GW1-2021-01787_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 ZQIl(FS. t
D.T. CHALMERS JR. FROM TO DESCRIPTION
Well Contractor Name
4146A
NC Well Contractor Certification Number 0, J� 15.INNER CASINGOR TUBING` eothern,al closed too`
�g�t\� FROM TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists ��� ��. 12.5 rt. 12.5 R 2 in Sch.40 PVC
Company Name C �QG lb:OUTER GASIIVG foP motif-c9sed wells OR'LINER'if a licable <
"�. FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: N/A ..423 ��
List all applicable well permits(i.e.County,State, V ce,Inj�ion,etc.) R. R. in.
3.Well Use(check well use): 17."SCREIL14% ` <1�* _ `•
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public 12.5 R. 22.5 R. 2 in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) R. n. in.
❑Industrial/Commercial ❑Residential Water Supply(shared)
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 rt. 0.5 n. Portland Cement Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 0.5 R. 10 n. Bent.Pellets Surface Pour
Injection Well:
pAqurfer Recharge ❑Groundwater Remediation 19:SAND/CRAVEL`PAGIC ifii'°'licable y '!•i:.. "rr�:: �� :�"- ,,,.;�-�x .. r•-=`
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I TO I MATERIAL I EMPLACEMENF METHOD
❑Aquifer Test ❑Storrnwater Drainage 10 tit. 25,111 Medium Sand Torpedo Sa d
❑Experimental Technology ❑Subsidence Control
20.DRILLIiVG'tiOG`at''tiich sdditional'sheeis if nece'ssa`v ' ,. a,: .... _ ` "
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soil/rock type,wain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
4.Date Well(s)Completed: 02/24/21 Well ID#: MW-01
Sa.Well Location:
Ruth Daniels Shorty's Site
R.
Facility/Owner Name Facility lD#(if applicable)
n.
202 S.CHURCH ST.,KENLY,NC
n. R.
Physical Address,City,and Zip 21;REM4RKS ' ``-`..4
JOHNSTON
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)
35.595133015 N -78.126242943 W 3/8/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or ❑Temporary By signing this form,1 hereby certify that the well(s)was(were)constructed in accordance with
1 5A NCAC 02C.0100 or 1 SA NCAC 02C.0200 Well Constnrction 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 rmder#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 INSTRUCTIONS
9.Total well depth below land surface: 22.5 (g,) 24a.For All Wells: Submit'this form within 30 days of completion of well
For multiple wells list all depths in different(example-3 ct 00'and 2@100) construction to the following;
10.Static water level below top of casing: 17.85 (ft.) Division of Water Resources,Information Processing Unit,
trwater 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,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 Supply&IniectionWells:
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

WELL LOG CATLIN
Engineers and Scientists
zzozsl SHEET 1 OF 2
PROJECT NO.: 220231 STATE: NC I COUNTY: JOHNSTON LOCATION: KENLY
PROJECT: SHORTY'S SITE LOGGED BY: COREY FUTRAL WELL ID:
DRILLER: D.T. CHALMERS JR. MW-01
NORTHING: 672730 1 EASTING: 2259835 CREW: TREVOR MIZELLE
SYSTEM: NCSP NAD 83 USft BORING LOCATION: —30'FROM S.CHURCH ST.NEAR TANK BASIN T.O.C.ELEV.:
DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HOUR DTW: 17.9 1 TOTAL DEPTH: 25.0
START DATE: 2/24/21 END DATE: 2/24/21 24 HOUR DTW: N/A I WELL DEPTH: 22.5
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5n 0.5n 0.5ft 0.5n (PPM) S G DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
(CH)-Tan with orange mottling grading;to gray with tan 0.0 = 0.5
and orange mottling,Sandy highly plastic CLAY
3.0
2 2 3.5 M
4
5.0
(CH)-Brown grading to tan with red mottling,Silty
Sapprolitic highly plastic CLAY a'
Mod.HCO from 5.0-10.0'BLS v
Very Strong HCO from 10.0-15.0'BLS
(V
8.0
5
13 22 1,163 D
2s
10.0
12.5
13.0
26
sz 2,401 3"15'
58 t(1 ) D
15.0
(CL)-Brown to tan and red,Silty slightly plastic CLAY.
Slight HCO
17.0 0>
(CH)-Brown grading to tan with red mottling,Silty o
Sapprolitic highly plastic CLAY. Slight HCO C t
18.0
12
zo 26 2,667 W
29
20.0
(ML)-Tan to brown with red motting,Clayey Sapprolitic
SILT. Strong HCO
Portland CementEm Bentonite Pellets #2 Medium Sand

WELL LOG CATLIN
zzoz3t
Engineers and Scientists
SHEET 2 OF 2
i
PROJECT NO.: 220231 STATE: NC COUNTY: JOHNSTON LOCATION: KENLY
PROJECT: SHORTY'S SITE LOGGED BY: COREY FUTRAL WELL ID:
DRILLER: D.T. CHALMERS JR. MW_01
NORTHING: 672730 EASTING: 2259835 CREW: TREVOR MIZELLE
SYSTEM: NCSP NAD 83 USft BORING LOCATION: -30'FROM S.CHURCH ST.NEAR TANK BASIN T.O.C.ELEV.:
DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HOUR DTW: 17.9 TOTAL DEPTH: 25.0
START DATE: 2/24/21 END DATE: 2/24/21 24 HOM DTW: N/A WELL DEPTH: 22.5
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (ppm) s G DEPTH DESCRIPTION DETAIL
(ML)-Tan to brown with red motting,Clayey Sapprolitic
SILT. Strong HCO(continued) 22.5
23.0
s
,4 191.2 D
30
25.0 2s.o .. 25.0
BORING TERMINATED AT DEPTH 25.0 ft
ElPortland Cement Bentonite Pellets E]#2'Medium Sand