add See Over'in Remarks Box)..You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 185 (ft.)
For multiple wells list all depths if different(example-3 a 00'and 2(4)100') Submit this GW-1 within 30 days of well completion per the following:
48• 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit,1611,MSC,Raleigh,NC 27699-1617
(Twiner level is above casing,use"+" 1
24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter: 10 (in.)
Program,1636 MSC,Raleigh,NCi 27699-1636
12.Well construction method: Mud Rotary 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) 150 Method of test: Pump
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: HTH Amount: 6oz
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Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone:[phone]
Sanford,North Carolina 27330 Fax:[phone]
Kay McGirt
Well #1
Formation Log
34.537422 N -79.272622 W
0-1' Black Topsoil
1'-3' Tan Sandy Clay
3'-9' Orange Clay
9'-18' Pink&White Clay
18'-35' Orange&White Clay w/Lenses of Sand
35'-53' Grey Clay, Soft Chatter w/Poorly Sorted Sands to;Gravel w/Shells
53'-61' Reddish Clay
61'-81' Purple&Grey Clay w/Lenses of Sand
76' Lenses of Rock
81'-85' Fine to Med Sand w/Chatter
85'-94' Sand Clay
94'-121' Sandy Grey Clay w/Very Soft Chatter
110' Lenses of Shells
121'-126' Clay, Getting Soft
126'-132' Tight Clay
132'-134' Soft Chatter
150'-190' Fine to Med Clear/Grey Sand w/Chatter Wood,Thin Lenses of Clay
190'-201' Lenses of Sand&Clay
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Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone: [phone]
Sanford,North Carolina 27330 Fax:[phone]
Kay McGirt
Well #1
Casing & Screen Log
34.537422 N -79.272622 W
+2'-160' 4" SCH 10 Stainless Steel Casing
160'-180' 4" Stainless Steel Screen .050 Slot
180'-185' 4" SCH10 Stainless Steel Casing
185' 4" Stainless Steel Plate
Neat Cement 0'-3'
Grouted 3'-55'
#3 Gravel 55'-190'
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