GW1--01299_Well Construction - GW1_20240229

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information: .
A.C. Schultes of Carolina, Inc. ' 14.WATER ZONES _
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
Connor Cordingley ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi+cased wells)OR LINER(if ap llcable)-
4568-A FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 35 ft. 1 6 in. PVC
Company Name ,
'16.INNER CASING OR TUBING(geothermal closed-loop) . _
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County.State, Variance,etc.) 0 ft. 184 ft. 8 1 in. .25 Black Steel
3.Well Use(check well use): 194 ft. 200 ft• 8 ' in' .25 304 SS
=17.SCREEN
Water Supply Well:
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 184 ft' 194 ft. 8 '°' .030 304 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 200 ft. `130 ft. 8 ij. i .030 304 SS
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.-GROUT.'
lhlrrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 168 ft. Cement Slurry 10 CY
OMonitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(ifapplicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM . TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 168 ft. 245 ft. Southern#2 Tremmie
oExperimental Technology ❑Subsidence Control ft. ft.
OGeothermal(Closed Loop) ❑Tracer 20..DRILLINGLOG(attach additional sheets if necessary) '
❑Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soilfrock type,grain size,etc.)
ft. ft. SEE ATTACHED
4.Date Well(s)Completed: 2/9/24 Well ID# Power Line Well ft. ft.
ft. ft. •
5a.Well Location:
Phillips Farm and Grain ft. ft. P` ED
Facility/Owner Name Facility ID#(if applicable) ft. ft.
PO Box 121, Wallace, NC 28466 ft. ft. FEB 2 9 7n24
ft. ft.
Physical Address,City,and Zip ,
Duplin .21:REMARKS ,1&:Gr...a:ti2.1 P?,%1;-1 UM,0 411 M,
laVI/Uiit)G
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: •
34.94295 N 77.98792 W
t L/
6.Is(are)the well(s): OPermanent or ❑Temporary Sig Con actor; / ate
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 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 ben provided to the will 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: 245 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3 rr 200'and 2 a 100)
10.Static water level below top of casing: 46 kit.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
If water level is above casing,use"+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 15 (in,) 24b.For Injection Wells: Copy Ito:DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: 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
I
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
350 24 Hr Pump Test Permit Program,1611 MSC,Raleigh,NC 27699-1 6 1 1
13a.Yield(gpm) Method of test:
13b.Disinfection type: HTH Amount: 1 lb
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

41A.C.SbhuIts
of Carolina
f11110ratlons of Water-&Wastewater Solurtl®ns
PHILLIPS FARM
POWER LINE WELL
Formation Description: Depth from Ground
Orange Sand 0 10
Orange Sandy Soft Clay 10 20
Med. Coarse Sand, Trace of Clay i 20 30
Trace, Med. Coarse Sand, Sandy Clay 30 40
Sand 40 58
Orange Sand 58 68
Sand _ _ 68 78
Gray Sandy Clay 78 98
Sand& Clay 98 108
Sand, More Clay, Shell 108 118
Sand& Shell 118 128
Sand& Shell, Trace of Wood 128 138
Sand, Shell, Clay 138 158
Clay, Sand, Shell, Mushy Clay 158 178
Mostly Sand/Trace of Shell, Little Clay 178 188
Sand, Some Shell,Little Clay 188 198
Sand 198 208
Sand, Trace of Shell 208 218
Sand, Trace of Clay i 218 228
Sand 228 238
Sand, Little Shell ! 238 248
Sand, Clay—Layer of Clay& Sand 248 268
Mostly Clay, Lignite, Trace of Rock 268 278
Clay 278 308
354 Sawdust Rd. Rocky Point, NC 28457 Office: [phone] www.acschultesnc.com
WATER&WASTEWATER CONSTRUCTION MAINTENANCE REPAIRS IMPROVEMENTS
INSPECTIONS SALES&INSTALLATIONS WELL DRILLING&REI1IABILITATION
LIFT STATIONS PUMPS&MOTORS VALVES&PIPING EMERGENCIES AND MOREL
1100 YEARSI,