GW1-2021-02660_Well Construction - GW1_20210805

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WELL CONSTRUCTION RECORD For Internal Use Only:
1.Well Contractor Information:
D.T.Chalmers, Jr. 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
4146A ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased welts OR LINER if a licable
CATLINEngineers and Scientists FROM TO DIAMETER i THICKNESS MATERIAL
ft. ft, in.
Company Name
16.INNER CASING OR TUBING eothermal closed-too
2.Well Construction Permit#•NSA FROM TO DIAMETER 1 THICKNESS MATERIAL
List all applicable well construction permits(i.e. UIC,County,State,Variance,eic.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural FIMunicipal/Public 5 ft• 15 ft. 2 in. 0.10 PVC
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ft. ft. in.
Industrial/Commercial QlResidential Water Supply(shared) 18.GROUT
Irrl ation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 1 rt 4 ft BENT.PELLETS SURFACE POUR
z Monitoring DRecovery
Injection Well:
_ rt. rt.
Aquifer Recharge DGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
Aquifer Storage and Recovery DSalinity Barrier, FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test DStormwaterDrainage 4 ft 15 ft #2 MED. SAND SURFACE POUR
Experimental Technology DSubsidence Control ft. ft.
Geothermal(Closed Loop) DTracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soll/mck e, rain size,etc.
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) ft. ft, SEE ATTACHED
4.Date Well(s)Completed:6/29/2021 Well ID#M W-O2 ft. ft.
5a.Well Location:
MICHAEL GALLAGHER ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft.
9716 Sauls Rd, Raleigh, NC ft.
Physical Address,City,and Zip ft. ft. Nor,
Y.
WAKE 21.REMARKS It
County Parcel Identification No.(PIN)
fofr 73 ion ro
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
35.615345 N -78.636275 W %._ 7/26/2021
6.Is(are)the well(s) Permanent or QTemporary Signature of Certified Well Contractor Date
By signing this form,1 hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: Dyes or )No with 15A NCAC 02C.0100 or 15A NCAC WC.0200 Well Construction Standards and that a
lfthis is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under i`21 remarks section or on the back of this form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page toprovide additional well site details or well
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 15.0 (ft.
P ) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths li dii ferent(example-3@200'and 1@100') construction to the following:
10.Static water level below top of casing: (ft.) 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 (in.) 24b. For Infection Wells: in addition to sending the form to the address in 24a
4.25' H.S. AUGERS above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: 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
p
13a.Yield(gpm) Method of test: 24c. For Water Supply& Infection�Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county'health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

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CATLIN
Engineers and Scientists
WELL LOGzzlo5s SHEET 1 OF 1
PROJECT NO.: 221055 STATE: NC I COUNTY: WAKE LOCATION'. RALEIGH
PROJECT: MICHAEL GALLAGHER PROPERTY LOGGED BY: M. AUPPERLE WELL ID:
DRILLER: D.T. CHAMLERS IVIVV-02
NORTHING: 679083 1 EASTING: 2108103 CREW: CATLI N
SYSTEM: NCSP NAD 83 USft BORING LOCATION: BY DUMPSTER T.O.C.ELEV.:
DRILL MACHINE: CM 550 METHOD: 4.25" H.S.A. 0 HOUR DTW: N/A TOTAL DEPTH: 17.0
START DATE: 6/28/21 END DATE: 6/29/21 24 HOUR DTW: N/A WELL DEPTH: 15.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5tt 0.5tc 0.5n 0.5ft (PPM) s c DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
' 0.5_TOP_SO_IL 0.0
(CL-ML) RED-BROWN,SILTY CLAY
a
0
3.0------------------------- N
(CL)-RED-TAN,SANDY CLAY v
4.0
5.0 5.0
2
6
7
12
8.0
——————————————————————————
(SC)-BROWN,CLAYEY SAND
oa.
10.0 s Q
�t
4 vU
10 1600 M
s
2
13.0
-----------
(CL)-WHITE,SANDY CLAY
15.0 15.0 15.0
3
3
3
5
17
17.0 .0
BORING TERMINATED AT DEPTH 17.0 ft
1
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Bentonite Pellets E3#2 Medium Sand