GW1-2022-08298_Well Construction - GW1_20220822

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
K�14ewATERZONE$' 'e'Sn. .
D.T. CHALMERS, JR. FROM TO I DESCRIPTION
Well Contractor Name re fL
4146A
NC Well Contractor Certification Numbers;rNivER GasING'oRST[rBfNG'othermalflosed-IT o0
FROM - TO I THICKNESS I MATERIAL. ..
CATLIN Engineers and Scientists 0 R -1 n. 1 Sch.40 1 PVC
Company Name itlb:{OUTER-CASING'fo'r multi=cased.wells ORiI;INERif.a licable
FROM I TO I DIAMETER THICKNESS I MATERIAL
2.Well Construction Permit#: N/A fL ft in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
fL fL in.
3.Well Use(check well use): W7:4sCREEN 01000111101111
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public -1 rt. 14 rt. 11 in. SIOt.010 Sch.40 PVC
i
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. 1, i in.
❑Industrial/Commercial ❑Residential Water Supply(shared) f s'fGROU t.4' .......... s�
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irri ation
ft rL
Non-Water Supply Well:
®Monitoring ❑Recovery ft fL
Injection Well: n. ft
❑Aquifer Recharge ❑Groundwater Remediation A19ASANDt/GitpVELTPa.CKri(a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stomlwater Drainage rL rL
❑Experimental Technology ❑Subsidence Control 0 rt. 16 rL Natural Backfill
r20:DRILli1NG�IpOG'attach.ddigfonal s-Th trif necessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO I DESCRIPTION color hardness soiVrock type,wain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 921 Remarks) ft ft.
4.Date Well(s)Completed: 08/09/22 Well ID#: TMW-01 rL rL
ft. ft 1
Sa.Well Location:
(✓ "
NCDEQ-SILVER LAKE RD. UST N/A ft All-
Facility/Owner Name Facility ID#(ifapplicable)
ft.5002 CAROLINA BEACH RD,WILMINGTON,NC 28412
ft. rL Win l r^:;26&,q Unii
Physical Address,City,and Zip
fill9 iEMARKS
NEW HANOVER 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)
34.14981 N -77.90341 W 8/10/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): O Permanent or M Temporary By signing thisforn,1 herehv certifi,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: .O 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
SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 14.0 (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@100) construction to the following:
10.Static water level below top of casing: (R,) Division of Water kesources,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 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: DPT 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 Svpuly&Infection Wells:
Also submit one copy of this form within 30 days of completion of we11
13b.Disinfection type: Amount: construction to the county t 4ealth 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

f ,
CATLIN
WELL LOG Engineers and Scientists
zzoz,a SHEET 1 OF 1
PROJECT NO.: 220214 STATE, NC COUNTY: NEW HANOVER LOCATION: WILMINGTON
PROJECT: LOGGED BY: C FUTRAL WELL ID:
SILVER LAKE RD. UST DRILLER: D.T. CHALMERS JR.
NORTHING: 147348 EASTING: 2331803 CREW: TMW-01
SYSTEM: NCSP NAD 83 USft BORING LOCATION: In Former UST Basin I T.O.C.ELEV.:
DRILL MACHINE: Power Probe METHOD: DPT 10 HOURIDTW: NM TOTAL DEPTH: 16.0
START DATE: 8/9/22 END DATE: 8/9/22 24 HOUR DTW: FIAD WELL DEPTH: 14.0
BLOW COUNT OVA o o SOIL AND ROCK WELL
DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPm) LAB. s G DEPTH DESCRIPTION DETAIL
-1.0
0.0 LAND SURFACE 0.0
0.0 (SWG)-Lt.gray,Sandy/Gravel mixture
1.0
(SP)-Brown grading to tan and gray,F.SAND
Direct SOIL:
Push NM TMW-01 D
(2-3')
4.0 4.0
(CH)-LT.gray with orange mottling,highly plastic CLAY
Dark gray from 7.0-7.5'BLS
Direct NM Sat. >
Push o a
oa
7.5
8 0 (SP)-Gray,F.SAND
Dark brown from 13.0-16.0'BLS
Direct NM W
Push
f -
12.0
Direct WATER: 114.0
Push NM TMW-01 Sat.
16.0 16.0 16.0
BORING TERMINATED AT DEPTH 16.0 ft in F.SAND
17
I
I
i
Native Backfill I