GW1-2022-01464_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 DESCRIP-nw,
Well Contractor Name
4366A '\ t r' fL
NC Well Contractor Certification Number 15.INNER CASING OR Tl1BING' ertaal
FROM TO DIAMETER 111CKNESS VI AITRI:AI.
CATLIN Engineers and Scientists 0 rt. 1 it.1 1 Sch. 40 1 PVC
Company Name t: 16.OITIERCASING for i OR LINER ifa icable
FROM TO DIAMETER 1111(CKNL'SS V1 A It RL-AI.
2.Well Construction Permit#: N/A rt. n. in.
List all applicable well permits(i.e.('ounty,State, Variance,Injection,etc.)
ft. ft. in.
3.Well Use(check well use): 17
.SCREEN
Water Supply Well: FROM To DIAMETER SLcrrsvr TuicKNrs M\mwnl
❑Agricultural ❑Municipal/Public 1 ft. 17 e. 1 itt. Slot 010 Sch. 40 PVC
❑Geothermal(Heating/Cooling Supply) El Residential Water Supply(single) It. ft. - in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
I P()A I 1O MATERIAL I EMPLACEMENT METHOD&AMOUNT
❑Irrigation
it. It.
Non-Water Supply Well: -
0.5 rt. 1.5 rt. Bent.Pellets Surface Pouf
MMonitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO :\taTI:RIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 1.5 n. 17 Medium Sand Torpedo Said
❑Experimental Technology ❑Subsidence Control ft. a.
20.DRILLING LOG attae6 additional sheeb if a
❑Geothermal(Closed Loop) ❑Tracer FROM To DI S(RIPTION ieolor.hardness.,,A t,xF t, �,a­­,et
❑Geothermal (Heating/Cooling Return ❑Other(explain under#21 Remarks) u. It.
4.Date Well(s)Completed: 12/14/21 Well ID#: P-3 rt t -'�G !O ft. n. ` \G
5a.Well Location: Pp
n. rt.
NCDEQ-Ed's Village Open Air Market N/A
n.
Facility/Owner Name Facility lD#(ifapplicable) 1
o.
103 W.Jackson Blvd.,Erwin,NC,ERWIN,NC 28339
u. n.
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)
35.337849 N -78.677047 W / 1/12/2022
Signature ofCertitied Well Contractor Date
6.Is(are)the well(s): O Permanent or ®Temporary By signing this form,I hereby certify that the we/l(s)was(were)constructed in accordance with
1 SA NCAC 01C.0100 or 1 SA NCAC 01C.0100 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: D 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 nurture of
the repair under;t21 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 injection or non-water supply wells ONLY with the same construcdon,you
can submit one/orm. 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 wells list all depths in dijjerew(example-3@200'and 2@100) construction to the following:
10.Static water level below top of casing: 12.2 (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 Injection 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 SyoDly&Iniection 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 Engineers and Scientists
22°22' SHEET 1 OF 1
PROJECT NO.: 220227 STATE: NC COUNTY: HARNETT LOCATION: ERWIN
PROJECT: ED'S VILLAGE OPEN AIR MARKET LOGGED BY: O. Da nes WELLID:
DRILLER: Austin Fowler P-3
Chalmers
NORTHING: 30703002 FASTING: 31600509 CREW: D.T.
SYSTEM: NCSP NAD 83 USft BORING LOCATION: -10 east of former UST Basin _ T.O.C.ELEV.: 99.48
DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HOUR DTW: 12.2 TOTAL DEPTH: 17.0
START DATE: 12/14/21 END DATE: 12/14/21 124 HOUR DTW: NM I WELL DEPTH: 17.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) IS G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 99.5 ao
0.0 o.5 (SM)-Brown SILTY F SAND 99.0 �a
2 3 3 1.3 D
4 (CL)-Brown LEAN CLAY 1.0�
N 1.5
5.0 5.0 94.5
(CL)-SAA w/Red and Gray Mottling,Faint HCO
4
3 13.0 D
5 6
8.0 _____ 91.5
------ ::.
(SC)-Red and Brown CLAYEY SAND.HCO 00
oa
oa
NU
10.0
5
' 10 348.2 P3(10-12) D
8
:r
14.0 ----------------------
f (SW)-Tan Well Graded SAND,Faint HCO
15.0
4
4 3 9.8 Sat.
:r
3
'f} 17.0 82.5 17.0 17.0
17.0
BORING TERMINATED AT ELEVATION 82.5 ft in well
graded SAND
Bentonite Pellets El#2 Medium Sand

MW-9
� N
h.
1 MW-8
' G
1
M,�W-06R I
MW-6
(CN
t Opp
® OW-4
MW-7
(CNL)
T-1
LEGEND MW-5 ® ED
P-3
' P-2
Piezometer STW-1 MW,1
Monitoring Well O
® (Type II) P-1
Temporary Monitoring
Well (Type II)
OMonitoring Well
(Type III)
e Slug Test Well MW-3
«M 12
❑ Approximate Location
of Former Tank Basin (.CNL)
❑ Parcel Boundary ,
M Eye, Earthstar Geographi ,CNE-S/Arhus D=,
DA,U RIDi IGN,and the GIS Use Co unity
NOTES:
1. Pre-existing well and tank locations were obtained from previous 60 30 0 60 120
reports prepared by other consultants and are approximate. Feet
2. CNL=Could Not Locate
PROJECT TITLE
ED'S VILLAGE FIGURE
ATLIN OPEN AIR MARKET
103 W JACKSON BLVD SITE MAP
CERWIN, NC 1
Engineers and Scientists
,NCiDFNT NO I JOB NO DATE SCALE DR4Wh BYICHECK ED BV
14709 220227 JAN 2022 AS SHOWN KMC/SJO