GW1-2021-06878_Well Construction - GW1_20210429

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WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
14..VVATER ZONES
D.T. CHALMERS, JR. ,y�s� FROM TO DESCREMON
Well Contractor Name
4146A
NC WeII Contractor Certification Number 0. 5soq 15.INNER EASING OR TOBING"eothe tal dosed-lo'o'"•4k= -• ..•- ": - .=
Q` QG�•`�� FROM TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists P $11 set 0 R. 1.5 R. 2 id Sch.40 1 PVC
Company Name 0 16�obTER CASING'foi Mdlti-cased wells 0k'-1NER'if a"licable` rc.M7 ,. i
\r�CS , O FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: N/A R, ft. in.
List al/applicable well permits(i.e.County,State, Variance,Injection,etc.)
R. R. in.
3.Well Use(check well use): 17 SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 1.5 R. 11.5 R. 2 in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) R. R. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 1&GROUT.r
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
Non-Water Supply Well:
®Monitoring ❑Recovery 0.4 ft. 0.8 R. Bent.Pellets Surface Pour
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation I9 SANDlCRAVELPAGK if a"`licalile Z}z1 ! . o ?:;:b' .`.x3. t
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL EMPLACEMEN"I ME IHOD
❑Aquifer Test ❑Stormwater Drainage 0.8 R. 12# Medium Sand Torpedo Sa d
❑Experimental Technology ❑Subsidence Control ft. R
20.DRILLINGLOG atlschadditionalsFieets'if.necessa " t. . . `"`
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCREMON color,hardness.soil/rock type,gain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
4.Date Well(s)Completed: 03/18/21 Well ID#: MW-2R
Sa.Well Location:
R. R.
Douglas Stevens Matthew's Market
ft. P
Facility/Owner Name Facility ID#(if appl icable)
R.
3196 VASS CARTHAGE RD.,WHISPERING PINES,NC 28327
R. R.
Physical Address,City,and Zip _
21.RE1NARIC$.
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)
35.27681 N -79.361772 W 4/9/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or ❑Temporary By signing this form,I hereby certify that the well(s)was(were)conrtnicied in accordance with
I JA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Constriction 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 we//owner.
If this is a repair,fill out known well construction information and explain the nature of
the repair tinder#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 same construction,you
can submit oneform. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 11.5 (B,) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths in different(example-3@200'and 2@100) construction to the following:
10.Static water level below top of casing: 2.8 (B) Division of Water Resources,Information Processing Unit,
Ifwater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8•25 (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.auger,rotary,cable,directpush,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 Svanly&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.
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Adapted from Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

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WELL LOG CATLIN
Engineers and Scientists
zzozao SHEET 1 OF 1
PROJECT NO.: 220240 STATE: NC I COUNTY: MOORE LOCATION: WHISPERING PINES
PROJECT: MATTHEW S MARKET LOGGED BY: S. O'NEIL WELL ID:
DRILLER: D.T. CHALMERS JR. MW_2R
NORTHING: 555,8681 EASTING: 1,892,029 CREW: E. SWAIN
SYSTEM: NCSP NAD 83 USft BORING LOCATION: •-5'OFF WEST CORNER OF AST CONTAINMENT T.O.C.ELEV.:
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: 5.3 TOTAL DEPTH: 12.0
START DATE: 3/18/21 END DATE: 3/18/21 24 HOUR DTW: 2.8 WELL DEPTH: 11.5
DEPTH BLOW COUNT OVA LAB 0 L SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) s c DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
0.0 (ML)-Brown,Sandy Silt 0.00 A' 0.4
1 3 MW-2R 0.8
3 L
3 0.0 �04) D 1.5 1.5 cn
(SP)-Tan,F.SAND N
2.0
2
2 4.7 M
2 2 3.5
4.0 (SM)-Tan,Silty SAND
5
7 11 13 1,516 Sat. 5.0
(ML)-Reddish-brown,Sandy SILT -
o�
oa
oQ
(n
(V U
10.0 10.0
(SP)-Tan to gray,Cse.SAND
1
z 3 59.8 Sat.
5 11.5 11.5
12.0 Z/z12.0 (CL)-Gray,mod.plastic CLAY 12.0
BORING TERMINATED AT DEPTH 12.0 ft in mod.
plastic CLAY
?%.• Concrete Bentonite Pellets #2 Medium Sand
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1044 Washington Street
ATLIN Raleigh, NC -2875
Engineers and Scientists (919) 83s-Zs75
www.CatlinUSA.com
April 13, 2021
North Carolina Department of Environmental Quality
Division of Water Quality
Information Processing
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: North Carolina Well Construction Record
Matthew's Market
3196 Vass Carthage Rd., Whispering Pines, NC 28327
CATLIN Project No.: 220240
To Whom it May Concern,
CATLIN Engineers and Scientists (CATLIN) recently constructed one (1) monitoring well
at the above referenced site. Attached to this letter is the completed North Carolina Well
Construction Record with associate Attachments for the above referenced site in
Whispering Pines, North Carolina.
If you have any questions or require additional information, please feel free to contact us
at [phone].
Sincerely,
D4
Sean O'Neil, P.E.
Project Manager
Encl.: CATLIN Letterhead, Well Construction Record, and Well Log
ENVIRONMENTAL CIVIL GEOTEICHNICAL
Wilmington, NC I Raleigh, NC I Washington, NC I Atlanta, GA I Charleston, SC