GW1--00788_Well Construction - GW1_20240131

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Bobby Allred II ;14.'WATER ZONES, - . '_, ,w ., '''' '
Well Contractor Name FROM TO DESCRIPTION,
ft. ft.
2610-A ft. ft + •
NC Well Contractor Certification Number
•,IS.OUTER CASING(for multi-cased•{vells)`OR;LINER'(ifap livable)
Charles R. Underwood Inc. FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. , in.
Company Name r16.INNER CASING ORTUBING(geothermal closed`loop) _, -
2.Well Construction Permit#: WS0601486 FROM TO DIAMETER THICKNESS MATERIAL •
List all applicable well construction permits(i.e.UiC,County,State,Variance,etc.) ft. ft. in. See Attached
3.Well Use(check well use): ft. ft in.
Water Supply Well:
FROM TO DIAMETER SLOT SIZE _ THICKNESS MATERIAL
in Agricultural ❑Municipal/Public ft. ft. in. See Attached
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft in. '
❑Industrial/Commercial ❑Residential Water Supply(shared) Ig•;GROUT
❑irrigation ❑Wells>100,000 GPD FROM _ TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 3 ft• Neat Cement Pour
❑Monitoring ❑Recovery 3 ft• 50 ft• Bentonite Tremie/Pump
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if,applicalle)r.. 6. ,- '''''=�'<
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM _ TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 50 it 170 ft. #3 Southern Silica Tremie/Pump
❑Experimental Technology 0 Subsidence Control ft. ft.
OGeothermal(Closed Loop) ❑Tracer 20.DRILLINGWG'(attach additional sheets if,necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
ft. ft. See Attached
4.Date Well(s)Completed: 1/5/24 Well ID# 3 ft. ft.
5a.Well Location: ft. ft. (,". --'^•
Maxie Maynor ft. ft. • _ �,..p L.-r, 'V L Ji
Facility/Owner Name Facility ID#(if applicable) ft. ft. J A N 1 2024
Rennert Rd, Rennert, 28386 I l 3
ft. ft.
Physical Address,City,and Zip ft. ft. li 1rJi ri•:r ,1 ice!.^.e;;ti^,,.4 ,sj u,I
r1.1,/n.l.oi v,
Robeson 937831440200 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: 1
34.798251 N -79.087392 W giN46 4&& �1 A 1/17/2024
6.Is(are)the well(s): iJPermanent or ❑Temporary Signature of Ced Well Contractor N Cl/ Date
i
By signing this form,I hereby certf that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or 15A 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#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 construction info
construction,only I 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: 160 (ft.)
For multiple wells list all depths ifdii ferent(example-3@200'and 2@100') Submit this GW-1 within 30 days,of well completion per the following:
18 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing:
If water level is above casing,use••+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
I
11.Borehole diameter 7'� (in.) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Mud Rotary
24c.For Water Supply and OpenLoop 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
425 PumpPermit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: HTH Amount: llb ,
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone:[phone]
Sanford,North Carolina 27330 Fax:[phone]
Maxie Maynor
Rennert Rd Farm
Well #3
Formation Log
34.798251 N -79.087392 W
0-1' Black Top Soil
1'-4' Brown Sandy Clay •
4'-6' Brown&White Sandy Clay
6'-10' Tan Sandy Clay
10'-14' Pink/White Sand
14'-18' Tan&White Clay
18'-23' Pink&White Clay a'
23'-38' Sand,Pink&White, Some Gravel
38'-45' Orange Clay&Brown
is
45'-60' Sand,Chatter,Poorly Sorted
60'-84' Sand, Grey, Wood w/Lenses of Grey Clay 1'
84'-86' Clay
86'-93' Sand, Grey, Chatter Wood
93'-98' Grey Clay
98'-111' Med to Fine Grey Sand,Chatter
111'-133' Clay w/Lenses of Sand
133'-139' Grey Chatter Sand,Fine to Med
139'-141' Clay
141'-155' Grey Chatter Sand
155'-171' Grey Clay, Sandy
171'-178' Lenses of Sand&Clay,Chatter

Charles R. Underwood Inc.
Municipal Pump Sales&Service
2000 Boone Trail Road Phone:[phone]
Sanford,North Carolina 27330 i ax:[phone]
Maxie Maynor
Rennert Rd Farm
Well #3
Formation Log
34.798251 N -79.087392 W
178'-182' Sand,Chatter Wood
182'-201' Grey Clay Mixed w/Red 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]
Maxie Maynor
• Rennert Rd Farm
Well #3
Casing & Screen Log
34.798251 N -79.087392 W
+2'-73' 8" SCH10 Stainless Steel Casing
73'-93' 8" Stainless Steel Screen .050-Slot
93'-101' 8" SCH10 Stainless Steel Casing
101'-1ll' 8" Stainless Steel Screen .050-Slot
111'-135' 8" SCH10 Stainless Steel Casing
135'-155' 8" Stainless Steel Screen .050-Slot
155'-160' 8" SCH10 Stainless Steel Casing
160' 8" Stainless Steel Plate
Neat Cement 0'-3'
Grouted 3'-50
#3 Gravel 50'-170'