GW1-2021-06616_Well Construction - GW1_20211007

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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.WATER'ZO1�ES
D.T. CHALMERS, JR. FROM TO I DESCRIPTION
Well Contractor Name
4146A
NC Well Contractor Certification Number W1 1ftNNERrGASIlVG ORtTUBING`"7heimal!c`IoserLloo
FROM TO DIAMETER TTi1CKNESS MATERIAL
CATLIN Engineers and Scientists 0 a. 5 a. 1 1 in.i Sch.40 PVC
Company Name $6XOUTERCASING fro muf iT c'"nsed#41VORVM!R_ .f ieable
FROM TO I DIAMETER MCKNESS I MATERIAL
2.Well Construction Permit#: N/A rt. rt. in.
List all applicable well permits(i.e.County,Slate, Variance,injection,etc.)
n. ft. in.
3.Well Use(check well use): t i s"GREEiv
Water Supply Well: FROM I To I DIAMETER I SLOT SIZE THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public 5 R. 15 fl 1 in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) R. rt in.
❑industrial/Commercial ❑Residential Water Supply(shared) MAK ROUT
FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irri ation
o. rt.
Non-Water Supply Well:
®Monitoring ❑Recovery 0 ft. 0.5It. Bent.Pellets Surface Pour
Injection Well: rt. u.
❑Aquifer Recharge ❑Groundwater Remediation 69TS1Nl 0FIXVELVAGIC to icable
EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL
❑Aquifer Test ❑Stormwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control 0.5 n. 16 n. Natural Backfill
920.rDRI1SISIriG .rOG as achTa'&dMo-5 Llhe"et'slifinecexsa
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color hardn 7;i r ck tym,main size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
4.Date Well(s)Completed: 06/16/21 Well iD#: P4-TW13 e. n. ��
S �O
5a.Well Location: �N
P
e.
Facility/Owner Name Facility[D#(if applicable)
ft.
MCAS CHERRY POINT,CHERRY POINT,NC 28533
rt. e.
Physical Address,City,and Zip
92—IVREMARKS
CRAVEN ptQ� .•
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)
34.90751629 N -76.8897533 W 9/29/2021
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)constructed in accordance with
15A NC—AC 02C.0100 or 15A NC4C 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.
if this is a repair,ill out known well construction in(ormation and explain the nature of
the repair umdcr#21 remarks section or on the back of this firm. 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 infection 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 (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(200'and 2@100) construction to the following:
10.Static water level below top of casing: 1 1.83 (B•) Division of Water Resources,Information Processing Unit,
lfwater 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.anger,mlary,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 Svoaly&lniection 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-I North Carolina Department of Environment and Natural Resources-Division of Water Rdsources Revised 2-22-2016
I

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ti. CATLIN
Engineem and Scientists
WELL LOG zeoat.oa SHEET 1 OF 1
PROJECT NO.: 218041.04 STATE: NC COUNTY: CRAVEN LOCATION: CHERRY POINT
PROJECT: PIT 4 (72GW50) AREA-LNAPL LOGGED BY: J. WILSON WELL ID:
DELINEATION DRILLER: D.T. CHALMERS JR.
NORTHING: 427995 EASTING: 2632615 CREW: C. FUTRAL P4-TW13
SYSTEM: NCSP NAD 83 USft BORING LOCATION: T.O.C.ELEV.: 25.51
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 HOUR DTW: 11.8 WELL DEPTH: 15.0
BLOW COUNT OVA o 0 SOIL AND ROCK WELL
DEPTH 0.5ft 0.5tt 0.5ft 0.5ft (PPm) LAB. s c DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 25.5 0.0
0.0 TOPSOIL 0.0 0.5
Direct NM D NO RECOVERY =
Push
U
2.0 a
o "
v -
Direct NM D U)
Push
4.0 4.0 21.5
(CL)-Dark brown,Sandy and Silty CLAY
Direct 235 D 5.0 =
Push
6.0
Direct Push 210 D
7.8 17.7
8.0 8.0 (SP)-Gray,vf.SAND 17.5
HCO
Direct Push 375 W
o> -
oa "
10.0 -6 _
�t -
n
Direct 595 W -
Push
12.0 =
Direct W
Push 775
14.0
Direct 370 W 15.0 =
Push
16.0 16.0 9.5 15.0
BORING TERMINATED AT ELEVATION 9.5 ft in vf.to
f.SAND
1"PVC Well set to 15.0'BLS.
Bentonite Pellets Native Backfill