GW1-2022-03539_Well Construction - GW1_20220324

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4
WELL CONSTRUCTION RECORD For Internal Use ONLY 1
This form can be used for single or multiple wells
1.Well Contractor Information:
Austin Fowler FROM To DESCRIPTION
Well Contractor Name ft. fL
I ,
4366A "' ft' I i
.._ .,... - --- - -�,.-....-..,-�.r a.-.,r..
NC Well Contractor Certification Number ?15.INN CASING ORTUBIIVG eothermal,dosed loo H:..
FROM TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft. 10 ft I '2 i..J Sch.40 1 PVC
Company Name H6{OiITERCA$INGrformul`ti-ce dwellsDR�I7�iERrfe irwalmawArm
FROM TO DIAMETER I THICKNESS I MATERIAL
2.Well Construction Permit#: NSA fL ft. in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
ft. ft. in.
3.Well Use(check well use): 10ASCREEN
Water Supply Well: FROM I To DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 10 rt• 20 R. 2 in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) f. IL in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 191'MaWOUTi
FROM TO MATERIAL En-IPLACEMENTMETHOD&AMOUNT
❑Irrigation
ft. rL
Non-Water Supply Well:
3 ft. 8 ft. Bent.Pellets Surface Pour
®Monitoring ❑Recovery
Injection Well: ft. rL
❑Aquifer Recharge ❑Groundwater Remediation tr9TS;M/GRAVEUfPAGttifa V.E.bi
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT NILIHOD
❑Aquifer Test ❑Stormwater Drainage 8 ft. 20 d Medium Sand Torpedo Sa d
❑Experimental Technology ❑Subsidence Control ft. ft.
=';0 I)RiL•LrING'L'OG'attach•�add`ifional'she`ets if•necessa`°- :
❑Geothermal(Closed Loop) ❑Tracer FROM TO I DESCRIPTION color,hardness soillrock type,wain size eta
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft ft.
4.Date Well(s)Completed: 03111/22 Well ID#: MW-04 IL ft
& IQ
j S ft. tL
Sa.Well Location:
rL NCDEQ-Linda Blalock
R
Facility/Owner Name Facility ID#(if applicable)
tL
1200 N.BROAD ST,FUQUAY-VARINA,NC 27526
IL fL
Physical Address,City,and Zip
Ai.RE111i1RICS'. rb' t''e+: `..': - . :a..•t+�t,fw"• P _.T
WAKE
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) f U
RM
PAD
35.59981 N -78.80117 W ! 022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): M Permanent or O Temporary By signing this form,I hereby certih,that the well(s)was(were)constricted in accordance with
]SA NCAC 02C.0100 or 15A NC.'AC 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.
Ifthis is a repair fill out known well construction information and explain the nature of
the repair under 921 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 SUBMITTAL INSTRUCTIONS
can.submit one form.
9.Total well depth below land surface: 20.0 (ft.) 24a.For All Wells: Submit this fonn within 30 days of completion of well
For multiple wells list all depths in different(example-3 a200'and 2@100) construction to the following:
10.Static water level below top of casing: 14.40 (R,) Division of water Resources,Information Processing Unit,
Ifwater 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 Resource's,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 Svnaly&In ielction 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

i CATLIN
Engineers and Scientists
WELL LOG 2t I SHEET 1 OF 1
PROJECT NO.: 221196 STATE: NC COUNTY: WAKE LOCATION: FUQUAY-VARINA
PROJECT: HARRINGTON PROPERTY LOGGED BY: Nate Newman WELL ID:
DRILLER: Austin Fowler MW-04
NORTHING: 2059106 1 EASTING: 673290 CREW: Trevor Mizelle
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Near former Gasoline UST and Fuel!,Oil UST T.O.C.ELEV.: 100.44
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: 14.4 TOTAL DEPTH: 20.0
START DATE: 3/11/22 END DATE: 3/11/22 124 HOURIDTW: NM WELL DEPTH: 20.0
BLOW COUNT OVA M L SOIL AND ROCK WELL
DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPM) LAB. Is DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE;' 100.4 0.0
ASPHALT underlain by ABC Stone 0.0 Aa
1.0 99.4 'd•
(CL)-Tan to brown,grading to reddish-brown and It. A
tan,Sandy CLAY
No sand from 11.0-11.5'BLS '3
A�
3.0
U
a
0
5.0 t
3
7 s 0.7 D N
10
8.0
10.0 10.0
t1
12 11 ,3 22.1 (1�0-12j M 11.5 C ess
(SP)-Red to It,brown,SAND
�> -
15.0 15.0 85.4 s
(CL)-Lt.brown to gray,Sandy CLAY ' :.•
s 13 1t 2.2 W 16.0 84.4 N
13 (SC)-Lt.gray,Clayey SAND
17.0 83.4
20.0 20.0
20.0 BORING TERMINATED AT ELEVATION 80.4 ft in
Sandy CLAY
i
nq; Concrete Bentonite Pellets 0#2 Medium Sand
i

N
f
ORMER
i� MW-04 FUEL OIL
U -T
�' FORMER
GASOLIN
FORMER
DISPEN ER
® MW-1
M®3 FORMER i 1
1,000-GAL. '�r
UST MW-02
LEGEND
® Active Monitoring
Well (Type II)
❑ Approximate Location
of UST System
❑ Parcel Boundary Source: Esri, Maxar,GeoEye, Earthsta Geographics,CNES/Airb s DS,
USDA, USGS,AeroGRID, IGN, and the IS User Community
NOTE: Well locations were obtained from previous reports
prepared by other consultants and are approximate. 20 10 0 20 40
Feet
PROJECT TITLE FIGURE
HARRINGTON PROPERTY
ATLIN 1200 BROAD STREET SITE MAP
CFUQUAY-VARINA, NC 1
Engineers and Scientists
MCIDENT NO I JOB N0. DATE SCALE DRAWN BY/CHECKED BV
26183 221196 MAR 2022 AS SHOWN KMU/SJO