GW1--04552_Well Construction - GW1_20240731

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
Jonathan Kamionka 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name 160 ft- 210 ft.
3465-A ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if a 'cable)
FROM TO DIAMETER THICKNESS MATERIAL
Bill's Well Drilling Co. ft. ft. in.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
WS0701192; CU3371 FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: +1 ft' 160 ft. 6-1/8 in. SDR21 PVC
List all applicable well permits(i.e.County,State,Variance,Injection,etc.) _
210 ft• 213 ft. 6-1/8 in' SDR21 PVC
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 160 ft. 210 ft. 6-1/8 in* .032 SDR21 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 1L GROUT
FROM i TO i MATERIAL EMPLACEMENT METHOD&AMOUNT
®Irrigation 0 ft. 150 ft• bentonite pumped
Non-Water Supply Well:
ft. ft.
❑Monitoring ❑Recovery
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery OSalinity Barrier 150 ft. 213 ft. #2 gravel trimmed
❑Aquifer Test ❑Stormwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,soil/rock type,grain sae,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft. SEE ATTACHED
3-14-24 Well 2 ft. ft.
4.Date Well(s)Completed: Well ID# ft. ft ' • j i
5a.Well Location: ft. ft. t
Faro Farms NC L L C Darden Farm ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft.
Faro Rd, Stantonsburg, NC 27883 ft. ft.
Physical Address,City,and Zip 21.REMARKS
Wayne
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Cer•frcation:
(if well field,one lat/long is sufficient)
N 3-14-24
Sign re of Certified Well Contractor Date
6.Is(are)the well(s): ©Permanent or OTemporary 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: DYes or ENo 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: 213 (ft) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths idifferent(example-3@200'and 2@I00') construction to the following:
10.Static water level below top of casing: 115 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"-" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 12 (in.) 24b. For Infection 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
13a.Yield(gpm) 160 Method of test: pumping 24c.For Water Supply&Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b.Disinfection type: HTH Amount: 2 cups 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

BILL'S WELL DRILLING CO.
800 McArthur Road
Fayetteville, North Carolina 28311 BI`'
Office [phone] E
s
[e-mail] RI ING
www.billswelldrilling.com
Date: 3/14/2024
Drilling Log Lithology
Faro Farms
Faro Rd, Stantonsburg, NC
From To Formation Description
0 11 sand clay
11 31 tan sand
31 41 tan sand w/gravel
41 51 gray sand
51 74 gray clay
74 84 fine gray sand&clay layers
84 102 gray sand
102 124 clay
124 134 sand &clay layers
134 154 gray clay w/red streaks
154 163 gray clay
163 174 coarse sand &clay layers
180 210 coarse sand w/gravel
210 213 orange clay
Jonathan Kamionka
3465-A