GW1-2021-00750_Well Construction - GW1_20211208

WELL CONSTRUCTION RECORD For Internal Use ONLY d
This form can be used for single or multiple wells
1.Well Contractor Information: i
f14CWATiAZ0NlES
D.T. CHALMERS,JR. FROM TO DEscR�noN
Well Contractor Name rL rL i
4146A fL rL
NC Well Contractor Certification Number 6510YNER'CASING OR.T[JBiNGY eothermMl>dosed loo
FROM 1 TO DIAMETER THICKNESS IMATERIAL
CATLIN Engineers and Scientists 0 rL 9.5 rt.1 1 in.iSCh.40 PVC
Company Name f16.fODTERCASING!for.mulli-caM'w51s OR XNW(fsic`sWe
FROM TO I DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: N/A
fL ft. in.
List all applicable well permits(i.e.Coun)4 State, Variance,Injection,etc.)
ft. � in.
ft
3.Well Use(check well use): ft S�fscR
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
El Agricultural ❑Municipal/Public 9.5 rL 19.5 ft. 1 in. Slot.010 SCh.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL rL
❑Industrial/Commercial ❑Residential Water Supply(shared) i18(GROUT
FROM TO MATERIAL EMPLACEMENI'METHOD&AMOUNT
❑Irrigation
ft. rt.
Non-Water Supply Well:
M Monitoring ❑Recovery rL R
injection Well: rL rL
❑Aquifer Recharge ❑Groundwater Remediation irmSAND7GRAVFd;P"A'CK'ifa icatile
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTMETHOD
fL ft.
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 0 rL 20 ft. Natural Backfill
F_0)DRI31NC.U0G'(attach ad li8.0 sheets iru ceu
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRI MON color,hardness soil/rock type.juain sia etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 921 Remarks) R R.
4.Date Well(s)Completed: 11/11/21 Well ID#: MW-8 rL rL
IrL rt. �O
5a.Well Location:
NCDEQ Lancaster Store rL r; f
Facility/Owner Name Facility ID#(if applicable)
rL t
8997 Lancaster Rd.,Castalia,NC,CASTALIA,NC 27816 tL ft. O
Physical Address,City,and Zip
92_1!IREMARICS'
NASH
County Parcel Identification No.(PIN) jj;j;�
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one lat/long is sufficient)
36.06257 N -78.082874 W 11/30/2021
SigratureofCertified Well Contractor Date
6.is(are)the well(s): O Permanent or ®Temporary By signing this form,I hereby certify that the well(s)was(mere)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: O 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 under 921 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
can submit one form. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 19.5 (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@100J construction to the following)
10.Static water level below top of casing: 18.0 (fi) Division of Water Resources,Information Processing Unit,
Ifwarer level is above casing use"+^ 1617 Mail Servi I ce'Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.25 (in.) 24b.For Infection Wells ONLY: In addition to sending the form to the
address in 24a above,also submit a copy ofthis 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 Se ice Center,Raleigh,NC 27699-1636
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 hea'lth 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

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CATLIN
WELL LOGEngineeis and Scientists
z Io SHEET 1 OF 1
PROJECT NO.: 220213 STATE, NC COUNTY: NASH LOCATION: CASTALIA
PROJECT: Lancaster Store LOGGED BY: O DAYNES WELL ID:
i
DRILLER: D.T. CHALMERS JR. MW-8
NORTHING: 30522767 1 EASTING: 31339319 CREW: K SWAI N
SYSTEM: NCSP NAD 83 ft BORING LOCATION: —37'FROM ROAD,NORTHWEST OF SITE T.O.C.ELEV.: NM
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: 18.0 TOTAL DEPTH: 20.0
START DATE: 11/11/21 END DATE: 11/11/21 24 HOUR'DTW: N/A WELL DEPTH: 19.5
BLOW COUNT OVA o L SOIL AND ROCK WELL
DEPTH o.sn o.sn o.sn o.sn (PPm) LAB. I � DEPTH DESCRIPTION ' DETAIL
f
0.5
0.0 LAND SURFACE 0.0
0.0 (ML-SM)-Brown SILT w/SAND
2 -
3 q O.8 MW-8 D 1.0 _
7 (0-2) (CH)-Orange CLAY w/SAND and Med.Plasticity
.0 >
4
I-----------------=-------- a
(ML)-Red SILT w/F.to C.SAND and Micas Q
t -
5.0
3 -
q 7 7 0.4 D =
9.5
10.0
2 3
3 0.5 M
s
13.0
C. (WR)-Tan F.to C.SAND w/SILT,Weathered Granite -
�>
oa
o v
15.0
2 3 0.5- Sat.
20
i
f -
I
1ss 20.0
-
20.0 20.0
BORING TERMINATED AT DEPTH 2O.0 ft In
WEATHERED GRANITE In WEATHERED GRANITE
I ,
Native Backfill