GW1-2021-06875_Well Construction - GW1_20210429

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 TO DESCRIPMON
Well Contractor Name 00, ^OT*` \x R. R.
4146A �� cy l• y
NC Well Contractor Certification Number ��� Q�o'�e FROM
RCASIONG-0RTIJBINDIAMEIER atdos HCKNESS w++MATERIA _
CATLIN Engineers and Scientists 9 �Q,`-'� 0«. 2 R. 2 Sch 40 PVC
Company Name ,J�' Q 16:OUTER CASING fo multi-cased ivells`OR LD7ER if a 'licat le . c a; =.?f
FROM TO DIAMETER I THICKNESS MATERIAL
2.Well Construction Permit#: N/A
R. R. in.
List all applicable ivell permits(i.e.County,State, Variance,Injection,etc.)
R. ft. in.
3.Well Use(check well use):
11 SCREEN x
Water Supply Well: FROM TO DIAMETER SLOT SUE THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public 2«. 12 R. 2 in. Slot.010 I Sch.40 1 PVC
❑Geothermal(Heating/Cool ing Supply) ❑Residential Water Supply(single) R. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) A&GROUr:r=.
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
Non-Water Supply Well:
®Monitoring ❑Recovery 0.5 R. 1 «. Bent.Pellets Surface Pour
Injection Well: R. R.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVELVACK dA'pfieiibl eJ.�3:- + . •- .,_ _.
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 1 R. 12 Medium Sand Torpedo Said
❑Experimental Technology 0Subsidence Control R. R
20.DRILLING LOG attach addittiihid shhefs f'n`ecessa" - 4
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soil rock type,erainsize etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) R, a
4.Date Well(s)Completed: 03/18/21 Well ID#: MW-01 «. «. -
R.
5a.Well Location:
«. «.
Garry Clark Hail's Auto Repair
«. P
FaciI ity/Owner Name Facility m#(if applicable)
R.
1468 VASS CARTHAGE RD.,WHISPERING PINES,NC 28327
R. R.
Physical Address,City,and Zip
21.REMARKS JT q..
MOORE
County 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)
35.305846 N -79.401207 W 4/9/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): O Permanent or O Temporary By signing this form,I herehy 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 copy of
7.Is this a repair to an existing well: O 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 tinder 921 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 tvells ONLY with the same construction,you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 12 (ft.) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths in different(example-3 cr 00'and 2@I00) construction to the following:
10.Static water level below top of casing: 5.58 (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: 8.26 (in.) 24b.For Infection 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.atiger,rotary,cable,direct posh,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 SvnDly&Infection Wells:
Also submit one copy of this form within 30 days of completion of well
13b.Disinfection type: Amount: construction to the county health department of the county where constructed.
Adapted from Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

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-- ---Z-w CATLIN
Engineers and Scientists
WELL LOG 220232 SHEET 1 OF 1
PROJECT NO.: 220232 STATE: NC COUNTY: MOORE LOCATION: WHISPERING PINES
PROJECT: HALL'S AUTO REPAIR LOGGEDBY: S. O'NEIL WELL ID:
DRILLER: D.T. CHALMERS JR. MW-01
NORTHING: 566,481 EASTING: 1,880,302 CREW: E. SWAIN
SYSTEM: NCSP NAD 83 USft BORING LOCATION: -S EAST OF UST T.O.C.ELEV.:
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: 8.4 TOTAL DEPTH: 12.0
START DATE: 3/18/21 END DATE: 3/18/21 124 HOURDTW: 5.6 WELL DEPTH: 12.0
DEPTH BLOW COUNT OVA LAB o L SOIL AND ROCK WELL
0.5ft 0.5tt 0.5ft 0.5rt (PPm) Sl G DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
O.O 0.5 (GV1n-GRAVEL 0'Oa �'d: 0.5
s 5 10 0.0 D (SC)-Red to orange,Clayey SAND a 1.0
13 1 PR 1.5
t
(SC/CL)-Red to white,Clayey SAND to Sandy CLAY 2.0 N
2.0
10
10 12 14 0.0 2 4') D
4.5
5.0 (CL)-Gray to brown,CLAY with cse sand lenses
4 -
6 6.0
11 0.0 D 12 (SC)-Brown,Clayey SAND o
oa
oa
�t
(V U
N
0.0 10.0
(SM)-Reddish-brown,Silty SAND. Saturated at 11.0'
4 BLS
6 6 0.0 M
4 ;
12.0 12.0 12.0 12.0
BORING TERMINATED AT DEPTH 12.0 ft in Silty
SAND
A;;:• Concrete Bentonite Pellets! Q#2 Medium Sand
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