GW1-2021-00752_Well Construction - GW1_20211208

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WELL CONSTRUCTION RECORD For Internal Use ONLY: G
This form can be used for single or multiple wells I[`
1.Well Contractor Information:
!<1$IVVA 1 ER ZONES11111110111111
D.T. CHALMERS,JR. FROM To I DESCRIPTI
Well Contractor Name ft IL
4146A ( ( ft ft
NC Well Contractor Certification Number I � t b t u' �S.IIlsIIYFdt?CASING ORB UBuvGr eoiherinal�elosed IM
FROM TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists (yt r ® e ,,,,,,, 0 rt 9.5 rt. 1 Sch.40 PVC
Company Name ��— 1D6C0UTER Ge'1SING fo m Ifi-c""age'd wells ORZiTINER if a cable
FROM TO I DIAMETER I THICKNESS MATERIAL
2.Well Construction Permit#: N/A i;'r''t'a^. t s•n;t
ft. R. 1 in.
List all applicable well permits(t.e.County,Stale%pVorian�ce,,lnjeclion e(c)�;� ,
��•� ::Y1,aiil r iI:T RUi,,:;, Il' �f�l l ft rt. in.
3.Well Use(check well use): NOWCRffiv
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 9.5 ft 19.5 ft 1 in. Slot.010 Sch.40 PVC
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❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft in.
❑Industrial/Commercial ❑Residential Water Supply(shared) lfr8AGROUT
FROM TO MATERIAL EMPLACEMENF METHOD&AMOUNT
❑Irrigation
ft n.
Non-Water Supply Well:
®Monitoring ❑Recovery ft. t•
Injection Well: rL ft.
❑Aquifer Recharge ❑Groundwater Remediation RosM1D/GRA�A7tP OM,lf;i sMe
}RO,Mr TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier ,
Cl Aquifer Test ❑Stormvater Drainage ft
ft
❑Experimental Technology ❑Subsidence Control 0 rc 20 ft Natural Backfill
�SUfURtli[II]SG�iOG"stleeh addiiion'al.ah'ee""ITrtnee
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hudnes soil/rock type,grain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) IL n.
4.Date Well(s)Completed: 11/11/21 Well ID#: MA-9 rr n O
��
Sa.Well Location: �
rt. rt.
NCDEQ Lancaster Store rt cr
Facility/Owner Name Facility ID#(ifapplicable)
ft. P
8997 Lancaster Rd.,Castalia,NC,CASTALIA,NC 27816
Physical Address,City,and Zip n. R.
�2iVtErvt:4tttts
NASH
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)
63.062487 N -78.082441 W 11/30/2021
SignatureofCertiSed Well Contractor Date
6.Is(are)the well(s): O Permanent or ®Temporary By signing this form,1 hereby certify that the well(s)was(were)constructed in accordance with
15A NCAC 02C.0100 or 15A NGIC 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 wel/owner.
if this is a repair,fill out known well construction information and explain the nature of
the repair under Ul 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: 19.5 (B,) 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;
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10.Static water level below top of casing: 19.15 (R,) Division of water Resources,Information Processing Unit,
lfwater level is above casing,use"+"
1617 Mail Service 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 of this form within 30 days of
12.Well construction method: HSA completion ofwell construction'to the following:
(i.e.auger,rotary,cable,direct push,etc.) I
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
24c.For Water Svaaly&I
13a.Yield(Rpm) Method of test: nfection Wells:
Also submit one copy of this Iform within 30 days of completion of well
13b.Disinfection type: Amount: construction to the county health department ofthe county where constructed.
Adapted from Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016
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I CATLIN
Engineets and Scientist.
WELL LOG z2oz13 SHEET 1 OF 1
PROJECT NO.: 220213 STATE: NC I COUNTY: NASH LOCATION: CASTALIA
PROJECT: LOGGED BY: O DAYNES WELL ID:
Lancaster Store DRILLER: D.T. CHALMERS JR.
NORTHING: 30522639 FASTING: 31339351 CREW: K SWAIN MW-9
SYSTEM: NCSP NAD 83 ft BORING LOCATION: —31'FROM ROAD<NORTHEAST FROM SITE T.O.C.ELEV.: NM
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: 19.2 TOTAL DEPTH: 20.0
START DATE: 11/11/21 END DATE: 11/11/21 124 HOURIDTw: N/A WELL DEPTH: 19.5
BLOW COUNT OVA o SOIL AND ROCK WELL
DEPTH 0 5ft 0.5ft 0.5ft 0.5ft (ppm) LAB, s c DEPTH DESCRIPTION DETAIL
s
0.6
0.0 LAND SURFACE 0.0
0.0 (ML)-Brown SILTY F.SAND
2 -
s 4 1.2 D 7 1 (CH)-Orange CLAY w/F.to C.SAND
a _
v
t -
U
5.0
z s 6.0 32 1.0 D 24 (WR)-Tan F.to C.SAND w/SILT,Well Graded,
Weathered Granite
9.6
10.0
R FUS L
70/ D I
.4
LL
of
oa
o�
v
�L -
15.0LL
"
R=FUSi L
60/ W
1 -
19.6
20.0 20.0 20.0
BORING TERMINATED AT DEPTH'20.0 ft In
WEATHERED GRANITE In WEATHERED GRANITE
Native Backfill
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