GW1-2022-07230_Well Construction - GW1_20220805

WELL CONSTRUCTION RECORD For Internal Use ONLY.
This form can be used for single or multiple wells
1.Well Contractor Information:
14.WATERZONES
Austin Fowler FROM TO DESCRIPTION
Well Contractor Name tL ft.
4366A a ft
NC Well Contractor Certification Number 15.INNER CASING OR TUBING aeothermal closed-too
FROM TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft.1 5 rt. i 1 i..J Sch.40 1 PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER(if a licable
FROM TO DIAMETER THICKNESS MATERIAL
2.Weil Construction Permit#: N/A ft. ft. in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
FL fL in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAn IETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 ft 15.5 ft. 1.21 in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. I I in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROAT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNr
❑Irri ation
rt. ft.
Non-Water Supply Well:
®Monitoring ❑Recovery 2 B. 3 ft.
Injection Well: fL ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVELPACK ifa ►icable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stomlwater Drainage 3 ft. 16# Medium Sand Torpedo Sa d3urface Pour
❑Experimental Technology ❑Subsidence Control ft fL
20.DRILLING LOG attach additional sheets it necessary
❑Geothermal(Closed Loop) El Tracer FROM TO DESCRIPTION color,hardness soil/rock type,amain siu etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) fL It.
4.Date Well(s)Completed: 04/26/22 Wel1ID#: 1601-B-TW02 Ft ft.
fL rL S �O
5a.Well Location: �N
ft f4
MEADOWS NA ft.
Facility/Owner Name Facility ID#(if applicable)
fL
CAMP LEGEUNE,NC rL tt. AUGu
Physical Address,City,and Zip
ZLIZZ
21.REMARKS
ONSLOW NA 1(A0falia%i0n rtacs®"UIM
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)
34.667139 N -77.338059 W (l ► 1 7/22/2022
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 ivell(s)was(were)consnvcted in accordance with
W N;AC 02C.0100 or 15A NCIC 02C.0200 Well Constniction 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/mown well construction information and explain the nature of
the repair under#21 remarks section or on the back of this•for•nn. 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 scone construction,you
can submit one form. SUBMITTAL INSTRUCTIONS
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9.Total well depth below land surface: 15.5 (g,) 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@1009 construction t0 the following:
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10.Static water level below top of casing: (B,) Division of Water Resources,Information Processing Unit,
Ifwaler level is above casing use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 2.25 (in,) 24b.For Iniection Wells ONLY: In addition to sending the form to the
address in 24a above,also stibmit a copy of this form within 30 days of
12.Well construction method: DPT completion of well construction to the following:
(i.e.auger,rolaty,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
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13a.Yield(gpm) Method of test: 24c.For Water SvaDly&Iniection Wells:
Also submit one cop),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-I North Carolina Department of Environment and Natural Resources-Division of Water Rei ources Revised 2-22-2016

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CATLIN
Engineers and Scientists
WELL LOG 2,ieo2..o2 SHEET 1 OF 1
PROJECT NO.: 218027.02 STATE: NC COUNTY: ONSLOW LOCATION: CAMP LEJEUNE
PROJECT: LOGGED BY: G I T. Moore WELL ID:
ROL LEAGACY SITE BB71 and 1601
DRILLER: Austin Fowler 1601-B-TW02
NORTHING: 337973 EASTING: . 2499700 CREW: CATLI N
SYSTEM: NCSP NAD 83 USft BORING LOCATION: T.O.C.ELEV.:
DRILL MACHINE: GeoProbe METHOD: DPT 0 HOUR DTW: NM TOTAL DEPTH: 16.0
START DATE: 4/26/22 END DATE: 4/26/22 124 HOUR DTW: N M WELL DEPTH: 15.5
DEPTH BLOW COUNT OVA LAB o o SOIL AND.ROCK WELL
0.5ft 0.5ft D.5ft 0.5ft (PPM) S c DEPTH DESCRIPTION ! DETAIL
0.0 LAND SURFACE I 0.0
0.0 (GWW)-Grass and Gravel 0.0
(SC)-Tan to brown,Clayey SAND
Direct N M D >a
Push
v
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3.0
4.0
I
I
5.0
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Direct
Push NM D
8.0
8.0
(SW)-Tan,SAND
9.2
9.6 (SC)-Gray,Clayey SAND 00
Direct Push NM Sat. 4 't (SW)-Gray,SAND .60
o a
v
I` NUS
12.0 12.0
(SC)-Gray,Clayey SAND
C. Direct Push NM Sat.
16.0 1s.o . . 16.0
BORING TERMINATED AT DEPTH 16.0 ft in Clayey
SAND
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Bentonite Pellets #2 Medium Sand
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