GW1-2021-00751_Well Construction - GW1_20211208

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WELL CONSTRUCTION RECORD For Internal Use ONLY: I
This form can be used for single or muhiple wells f
1.Well Contractor Information:
SANNVATERZONFS
D.T. CHALMERS,JR. FROM TO DESCRIPTION
Well Contractor Name rt ft.
4146A ft. it.
NC Well Contractor Certification Number JT5.'11NNER CASING'6WTUBING rothem all"elosed too
FROM TO DIAMETER THICKNESS I MATERIAL
CATLIN Engineers and Scientists 0 rt 8 fLI 2 in. SCh.40 PVC
Company Name i1C16TOUTT3tGAffiNG'formulii-c"a ed,wdlsTORIISI4fW Urm—i Fa`Me"
FROM TO I DIAMETER I THICKNESS I MATERIAL.
2.Well Construction Permit#: N/A rt e. in
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
ft (t i in.
3.Well Use(check well use): Iri7fSCMIN
Water Supply Well: FROM18rt
TO DIAMETER SLOT SIZE THICLwEss MATERIAL
❑Agricultural ❑Municipal/Public 18 R 2 in. Slot.010 Sch.40 PVC
❑Geothermal(I Ieating/Cooling Supply) ❑Residential Water Supply(single) ft in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 1018[031COUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
ft ft.
Non-Water Supply Well:
1 ft. 7 rt. Bent.Pellets Surface Pour
®Monitoring ❑Recovery
Injection Well: IL ft
,,. .
❑Aquifer Recharge ❑Groundwater Remediation 169:t"SAND%GRAVEaIIPACK7ta""`ica65e
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 7 rL 18# Medium Sand Torpedo Sa d
❑Experimental Technology ❑Subsidence Control ft 2
920jDRH SLING+LTOGra�t cch additional bee is it,oecessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color hardness soil/rock a six etc.
❑Geothermal(Heating/CoolingReturn ❑Other(explain under#21 Remarks) ft ft
4.Date Well(s)Completed: 11/11/21 Well ID#: MW-3R ft. e. ��
ft. ft. S �O
5a.Well Location:
ft rL ,� P►
NCDEQ Lancaster Store rL
Facility/Owner Name Facility ID#(ifapplicable)
ft
8997 Lancaster Rd.,Castalia,NC,CASTALIA,NC 27816 I J r
Physical Address,City,and Zip ftR.
9114REMA'I2Iti;5..
NASH �F
County Parcel Identification No.(PIN) _
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: l
22•Certification:
(if well field,one lat/long is sufficient) f
f
36.062188 N -78.082937 W 11%30%/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or OTemporary
By signing this form,!hereby certify that the well(s)was(vere)constructed in accordance with
15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: Oyes 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 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 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: 18.0 (ft.) 24a.For All Wells: Submitthis 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: DRY (R,) 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 Iniection 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: 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 Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water SvpDly&Iniection Wells:
Also submit one copy of thislform within 30 days of completion of well
13b.Disinfection type: Amount: construction to the county health department of the county where constructed.
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Adapted from Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Re urces Revised 2-22-2016
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CATLIN
I Engineers and scientists
WELL LOG 220213 SHEET 1 OF 1
PROJECT NO.: 220213 STATE, NC COUNTY: NASH LOCATION: CASTALIA
PROJECT: LOGGED BY: O;DAYNES WELL ID:
Lancaster Store DRILLER: D.T. CHALMERS JR.
NORTHING: 30522787 EASTING: 31339458 CREW: K SWAIN IVIVU-3R
SYSTEM: NCSP NAD 83 ft BORING LOCATION: NORTHWEST OF MW-3 T.O.C.ELEV.: 100.60
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: DRY TOTAL DEPTH: 18.0
START DATE: 11/11/21 END DATE: 11/1 1/21 24 HOUR'DTW: NM WELL DEPTH: 18.0
BLOW COUNT OVA o L
DEPTH LAB. o
SOIL AND ROCK ; WELL
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0.5ft 0.5ft 0.5ft 0.5ft (PPM) S DEPTH DESCRIPTION j� ELEVATION DETAIL
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0.0 LAND SURFACE 100.6 0.0
�•� ARTIFICIAL GRAVEL FILL 0.0 Ad
24 s q 0.1 D to s9s '`Fg 1.0
s (CH)-Orange FAT CLAY w/SAND
3.0 97.6
( )-Orange SILT w/SAND,Low Plasticity
-----------------
_______
ML
a
0
t
in
(V
5.0
2 3 MW-3R
q 0.4 (5-7) D 5
7.0
8.0
9.0 ______91.6
(WR)-Tan F.to C.SAND w/SILT,Well Graded,
Weathered Granite
10.0
3 8
9 0.0 D
20
o�
oa
oa
<n r
LL
tV U
15.0
5
s, 33 0.0 M
8
18.0 i 82.6 18.0 18.0
18.0
BORING TERMINATED AT ELEVATION 82.6 ft In
WEATHERED GRANITE In WEATHERED GRANITE
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f
t
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Concrete Bentonite Pellets #2 Medium Sand
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