GW1-2021-02662_Well Construction - GW1_20210805

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. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a licable
CATLIN Engineers and Scientists FROM TO DIAMETER I THICKNESS MATERIAL
ft. ft. in.
Company Name
A 16.INNER CASING OR TUBING eothermat closed-loop)
N
2.Well Construction Permit#:" "/- - FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well COnStr C11017 permits(i.e. U1C,County,State,Variance,etc) ft. ft. in.
3.Well Use(check well use): it. tt. I
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
_ Agricultural []Municipal/Public 5 ft- 15 1" 2 in. 0.10 PVC
Geothermal(Heating/Cooling Supply) [(Residential Water Supply(single) g, tt• in.
Industrial/Commercial DResidential Water Supply(shared) 18.GROUT
ItTI ation FROM TO MATERIAL; EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: tL 3 IL BENT.PELLETS SURFACE POUR
x Monitoring DRecovery ft. ft.
Injection Well:
rc. rc.
Aquifer Recharge DGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
Aquifer Storage and Recovery DSalinity Barrier FROM TO I MATERIAL I EMPLACEMENT METHOD
Aquifer Test ]StormwaterDrainage 3 rL 15 rL #2 MED.iSAND SURFACE POUR
Experimental Technology DSubsidence Control
Geothermal(Closed Loop) Tracer 20.DRILLING LOG attach additional sheets if necessary)
Geothermal(Heating/Cooling Return) 00ther(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soil/rock type,grain size,etc.
rc. rc. SEE ATTACHED
4.Date Well(s)Completed:6/29/2021 Well ID#MW-O3
ft. ft.
5a.Well Location:
MICHAEL GALLAGHER
Facility/Owner Name Facility ID#(if applicable) ft. ft.
9716 Sauls Rd, Raleigh, NC ft. ft.
Physical Address,City,and Zip ft. ft. A ovq
WAKE 21.REMARKS H
45rd­
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
35.615198 N -78.636249 W � � � 7/26/2021
6.Is(are)the well(s)oPermanent or DTemporary Signature of Certified Well Contractor Date
By signing this form,1 hereby certify that the wel/(.$)was(were)constructed in accordance
7.Is this a repair to an existing well: [DYes or )No with 15A NCAC 01C•.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
/f this 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 921 remarks section or on the hack 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 to provide additional well site details or well
construction,only 1 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 below land surface:depth 15.0 (ft.
P ) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@1005 construction to the following:
10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit,
1f water 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
1
13a.Yield(gpm) Method of test: 24c. For Water Supply& Injection`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

i .
CATLIN
WELL LOG Engineers and Scientists
221055 SHEET 1 OF 1
PROJECT NO.: 221055 STATE: NC I COUNTY: WAKE LOCATIOk RALEIGH
PROJECT: MICHAEL GALLAGHER PROPERTY LOGGED BY: M. AUPPERLE WELL ID:
DRILLER: D.T. CHAMLERS MVW_03
NORTHING: 679029 1 EASTING: 2108110 CREW: CATLIN
SYSTEM: NCSP NAD 83 USft BORING LOCATION: BACK CORNER OF BUILDING T.O.C.ELEV.:
DRILL MACHINE: CME 550 METHOD: 4.25" H.S.A. 0 HOUR DTW: N/A TOTAL DEPTH: 17.0
START DATE: 6/28/21 END DATE: 6/29/21 124 HOUR DTW: N/A WELL DEPTH: 15.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPm) S G DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
0.5_TOPSOIL 0.0
(SP-CL)-TAN,POORLY GRADED SAND TO TAN,
SANDY CLAY
U
a
0
e
3.0------------------------- 3.0
(SC)-ORANGE,CLAYEY SAND
5.0 s.o
3
3 1415
7
19
8.0____ _ _
-------------
(CL)-TAN,SANDY CLAY
of
oa
10.0 Q
�t
3 iv U
z M
2
5
13.0 _____
———————
(SP)-WHITE,POORLY GRADED SAND
15.0 16.0
15.0
2
4
6
6
17.0.0
BORING TERMINATED AT DEPTH 17.0 ft
i
Bentonite Pellets El#2 Medium Sand

7
�- lmi Old Dairy Road
CATLINWilmington, NC 28405
Engineers and Scientists [phone]
www.CatlinUSA.com
July 29, 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 Construction and/or Abandonment Record(s)
Michael Gallagher Property
9716 Sauls Road
Raleigh, Wake County, NC
CATLIN Project No.: 221055
To Whom it May Concern,
CATLIN Engineers and Scientists (CATLIN) recently constructed two (2) 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,
-,4� 0AXP
Sean O'Neil, PE
Project Manager
Enclosures
CATLIN Letterhead_ILM
ENVIRONMENTAL CIVIL GEOTECHNICAL
Wilmington, NC I Raleigh, NC I Washington, NCI Atlanta, GA I Charleston, SC