GW1-2021-01003_Well Construction - GW1_20210419

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information: -
14.WATER ZONES
D.T. CHALMERS, JR. FROM r 57Ru7t1,:
Well Contractor Name ft.1 r.
4146A
NC Well Contractor Certification Number 15.INNER CASING OR TUBING[geothermal deseddoo
FROM TO DI:ASIFTER TFiICKNFSS VL�rF:RIAI.
CATLIN Engineers and Scientists 0 ft. 5 ft. _ 2 Sch.4o PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER fifillUllicablell
FROM 10 DI-AMETER THICKNESS M,A"fFRI aI_
2.Well Construction Permit#: N/A ft. ft. in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.) It. ft. in.
3.Well Use(check well use): 17 SCREEN -
Water Supply Well: FROM I To DIAMETER st.OTSIZE TMCKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 ft. 15 ft 2 in. Slot.010 Sch.40 PVC
❑Geothemial(Heating/Cooling Supply) ❑Residential Water Supply(single) 11.
❑industrial/Commercial ❑Residential Water Supply(shared) I& 'ROUT
FROM 10 MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 ft. 0.8 ft. Portland Cement Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 0.8 11. 3 ft. Bent.Pellets Surface Pour
Injection Well: ft. ft.
❑Aquifer Recharge ❑GroundwaterRemediation 19.SAND/GRAVEL PACK ifs livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Storniwater Drainage
3 rt. 15 X Medium Sand Torpedo Said
❑Experimental Technology ❑Subsidence Control
ft. rt.
20.DRILLING LOG attach additional sheets if necessary)
❑Geothemial(Closed Loop) ❑Tracer FROM rU DESCRIPTION color,hardness soil rock type,grain size etc 1
❑Geothemial(Heating/Cooling Retum) ❑Other(explain under#21 Remarks)
4.Date Well(s)Completed: 03/25/21 Well ID#: MW-02
S 000
GO
Sa.Well Location: ft. ft.
Norcott Bell Jones Small Engine(NCDOT)
Facility/Owner Name Facility ID#(if applicable) , -
f
4800 BRAGG BLVD,FAYETTEVILLE,NC
Ph%sical Address.City_and Zip
21.REMARKS _
CUMBERLAND J
Count Parcel identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one lat/long is sufficient)
35.091399 N -78.954079 W w( 3/30/2021
Signature of Certified Well Contractor Date
6.is(are)the well(s): M Permanent or O Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
15A N(AC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: ❑Yes or ®No 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 ofthis 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 saute construction,you
can submit one form. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 15 (ft.) 24a.For All Wells: Submit this form v6thin 30 days of completion of%veil
For multiple wells list all depths in different(example-3 r200'and 2(a'100) construction to the following:
10.Static water level below top of casing: 6.04 (ft.) Division of Water Resources,information Processing Unit,
If water level is above casing,rise"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8 1/4 (ill.) 24b.For Iniection Wells ONLY: In addition to sending the form to the
address in 24a above,also submit a copy of this form within 30 days of
12.Well construction method: HSA completion of well 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) Method of test: 24c.For Water Svpaly&Iniection Wells:
Also submit one copy of this form within 30 days of completion of%veil
13b.Disinfection type: Amount: construction to the county health department of the county where constructed.
Adapted from Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

220 Old Dairy Road
Wilmington, NC 28405
ATLIN (910)4 1
www.CatlinUSA.coA.com
Engineers and Scientists
March 30, 2021
North Carolina Department of Environmental Quality
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: NC Well Construction Records
Jones Small Engine (NCDOT)
4800 Bragg Blvd., Fayetteville, North Carolina 28303
CATLIN Project No.: 221034
To Whom It May Concern:
CATLIN Engineers and Scientists (CATLIN) recently constructed two (2) monitoring wells at the above
referenced site. Attached to this letter are completed North Carolina Well Construction Records with
associated Attachment(s) for the above referenced site located at 4800 Bragg Blvd. in Fayetteville,
North Carolina.
If you have any questions or require any additional information, please feel free to contact us at (910)
452-5861.
Sincerely,
Benjamin J. Ashba, P.G. Corey Futral, CWC
Contract Manager Project Manager
Encl.: CATLIN Letterhead, Well Construction Records, and Well Logs

WELL LOG CATLIN
Engineers and Scientists
zz,o3a SHEET 1 OF 1
PROJECT NO.: 221034 STATE: NC COUNTY: CUMBERLAND LOCATION: FAYETTEVILLE
PROJECT: Jones Small Engine (NCDOT) LOGGED BY: T. MIZELLE WELL ID:
DRILLER: D.T. CHALMERS JR. MW-01
NORTHING: 488169 1 EASTING: 2013749 CREW: C. FUTRAL
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Near Previous Gasoline Release T.O.C.ELEV.: NM
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: 3.6 TOTAL DEPTH: 15.0
START DATE: 3/25/21 END DATE: 3/25/21 124 HOUR DTW: N/A WELL DEPTH: 15.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) It G DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
(GV1n-ASPHALT and ABC STONE Mixture 0.0 -
(SP)-Gray,F.SAND — 0.8
U
a
0
3.0 3.0 y 3.0
(SC)-Gray,F.SAND with clay
o , 1.4 MW5)1 WPC
5.0
8.0 8.0
(CH)-Gray with orange mottling,Sandy highly plastic
z z MV/-01 CLAY. Strong HCO from 8.0-10.0'BLS
3 4 482.2 (o-1o�) Sat.
o�
oa
oa
�t
V<n
13.0
3
4 6 19.7 W
6
15.0 15.0 15.0 15.0
BORING TERMINATED AT DEPTH 15.0 ft
Portland Cement Bentonite Pellets #2 Medium Sand