GW1-2021-06626_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: g ,r,
ES
D.T. CHALMERS, JR. ^ 1021 �iROwATnt-zo> -
,.r T n 1 r. FROM To— I DESCRIPTION
Well Contractor Name Ing OVA ft. R.
4146A 311on 'cee On R. R.
NC Well Contractor Certification Number ,U{�j� Q J SfS.VNWf GA3�1G`OR',TUBiNG: eothe�closed4g
FROM I TO I DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft.1 5 It 1 1 in.i Sch.40 1 PVC
Company Name 06XOUTERCe S G fo mu`lii-c""ta e`dw Is OBZI$NER:if,a icabte
FROM TO I DIAMETER THICKNESS I MATERIAL
2.Well Construction Permit#: N/A ft. rt. in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
R. R. in.
3.Well Use(check well use): 11154fSGREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 ft. 15 rt. 1 in. Slot.010 SCh.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) rt. fL
❑Industrial/Commercial ❑Residential Water Supply(shared) ifiB..T0
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irri ation
Non-Water Supply Well: rt. rt.
0 rt. 0.5 rt. Bent.Pellets Surface Pour
®Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation ;19:fsAND76RAVELWAtkTif a ieable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage R R.
❑Experimental Technology ❑Subsidence Control 0.5 R. 16 R. 11 Natural Baekfill
12U:11)RllrISiNGrLrOGYe'fteehTaddfldS.=sheets if necessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soil/rock type,wain sire etc.
❑Geothermal(Heatin Cooli ng Return) ❑Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed: 06/16/21 Well ID#: P4-TW11 ft. R.
5a.Well Location:
ft. rt.
Facility/Owner Name Facility ID#(If applicable)
R.
MCAS CHERRY POINT,CHERRY POINT,NC 28533
ft. R.
Physical Address,City,and Zip
tziifFErvlaiRlts
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)
34.90786788 N -76.88971649 W 9/29/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ❑Permanent or O Temporary By signing this form,I hereby certify that the we/l(s)was(were)constructed in accordance with
15A NCAC 02C.0100 or 15A NCAC'02C A200 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,ill 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 same 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: 1 1.95 (ft,) Division of Water Resources,information Processing Unit,
Ifwater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 2 (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: DPT 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
4
I
13a.Yield(gpm) Method of test: 24c.For Water Supply&Infection Wells:
Also submit one copy of this form within 30 days of completion of well
13b.Disinfection type: Amount: construction to the county hi alth department of the county where constructed.
f
Adapted from Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

`0�-Wro CATLIN
WELL LOG Engineers and Seientists
itaoal.aa 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-TW11
NORTHING: 428123 1 EASTING: 2632623 CREW: C. FUTRAL
SYSTEM: NCSP NAD 83 USft BORING LOCATION: T.O.C.ELEV.: 24.37
DRILL MACHINE: Power Probe METHOD: DPT 0 HOUR DTW: NM TOTAL DEPTH: 16.0
START DATE: 6/16/21 END DATE: 6/16/21 124 HOUR DTW: 12.0 WELL DEPTH: 15.0
BLOW COUNT OVA o o 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 24.4 0.0
TOPSOIL 0'0 0.5
Direct Push 30.2 M ' ,/ 1.0 23.4
(SM)-Orange,Silty SAND
2.0 r 2.0 22.4 >
(SC/CL)-Gray,Clayey SAND to Sandy CLAY Q
Direct Push 31.2 M
4.0 4.0 20.4
(SP)-Tan grading to gray,vf.to f.SAND with minor day
Direct lenses 5.0 -
Push 36.1 M
6.0
Direct 143.2 M 7.0 17.4 -
Push HCO
8.0
Direct Push 482.1 M
-
oj
on.
10.0
e
Direct Push 318.4 W
12.0 -
Direct Push 362.2 Sat. ;•;
14.0
Direct 367.4 Sat: 15.0
Push
16.0 16.0 a.a _- 1s.o
BORING TERMINATED AT ELEVATION 8.4 ft in vf.to
f.SAND with some clay lenses
1"PVC Well set to 15.0'BLS.
Bentonite Pellets FI Native Backfill
I