GW1-2022-03541_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:
A41WATER`ZONES'.
Austin Fowler FROM To DESCRIPTION
Well Contractor Name ft ft.
R
4366A fL ft
- - - -
NCWellContractorCertificationNumber 5o1NNER`CI ToNGOR,T[JBIND'�eETE mal:closednoo
THICKNESS I MATERIAL
CATLIN Engineers and Scientists 0 ft 10 ft 2 in. Sch.40 PVC
1S 6$ODTEk C—A—S]NGr(for mulii-cas¢"ed.wdl l ORILDiEW if a ic—.bl
Company Name FROM TO DIAMETER THICKNESS I MATERIAL
2.Well Construction Permit#: N/A ft. a in.
List all applicable well permits(i.e.County State, Variance,Injection,etc.)
ft fL in.
3.Well Use(check well use):
:17:iSGREEN
Water Supply Well: FROM TO I DIAMETER I SLOTS12E I THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 10 ft. 20 ft-1 2 in. Slot.010 Sch.40 PVC
ElGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft It. in.
❑Industrial/Commercial ❑Residential Water Supply(shared)
'19JGROUT
FROM TO I MATERIAL Eha'LACEMENT METHOD&AMOUNT
❑Irrigation
ft ft
Non-Water Supply Well:
4 ft 8 ft Bent.Pellets Surface Pour
®Monitoring ❑Recovery
Injection Well: n. ft
❑Aquifer Recharge ❑Groundwater Remediation 4191Si /GR WTYPACKJ f a icable
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stomtwater Drainage 8 ft 20 Medium Sand Torpedo Said
❑Experimental Technology ❑Subsidence Control n. ft
3'U'1)RILI t1VGSI OG attaehrddilionai shy f necessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness,
ardness soil/rock type,main size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) fL ft
4.Date Well ft ft
s)Completed: 03/11/22 Well MW-02 �O
ft ft Ct�
5a.Well Location:
rt. ft.,
NCDEQ-Linda Blalock
ft
Facility/Owner Name Facility ID#(if applicable)
ft
1200 N.BROAD ST,FUQUAY-VARINA,NC 27526
ft ft
Physical Address,City,and Zip
11.REMkRKS-JWi
WAKE
County Parcel Identification No.(PiN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: I
(if well field,one lat/long is sufficient) `
35.599616 N -78.800936 W I 3/21/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): M Permanent or ❑Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
l9A 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: 0 Yes or ®No this record has been provided to the well owner.
Irthis 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
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@I009 construction to the following`.
10.Static water level below top of casing: 14.85 (B,) Division of Water Resources,Information Processing Unit,
If water level is above casing use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
It.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 Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
k '
13a.Yield(gpm) Method of test: 24c.For Water Svaaly&I nfection 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
k
WELL LOG CATLIN
Engineers and Scientists
22,1ss 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-02
NORTHING: 2059175 1 FASTING: 673219 CREW: Trevor Mizelle
SYSTEM: NCSP NAD 83 USft BORING LOCATION: East side of Building T.O.C.ELEV.: 100.00
DRILL MACHINE: CM 45B TRACK METHOD: HSA 0 HOUR DTW: 14.9 TOTAL DEPTH: 20.0
START DATE: 3/11/22 END DATE: 3/11/22 24 HOUR'DTW: NM WELL DEPTH: 20.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft o.5ft 0.5ft 0.5ft (PPM) S G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE; 100.0 0.0
ASPHALT 0.0 Ad
1.0 99.0 ?N
(SC)-Dark brown grading to It.brown,Clayey SAND Ad.
Slight Gay from 5.0-7.0'BLS
D.�
D.A.
A 4.0
U
5.0 5.0 1 95.0
(CL)-Reddish-brown,Sandy CLAY
3
° 6 0.0 D N
14
8.0
10.0 10.0 90.0 10.0
(SC)-Orange,Clayey SAND
12 14 11.0 89.0
17 17 0.1 M
(CL)-Reddish-orange,Sandy CLAY
Lt.orange from 13-15'BLS
o>
15.0 A 15.0 85.0
(SC)-Reddish-orange,Clayey SAND
4 13 13 0.4 W .. ..; 16.0 84.0 am
1s (SW)-White to gray,f.to cse.SAND
:•'i 17.0 83.0
(SC)-Reddish-orange grading to tan,Clayey SAND
i
20.0 20.0 ! 80.0 20.0 20.0
BORING TERMINATED AT ELEVATION 80.0 ft in
Sandy CLAY
�4
�q.r Concrete Em Bentonite Pellets ( #2 Medium Sand