GW1-2021-02646_Well Construction - GW1_20210811

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
14.WATER ZONES
D.T. CHALMERS FROM TO DESCRIPTION
Well Contractor Name 1 rt. ft
4146A 1 �\rq
P�C. �GeJ � n. a
NC Well Contractor Certification Number ��b� �JeGto 1FS.DINER CASIorviNG OR TUBINDGA it ER al dose ICIQJESS MATERIAL
CATLIN Engineers and Scientists �n���C� Q 0 ft. 12 rL 2 iri.1 SGh.40 1 PVC
Company Name 16.OUTERCASING formulti-cased wells ORLINER ifa licable
FROM TO DIAMETER I MCKWESS I MATERIAL
2.Well Construction Permit#: N/A rt. rL in.
List all applicable well permits(i.e.CounNy State, Variance,infection,etc.)
rt ft
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM I To I DIAMETER I SLOT SIZE I TMCIWESS I MATERIAL
❑Agricultural ❑Municipal/Public 12 n. 27 ft.1 2 in. SIDt.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
rt. ft
Non-Water Supply Well:
®Monitoring ❑Recovery 0.5 rt. 10 ft.
Injection Well: ft. 2
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENTMETHOD
❑Aquifer Test ❑StormwaterDrainage 10 It. 270. #2 Medium Sand #2 Medium Sand
❑Experimental Technology ❑Subsidence Control ft. ft
20.DRILLING LOG-attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM To DESCRIPTION color,hardness soil/rock a in size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft
4.Date Well(s)Completed: 07/12/21 Well ID#: MW-02 ft. ft
ft. ft. �O
5a.Well Location: �N
rt. ft P
NCDEQ
n.
Facility/Omroner Name Facility ID#(if applicable)
ft.
12127 Hoy 42 W,FuguaV-Varina,NC
ft. ft
Physical Address,Citv,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)
35.5626562866 N -78.8716388423 W 7/30/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or ❑Temporary Br signing this form,1 hereby certify that the we//(s)wav(Here)constructed in accordance with
I5A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Convinrclion Standordv and that a copy of
7.Is this a repair to an existing well: ❑Yes or W No this record has been provided to the well owner.
f%this is a repair/ill out known well construction in%rmahon and explain the nature o/'
the repair under 421 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 mulliple 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: 27 (ft,) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths in d fferent(example-3@200'cmd 2@100) construction t0 the following:
10.Static water level below top of casing: (ft,) Division of Water Resources,Information Processing Unit,
Ifwater lciel 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: 4.25' H.S.Auger 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
1
13a.Yield(gpm) Method of test: 24c.For Water SvDDIv&Injection 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

WELL LOG CATLIN
Engineers and Scientists
zzo22s SHEET 2 OF 2
PROJECT NO.: 220229 STATE: NC COUNTY: HARNETT LOCATION: Fu ua -Varina
PROJECT: Hobby Store LOGGED BY: M. Aupperle WELL ID:
DRILLER: D.T. CHALMERS MVW-02
NORTHING: 659732 1 EASTING: 2038175 CREW: O. DAYNES
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Southeast corner of buill ing off NC-42 T.O.C.ELEV.:
DRILL MACHINE: CME-550 METHOD: 4.25' H.S. Auger 0 HOUR DTW: N/A TOTAL DEPTH: 27.0
START DATE: 7/12/21 END DATE: 7/12/21 124 HOUR DTW: N/A WELL DEPTH: 27.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
o.sft o.sft o.sft o.sft (PPM) s c DEPTH DESCRIPTION DETAIL
(CL)-Gray,LEAN CLAY(continued)
24.0
(SC)-Red,clayey,f.SAND
2s.o
(SM)-White,silty,f.SAND
27.0 r 27.0 27.0 27.0
BORING TERMINATED AT DEPTH 27.0 ft
Bentonite Pellets El#2 Medium Sand
I

1044 Washington Street
Raleigh, North Carolina 27605
CAT N Telephone:[phone]
Engineers and Scientists
www.catlinusa.com
August 10, 2021
North Carolina Department of Environmental Quality
Division of Water Quality
Information Processing
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: North Carolina Well Construction Record and Boring Log
Hobby Store
12127 Hwy 42 W., Fuquay-Varina, NC 27526
Incident Number: 42046
CATLIN Project No.: 220229
To Whom it May Concern,
CATLIN Engineers and Scientists (CATLIN) recently constructed three (3) monitoring
wells at the above referenced site. The completed North Carolina Well Construction
Records and Boring Logs are attached.
If you have any questions or require additional information, please feel free to contact
us at [phone].
Sincerely,
Sean J. O'Neil, P.E.
Project Manager
Enclosures
Boring Logs and Well Construction Records

' CATLIN
Engineers and Scientists
WELL LOG 220z29 SHEET 1 OF 2
PROJECT NO.: 220229 STATE: NC COUNTY: HARNETT LOCATION: Fu ua -Varina
PROJECT: Hobby Store LOGGED BY: M. Aupperle WELL ID:
DRILLER: D.T. CHALMERS MW-02
NORTHING: 659732 1 EASTING: 2038175 CREW: O. DAYNES
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Southeast corner of buill ing off NC-42 T.O.C.ELEV.:
DRILL MACHINE: CME-550 METHOD: 4.25' H.S. Auger 0 HOUR DTW: N/A TOTAL DEPTH: 27.0
START DATE: 7/12/21 END DATE: 7/12/21 124 HOUR DTW: N/A WELL DEPTH: 27.0
BLOW COUNT OVA o a SOIL AND ROCK WELL
DEPTH 0.5ft 0.5ft 0.5ft 0.5a (PPM) LAB. S G DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
0.4 asphalt 0.0
(SP)-brown to tan-red,POORLY GRADED SAND
4.0
(SC)-Red-white,clayey,f.SAND
5.0
5 a
0
11 14 17.2 1345
v
17 u
(V
8.0
(SC-CL)-Tan,clayey,f.SAND,with interbedded layers
of red,sandy LEAN CLAY
10.0 10.0
4
7 15 48 1400
12
12.0 12.0
----------
(SC)-Red-brown,clayey,f.SAND
15.0
e
6 W
17
16
oU
oa
oQ
20.0 20.0 •::.
(CL)-Gray,LEAN CLAY
s
8
5
6
Bentonite Pellets El#2 Medium Sand