GW1-2021-00186_Well Construction - GW1_20211213

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple Hells
1.Well Contractor Information: --
14.WATER ZONES
D.T. CHALMERS, JR. FROM TO DESC'RlVnON
Well Contractor Name ft. ft.
4146A It, ft.
NC Well Contractor Certification Number 15.INNER CASING OR TUBING eothermal closed loo
FROM TO DIAMEn:R TFIICKNFSS M.4 FERAL
CATLIN Engineers and Scientists 0 ft.1 15 ft. 2 in.1 Sch.40 1 PVC
Company Name 16.OUTER CASING tfor multi-cased wells OR LINER tif ainilicablel
FROM TO DIA\IETIR TMCKNESS NATERIAL
2.Well Construction Permit#: N/A n. ft. in.
List all applicable well permits(.e.County,State, I'(1rrancC,ln/eeuon,etc.)
ft. ft. in.
3.Well Use(check well use):
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLAT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 15 ft. 30 n. 2 in. Slot.010 SCh. 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. R. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
IROMI 10 S4ITERIAL EMPLACENIENTNETHOD&AMOUNT
❑Irrigation
Ili ft.
Non-Water Supple NN ell:
®Monitoring ❑Recovery 1 If. 12.5 ft. Bent.Pellets Surface Pour
Injection NN ell: a. n.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if a icable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL FMIPLACFMF\T METHOD
12.5 ft. 30 fL #2 Medium Torpedo Sand
❑Aquifer Test ❑Stomtwater Drainage
❑Experimental Technology ❑Subsidence Control ft. a.
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DFSCRIPTION color,hardness,soil/rock nine,giatnsm,etc
❑Geothermal(Heating/Cooling Return) ❑Other(explain under-21 Remarks) n. n.
4.Date Well(s)Completed: 09/29/21 Well iD#: MW1-R
5a.Well Location:
NCDEQ Highway 56 Grocery `
Facility/Owner Name Facility 1D#(if applicable)
u.
5050 NC-56, Franklinton, NC 27525
Physical Address,City,and Zip -
F 21.REMARKS
RANKLIN N/A
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one Iat/long is sufficient)
36.102497 N -78.433806 W 12/1/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): M Permanent ur ❑Temporary Br signing ihisform,1 hereby certijv that the well(s)was(were)consinicied in accordance with
15A N(AC•02 •.0100 or 15A N(-AC 02C.0200 We11 Construction Standards and that a copy of
7.Is this a repair to an existing well: ❑Yes or MNo this record has been provided to the well owner
if this is a repair,Jill out known well construction mformahon and explain the nature of
the reparr 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: construction details. You may also attach additional pages if necessary.
For multiple uyecttun or non-water stippty wells ONLY wah the same construction,you
can submit one form. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 30.0 (g,) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths in dtjjerent(example-3na�(/0'and 2@10) construction to the following:
10.Static water level below top of casing: 26•0 (It.) Division of Water Resources,Information Processing Unit,
If water 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 wlthm 30 days of
12.Well construction method: 4.25 HS AUGER 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 Svnaly&Infection Wens:
Also submit one copy of this form�N ithin 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 Resources Revised 2-22-2016

CATLIN
WELL LOG Engineers and Scientists
zz,z,a SHEET 1 OF 2
PROJECT NO.: 221214 STATE: NC COUNTY: FRANKLIN LOCATION: FRANKLINTON
PROJECT NAME: Highway 56 Grocery LOGGED BY: O DAYNES WELL ID:
DRILLER: T CHALMERS MW1-R
NORTHING: 30626263 1 EASTING: 31323402 CREW: A FOWLER
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Southeast of MW-1 T.O.C.ELEV.: 387.51
DRILL MACHINE:CME 45B TRACK METHOD: 4.25 HS AUGER 0 HOUR DTw: 26.0 TOTAL DEPTH: 30.0
START DATE: 9/29/21 FINISH DATE: 9/29/21 124 HOUR DTw: NM WELL DEPTH: 30.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5tt 0.5tt 0.5rt 0.5tt (PPM) s DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 387.5 0.0
0.2 .ASPHALT 3 0.0 A.
7-0-'-(CL)-Red CLAY w/SAND, Moderate Plasticity r` 10
3 5 10 7 0.5 D 1.2 386.3
(SM)-Brown SILTY SAND
' t
3.0 384.5
5.0
3 6 9 11 12.9 D
ch
0
t
U
(ML-SM)-Red-Brown SILT w/SAND;and Micas N
10.0
2 5 6 6 54.7 MW-1 R D
(10-12)
12.5
15.0 1s.o
1 2 3 4 96.8 1-1 R D
(15 17) (ML)-Red-Brown SILT w/Micas and Black
Mottling(Faint HCO)
19.0 368.5
20.0 (SM)-White SILTY SAND(Faint HCO)
1 2 2 3 44.9 M 21.0 366.5
Red to Brown-Tan SILT w/SAND and Micas
O
A:
Concrete Im Bentonite Pellets El#2 Medium Sand

WELL LOG CATLIN
Engineers and Scientists
z2'`'4 SHEET 2 OF 2
PROJECT NO.: 221214 STATE: NC COUNTY: FRANKLIN LOCATION: FRANKLINTON
PROJECT NAME: Highway 56 Grocery LOGGED BY: O DAYNES WELL ID:
DRILLER: T CHALMERS MW1-R
NORTHING: 30626263 1 EASTING: 31323402 CREW: A FOWLER
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Southeast of MW-1 T.O.C.ELEV.: 387.51
DRILL MACHINE:CME 45B TRACK METHOD: 4.25 HS AUGER 0 HOUR DTW: 26.0 TOTAL DEPTH: 30.0
START DATE: 9/29/21 FINISH DATE: 9/29/21 124 HOUR DTW: NM WELL DEPTH: 30.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5tt o.5ft 0.5ft 0.5tt (ppm) s c DEPTH DESCRIPTION ELEVATION DETAIL
�>
oa
oy
int
<V N
25.0
Red to Brown-Tan SILT w/SAND and Micas
1 1 3 3 NM W (Faint HCO)(continued)
30.0 30.0 357.5 30.0 30.0
Boring Terminated IN SILTY, F.SAND at
Elevation 357.5 ft
°u: Concrete Bentonite Pellets El#2 Medium Sand

t i
`_ i •k
MW-4 SVE-1
i
• �, ® ® (CNL) t�
- Q(CNL)
MW 1 �
- (CNe�v
® MW-6
MW-1 R Ar.
-5D
i (CNL) , ;
A _ f �•
>s
MW-7
t1r (CNL)
MW-3
®(CNL) +
MW-2
® (CNL)
MW-10
Al
LEGEND
® Active Monitoring MW-g
Well (Type II) ®(CNL)
® Destroyed Monitoring
Well (Type II)
1� V
ODestroyed Monitoring
Well (Deep)
Approximate Location 0�
of Former UST Basins
MW-8
n Parcel Boundary (CNL)
Source:Esri, Maxar, GeoE e Earthstar Geo ra cs, ES!Airbus DS,
USDA,USES,AeroGRJD, IGN,.. d the GIS Us Community
NOTES.
1. Well and tank locations were obtained from previous 40 20 0 40 80
reports prepared by other consultants and are approximate.
2. CNL=Could Not Locate (assumed destroyed) MEMENJFeet
PROJECT TITLE
FIGURE
HIGHWAY 56 GROCERY
ATLIN 5050 NC-56 EAST SITE MAP
FRANKLINTON, NC
Engineers and Scientists
INCIDENT N0. JOB N0. DATE SCALE DRAWN BYICHECKED BY
24136 221214 DEC 2021 AS SHOWN KMC/SJO