GW1-2021-06621_Well Construction - GW1_20211007

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
2l4:VWATER'Z0NES
D.T. CHALMERS JR. REG FROM TO DESCRIPTION
Well Contractor Name © � ft. fL
v�► ft. ft.
NC WellContractor Certification Number ,D C`��QO�N�Oe 31on 9 FROM I To M5.%NW*C)%YlK ORGTt1BIND1AMETER aI: TMI CIQJE55 MATERIAL
CATLIN Engineers and Scientists 0 rL 5 ft. ; 1 m.1 SCh.40 1 PVC
Company Name ✓ff6x01lERGASIN1; ror"m Iii-`ccasedwells OR1f1 R—Tif.e icaMe
FROM I TO I DIAMETER I THICKNESS MATERIAL
2.Well Construction Permit#: N/A ft. ft. in.
List all applicable well permits(i.e.County,Stale, Variance,Injection,etc.)
ft. n. in.
3.Well Use(check well use): 1fi7X9tf&EFq
Water Supply Well: FROM I TO DIAMETER SLOT SIZEI THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 R. 15 ft.15 in. Slot.010 SCh.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) a. R in.
❑Industrial/Commercial ❑Residential Water Supply(shared) �TGROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑1ni ation
Non-Water Supply Well:
®Monitoring ❑Recovery 0 ft. 0.5 ft. Bent.Pellets Surface Pour
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation !b9(Sa15D7GRA3E[JrPAGK7ita icable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I To I MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 0.5 u. 16 u. Natural Backfill
M%.JDRI ... —G�aa tach�Gd'diliona?3h'e"elifnecessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO I DESCRIPTION color hardness soil/rock type.erain size etc.
❑Geothermal(Heatin Cool i ng Return) ❑Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed: 06/16/21 Well ID#: P4-1W05 ft. ft.
u. ft. S �O
5a.Well Location: �N
ft. W
P
n.
Facility/Owner Name Facility[Ik!(if applicable)
ft.
MCAS CHERRY POINT,CHERRY POINT,NC 28533
rt. a.
Physical Address,City,and Zip
EZ 1MRElCiAI2KS
CRAVEN
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)
34.90770759 N -76.89001174 W 9/29/2021
Signature of Certified Well Conhactor Date
6.Is(are)the well(s): ❑Permanent or ®Temporary By signing ihisform,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 copy of
7.Is this a repair to an existing well: ❑Yes or ®No this record has been provided to the well owner.
[f this is a repair,ill out known well construction information and explain the nature q/.
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 mulliple injection or non-wetter supply wells ONLY with the stone construction,you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 15 (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@200'and 2@100) construction to the following:
10.Static water level below top of casing: 12.05 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above caving,use"y„ 1617 Mail Service Center,Raleigh,NC 27699-1617
4
11.Borehole diameter: 2 (in.) 24b.For Iniection Wells ONLY: Iti 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: APT 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
i
13a.Yield(gpm) Method of test: 24c.For Water Syprtly&Iniection 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 ofthe county where constructed.
Adapted from Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

rftw CATLIN
WELL LOG Engineers and Scientists
2isoat.oa SHEET 1 OF 1
PROJECT NO.: 218041.04 STATE: NC COUNTY: CRAVEN LOCATION: CHERRY POINT
PROJECT: PIT 4 (72GW50) AREA-LNAPL LOGGED BY: S. CHASTEEN WELL ID:
DELINEATION DRILLER: D.T. CHALMERS JR. P4-TWO5
NORTHING: 428063 1 EASTING: 2632536 CREW: C. FUTRAL
SYSTEM: NCSP NAD 83 USft BORING LOCATION: T.O.C.ELEV.: 25.37
DRILL MACHINE: Power Probe METHOD: DPT 0 HOUR DTW: NM TOTAL DEPTH: 16.0
START DATE: 6/16/21 END DATE: 6/16/21 24 HOURDTW: 12.1 WELL DEPTH: 15.0
BLOW COUNT OVA o L SOIL AND ROCK WELL
DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPm) LAB. S G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 25.4 0.0
0.0 ' ' ' TOPSOIL 0.0
0.5
id
Direct Push 2.2 M 1.0 24.4 =
(SC)-Dark tan grading to dark gray and black,clayey
SAND
2.0 0-
Direct
Push 8.7 M -
4.0
Direct 5 5.0
.4 M =
Push -
6.0 6.0 19.4 =
(SP)-Light gray,vf.SAND -
Direct
Push 16.2 M
-
8.0
8.0 17.4 =
(CL)-Gray,Sandy CLAY with HCO
Direct Push 552.4 W 9.0 16.4
(SP)-Gray,vf.SAND with Clay lenses and HCO o
10.0 10.0 15.4
(SP)-Gray,vf.SAND with HCO U.
r
Direct Push 420.9 W
12.0 12.0 13.4
Strong HCO and sheen
Direct Push 404.2 Sat.
14.0
Direct 294.7 Sat. 15.0
Push =
16.0 16.0 9.4 16.0
1s.o BORING TERMINATED AT ELEVATION 9.4 ft in vf.to
f.SAND with some clay lenses
1"PVC Well set to 15.0'BLS.
I
Bentonite Pellets Native Backfill