GW1-2022-01463_Well Construction - GW1_20220120

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information: ".
;- 14.WATER ZONES
Austin Fowler FROM TO DESCRIPTION
Well Contractor Name
4366A
NC Well Contractor Certification Numhc•i 15.INNER CASING OR TUBING eothermal cl
FROM TO I)l IlT It TIIICF: F.SS I MATERIAL
CATLIN Engineers and Scientists 0 ft.1 1 ft.1 1 1 Sch 40 1 PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER ifs icable
FROAI TO DIAMIfTYR 11M KAI 5ti VI VPRLAI
2.Well Construction Permit#: N/A e. rt. in.
List all applicable well permits(i.e.Countyy,Stair. I ar•urnce,Injection,etc.)
R. ft. in.
3.Well Use(check well use): 17 SCREEN
Water Supply Well: FROM TO DIAMETER SLOT W1 T1ucn\1- vn n Ri v
❑Agricultural ❑Municipal/Public 1 n. 17 rt. 1 tu Slot.010 Sch 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft.
❑Industrial/Commercial ❑Residential Water Supply(shared) I&GROUT
FROM If) �D\TERIAI_ EMPLACEMENT METHOD&AMOUNT
❑Irrigation
n. n.
Non-Water Supply Well: -
MMonitoring ❑Recovery 0,5 rt. 1.5 n. Bent Pellets Surface Pour
Injection Wen: ft. n.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL.PACK if a icable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL EhIPLACEMENT METFIOD
❑Aquifer Test ❑Stormwater Drainage 1.5 ft. 17 Medium Sand Torpedo Sa
❑Experimental Technology ❑Subsidence Control ft. f.
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM To DI sc z[P 110 color.Imrdness.soil-1,n x_t n et
❑Geothermal (Heating/Cooling Return ❑Other(explain under 421 Remarks) It. u. -_
4.Date Well(s)Completed: 12/14/21 Well ID#: P-2 It. rt. `,�G
'` 00O
5a.Well Location: - r
NCDEQ-Ed'S Village Open Air Market N/A `
Ii.
Facility/Owner Name Facility IDff(if applicable) t
rt.
103 W.Jackson Blvd.,Erwin,NC,ERWIN,NC 28339
n. l.
Physical Address,City,and Zip
21.REMARKS
HARNETT
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)
35.337877 N -78.677189 W / 1/12/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ❑Permanent or ®1 emporary By signing this form,I hereby certify,that the well(s)was(were)constructed in accordance with
15A NCAC 01C.0100 or 1 SA NCAC 01C.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.
Ifthis is a repair,fill out known well construction information and explain the nature of
the repair under=21 remarks.vection or on the hack 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
can submit one form. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 17.0 (g,) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple welly list all depthv in different(example-.?a lXP art!2@1009 construction to the following:
10.Static water level below top of casing: 13.0 (g,) 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: 6.26 (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 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 SvnDly&Infection 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-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

CATLIN
WELL LOG tsgin"mand Scientists
z2o227 SHEET 1 OF 1
PROJECT NO.: 220227 STATE: NC COUNTY: HARNETT LOCATION: ERVAN
PROJECT: EUS VILLAGE OPEN AIR MARKET LOGGED BY: O. Da nes WELL ID:
DRILLER: Austin Fowler P-2
NORTHING: 30703044 EASTING: 31600498 CREW: D.T. Chalmers
SYSTEM: NCSP NAD 83 USft BORING LOCATION: -43 feet north of P-1 T.O.C.ELEV.: 100.07
DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HOUR DTW: 13.0 TOTAL DEPTH: 17.0
START DATE: 12/14/21 END DATE: 12/14/21 124 HOUR DTW: NM WELL DEPTH: 17.0
BLOW COUNT OVA M L SOIL AND ROCK WELL
DEPTH O.Sft 0.5ft 0.5ft 0.5ft (ppm) LAB. s G DEPTH DESCRIPTION ELEVATION DETAIL
Lo LAND SURFACE 100.1 0.0
0.5 0.5 ASPHALT 99.6 0 Oa
1.0 (SM)-Brown SILTY F.SAND,HCO 99.1 1.Oa
2 2 9 7 D (CL)-Brown CLAY w/Black Mottling,HCO 1.5
2 3
5.0 5.0 95.1
(CL)-Brawn,Gray,and Red Mottled CLAY w/Medium
2 4 Plasticity
7 8.8 D
e
80 92.1
:`•
(SC)-Gray and Red CLAYEY SAND.HCO o�
oa
oa
m�
10.0
2 s
s 785 P2(10-12) M
to
(CL)-Gray CLAY,HCO
LL
15.0 7 e
15.5 4 4 95.7 W 15.5 sa.s
r? (SW)-Tan Well Graded SAND,HCO
31.6 Sat. Ate'
17.0 17.0 83.1 17.0 17.0
BORING TERMINATED AT ELEVATION 83.1 ft in well
graded SAND
Bentonite Pellets #2 Medium Sand