GW1-2022-03462_Well Construction - GW1_20220324

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 DESCRIPTION
Well Contractor Name ft ft
4366A ft
NC Well Contractor Certification Number 15.INNER CASING OR TUBING eothermal closed-loo
FROM TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft.1 10 ft.1 1 in. Sch. 40 1 PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER if applicable
FROM TO DIAMETER I THICKNESS I MATERIAL
2.Well Construction Permit#: N/A
ft ft in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
ft ft in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
El Agricultural ❑Municipal/Public 10 ft 20 ft 1 in Slot.010 Sch. 40 PVC
❑Geothermal(Fleating/Cooling Supply) ❑Residential Water Supply(single) ft ft is
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
ft ft
Non-Water Supply Well:
®Monitoring ❑Recovery 6 ft 9 ft Bent. Pellets Surface Pour
Injection Well: ft ft
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 9 ft 20 orpedo Sand Torpedo San
❑Experimental Technology ❑Subsidence Control a' a
20.DRII,LING LOG attach additional sheets if necessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hmdness soil/rock type,pyain size etc.
❑Geothermal(Fleating/Cooling Return) ❑Other(explain under#21 Remarks) ft ft
4.Date Well(s)Completed: 03/08/22 Well ID#: TMW-01 ft ft -
ft ft �O
5a.Well Location:
N/A ft P►
NCDEQ-Archdale Produce
ft
Facility/Owner Name Facility ID#(if applicable)
ft
10425 S.Main St.,Archdale, NC 27263
ft ft
Physical Address,City,and Zip
21.REl\f ARKS
RANDOLPH N/A
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)
35.896141 N -79.940936 W 3/24/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ❑Permanent or ®Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: ❑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 under#21 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: 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same construction,you
can submit one form. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 20•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@200'and 2@I00) construction to the following:
10.Static water level below top of casing: 6.2 (ft.) Division of Water Resources,Information Processing Unit,
Ifwater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 4.25 (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 Svnnly&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

CATLIN
WELL LOG Engineers and Scientists
zzozss SHEET 1 OF 1
PROJECT NO.: 220288 STATE: NC COUNTY: RANDOLPH LOCATION: Archdale
PROJECT: Archdale Produce LOGGED BY: Sandy Miller WELL ID:
DRILLER: Austin Fowler TMW-01
NORTHING: 1721298 EASTING: 782413 CREW: Nate Newman
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Near SE property border T.O.C.ELEV.: 95.92
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: 6.2 TOTAL DEPTH: 20.0
START DATE: 3/8/22 END DATE: 3/8/22 24 HOUR DTW: N/A WELL DEPTH: 20.0
DEPTH BLOW COUNT OVA LAB 0 o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) s G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 95.9 0.0
Med.brown,TOPSOIL
0.0
,• + 4.0 91.9
4.0
(SC)-Orange to tan/brown Clayey CSE.SAND with
1 trace quartz o
10 0.3 M
13 U)
9.0 9.0
so/ 10.0 85.9 10.0
.4 0.1 M
,..- (SW)-White to tan grading to gray and brown,CSE.
SAND with mica and quartz
LL
14.0
o U
50/ o as
.4 0.2 M 1:' o 0
U)LL
19.0 19.0 76.9
so/ 1.1 M (CL)-Gray,Silty CLAY
20.0 20.0 75.9 20.0 20.0
at BORING TERMINATED AT ELEVATION 75.9 ft in Silty
cc CLAY
Bentonite Pellets El#2 Medium Sand

220 Old Dairy Road
CATLIN Wilmington, NC 28405
45
[phone]-5861
Engineers and Scientists
www.CatlinUSA.com
March 24, 2022
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
Archdale Produce
10425 S. Main St.
Archdale, North Carolina 27263
Incident No.: 18114
CATLIN Project No.: 220288
To Whom it May Concern,
CATLIN Engineers and Scientists (CATLIN) recently constructed three (3) monitoring
wells at the above referenced site. Attached to this letter are the completed North
Carolina Well Construction Records with associated Attachments for the site in
Archdale, North Carolina.
If you have any questions or require additional information, please feel free to contact
us at [phone].
Sincerely,
Benjamin J. Ashba P.G. Corey D. Futral, CWC
Project Manager Project Geologist
Enclosures
Well Construction Records, Well Logs, and Site Map
ENVIRONMENTAL CIVIL GEOTECHNICAL
Wilmington, NC I Raleigh, NC Washington, NC I Atlanta, GA I Charleston, SC