GW1-2022-08384_Well Construction - GW1_20220519

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
14.WATER ZONES
D.T. CHALMERS, JR. FROM To I DESCRIPTION
Well Contractor Name ft. ft.
4146A fL fL
NC Well Contractor Certification Number 15.INNER CASING OR TUBING eothermal closed-loop
t
FROM TO DIAMETER THICKNESS I MATERIAL
CATLIN Engineers and Scientists 0 ft.1 5 fL 1 in.1 Sch.40 1 PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER if a licable
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: N/A fL rL in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
f4 fL in.
3.Well Use(check well use): n.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public 5 ft. 15 a. 1 in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
rL
Non-Water Supply Well: o•
®Monitoring ❑Recovery fL ft.
Injection Well: fL ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(ifap hcable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To I MATERIAL EMPLACEMENT METHOD
fL fL
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 0 ft. 16 Natural Bac ft.
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO I DESCRIPTION color,hardness.soil/rock wpe in size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) fL ft.
4.Date Well(s)Completed: 04/28/22 Well ID#: TMW-02 fL rL ,���
rL rL � .0 Ir
5a.Well Location: �N
ft. fL
NCDEQ-Bowden Grocery and Grill 0-017636
rL
Facility/Owner Name Facility ID#(if applicable) i
fL
6879 US HWY 401 SOUTH,BUNNLEVEL,NC 28323
fL
Physical Address,City,and Zip fL
21.REMARKS a
HARNETT NA
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) o•, ^z>•'i.�Ja'
35.307353 N -78.781469 W 5/13/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ❑Permanent or M Temporary By signing this form,I hereby certifi,that the well(s)was(were)constructed in accordance with
iSA NCAC.'02C•.0100 or 15A NCAC NC.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 maner.
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 ofthis•form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional Nvell 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: 15.0 (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@100) construction to the following:
10.Static water level below top of casing: 4.1 (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: Direct Push 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 Svpply&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
zz0zzs SHEET 1 OF 1
PROJECT NO.: 220226 STATE: NC couNTY: HARNETT LOCATION: BUNNLEVEL
PROJECT: gOWDEN GROCERY AND GRILL LOGGED BY: T. PARKS WELL ID:
DRILLER: D.T. CHALMERS JR. TMW-02
NORTHING: 566859 1 EASTING: 2065196 CREW:
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Between Orphan LISTs T.O.C.ELEV.: 98.34
DRILL MACHINE: Power Probe METHOD: Direct Push 0 HOUR DTW: 4.1 TOTAL DEPTH: 16.0
START DATE: 4/28/22 END DATE: 4/28/22 124 HOUR DTW: N M WELL DEPTH: 15.0
DEPTH BLOW COUNT OVA LAB o a SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPm) S c DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 98.3 0.0
0.0 (G"-Tan,Sandy GRAVEL 0.0 _
o�
O
1.5 96.8
Direct Push NM TMW-02 M (SC)-Brown,Clayey SAND a _
(2 3) 2.5 95.8 c -
(CL)-Tan grading to gray,Sandy CLAY N
4.0 - -
5.0 -
Direct N -
Push M M
8.0
of
Direct N M Sat. 10.0 88.3 0
Push (SC)-Tan to gray,Clayey SAND
�y
12.0 12.0 86.3 -
(SP)-Gray,SAND -
Direct NM Sat.
Push
I
15.0
16.0 16.0 82.3 16.0
BORING TERMINATED AT ELEVATION 82.3 ft in
SAND
E—INative Backfill