GW1-2022-01895_Well Construction - GW1_20220210

• WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
r
1.Well Contractor Information:
14.WA7ERZONES
Austin Fowler PROM TO DESCRIPTION
Well Contractor Name
4366A
NC Well Contractor Certification Number 15.INNER CASING OR 7LBING eotbetvtal closed loo
FROM TO DIAMETER TMCKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft. 3 fl. 2 in. Sch.40 1 PVC
Company Name 16.Ot17`ER CASING for multi-cased wells OR LINER if a icable
FROM TO I DIAMETER I THCKNESS MATERIAL
2.Well Construction Permit#: N/A ft. 1t. in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
fl. fl. in.
3.Well Use(check well use): 17 SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 3 ft. 13 ft. 2 in. Slot.010 Sch.40 PVC
❑Geothennal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. k. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TU Al:ATERIAI_ liVIPLACEMEV"r IVEI}IOUd AAfOGAT
❑Irri ation 0 ft. 0.5 11. Concrete Surface Pour
Non-Water Supply Well: -
0.5 ft. 2 ti. Bent. Pellets Surface Pour
0Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK ifs licable
f R,A1 TO MATERIAL_ EMPLACEMENFbtETNOD
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage 2ii. 13# h1edium Sand Torpedo Sa d
❑Experimental Technology ❑Subsidence Control ft. ft,
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM To I DESCRIPTION i, i hardness s ib-1,tcpe,gTain size etc
❑Geothermal(Heating/Coolin Return) ❑Other(explain under#21 Remarks) u. n.
4.Date Well(s)Completed: 12/16/21 Well ID#: MW-02 It.
IC. k. �O
5a.Well Location: �N
NCDEQ- Lumberton Mobile N/A �C
ti. P`Facility/Owner Name FaciGt} [D#(if applicable) _
ti.
Lumberton,NC 283360
Physical Address,City,and Zip -
21.REMARKS
ROBESON N/A
Count 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)
zGE%S
34.672033 N -79.008118 W 2/3/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): M Permanent or ❑Temporary By signing thisform,I hereby certify that the well(s)was(were)mnstnicied in accordance with
1 SA Ak AC 02C.0100 or 1 JA NC AC OX.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 tinder#21 remarks section or on the back ofthisform. 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 eonstrucdon,you SLBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 13.0 (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 W00'and 2@1009 construction to the following:
10.Static water level below top of casing: 7.4 (B,) 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 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 SvpDly&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 Engineers and Scientists
22ozs� SHEET 1 OF 1
PROJECT NO.: 220237 STATE: NC COUNTY: ROBESON LOCATION: Lumberton
PROJECT: Lumberton Mobile LOGGED BY: O DAYNES WELL ID:
DRILLER: A FOWLER MW-02
NORTHING: 335572 1 EASTING: 1997559 CREW: CATLIN
SYSTEM: NCSP NAD 83 USft BORING LOCATION: On north portion of building near LISTs T.O.C.ELEV.: NM
DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HOUR DTW: 7.4 TOTAL DEPTH: 13.0
START DATE: 12/16/21 END DATE: 12/16/21 124 HOUR DTW: NM WELL DEPTH: 13.0
BLOW COUNT OVA o o SOIL AND ROCK WELL
DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPM) LAB. S, G DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
0.0 a
d.•.;�. CONCRETE 0.5
0.7
;. 0.7
U
(SP-SM)-Brown F.to Med.SAND w/SILT a
s
s s 0.0 D 2.0
8 y
iv
3.0
5.0
5.5
2 (SC)-Gray CLAYEY SAND w/F.SAND Interlayers
s 0.1 M
s
pUf _
o
8.0 ...,
(SM)-Brown SILTY SAND t
iv u
• i
10.0
10.5
3 3 11.0 (SP)-Gray F.SAND
to 16 1.1 Sat. 11.4 w/CLAYEY SAND
13.0 113.0 13.0 13.0
BORING TERMINATED AT DEPTH 13.0 ft in f. SAND
w/clay
Coarse Gravel Bentonite Pellets #2 Medium Sand
Pack El

N
0
FORMER
UST BAST ®B-3
Ir-
MW-02 •
* i
GASOLINE
DISPENSER
M
LEGEND
® Monitoring Well • 1i
(Type II)
Abandoned ,
® Monitoring Well
(Type II)
0 Piezometer
Q Parcel Boundary
Approximate Location
of UST System
U e •GRdD. IGN,and the GISYUsSer Com it
NOTE:Well locations were obtained from previous reports by
other consultants and are approximate. 30 15 0 30 60
Feet
PROJECT TITLE FIGURE
LUMBERTON MOBILE
CATLIN 5105 N FAYETTEVILLE RD SITE MAP
LUMBERTON, NC 1
Engineers and Scientists
INCIDENT N0. JOB N0. DATE SCALE DRAWN BY/CHECKED BV
20262 220237 JAN 2022 AS SHOWN KMC/BJA