GW1-2022-08978_Well Construction - GW1_20220919

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
COREY D. FUTRAL 14.wATERZONES
FROM TO DESCRIPTION
Well Contractor Name ft ft.
4330-B ft. ft.
NC Well Contractor Certification Number 15.INNER CASING ORTUBING eothermal clased-loo
FROM- TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists ft. a in.
Company Name 16.OUTER CASING for multi-cased wells OR LINER if a licable
FROM TO 1.DIAMETER I THICKNESS MATERIAL
2.Well Construction Permit#: N/A ft.1 ft in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
_ ft R .- in.
3.Well Use(check well use): n.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE- THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 0 ft 22 ft. 1 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
Non-Water Supply Well: ft ft
®Monitoring ❑Recovery ft ft
Injection Well: ft ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL EMPLACEMENTMEIHOD
❑Aquifer Test ❑Stormwater Drainage (c ft
❑Experimental Technology. ❑Subsidence Control 0 rt 23 rt Natural Backfill'
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color.hardness soil/rock type,grain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft
4.Date Well(s)Completed: 9/7/2022 Well ID#: TMW-01 ft ft. -.
ft. ft. S�400 O
5a.Well Location: ��
NA ft f. �
N ft. G
CDEQ-LINDA BLALOCK
Facility/Owner Name Facility ID#(if applicable) a
2014:BROAD ST,DURHAM,DURHAM,NC 27705 '.
Physical Address,City,and Zip it rt _ i .
- 21.REMARKS ti
DURHAM NA
County Parcel Identification No.(PIN) RK
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: C �/
(if well field,one lat/long is sufficient)
36.027239 N -78.914554 W 9/1 212 0 22
Signature of Certified Well Contractor Date
6.Is(are)the well(s): 0 Permanent or O Temporary, By signing this form,I hereby certij,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.
Iflhis 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 thisform. D.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,your SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 22.0 (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'cmd 2@1009 construction to the following:
10.Static water level below top of casing: 21.5 (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: 2.25 (in.) 24b.For Iniection We 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 Se ice Center,Raleigh,NC 27699-1636
I3a.Yield'(gpm) Method of test: 24c.For Water Svoply&Iniection Wells:
Also submit one copy ofth'is form within 30 days of completion of well
construction to the county health department of the county where constructed.
13b.Disinfection type: Amount: ff
Adapted from Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

I
ENVIRONMENTAL,CIVIL
GEOTECHNICAL CATLIN.
IMtmmgton,Raleigh,Washington,
Charleston Engineers and Scientists
WELL LOG 22179 SHEET 1 OF 1
PROJECT NO.: 221179 STATE: NC COUNTY: DURHAM LOCATION: DURHAM
PROJECT: LOGGED BY: C. FUTRAL WELL ID:
BULL CITY OIL CO DRILLER: !E. SWAIN
NORTHING: 828825 1 EASTING: 2025266 CREW: TMVII-01
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Across Broad St.from site in ROW T.O.C.ELEV.: N M
DRILL MACHINE: Power Probe METHOD: DPT 1 0 HOUR DTW: 21.5 TOTAL DEPTH: 23.0
START DATE: 9/7/22 END DATE: 9/7/22 124 HOUR DTW: 21.5 WELL DEPTH: 22.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPm) S c DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
0.0 '—''.' 0.5 (ML)-.Brown,Silty TOPSOIL 0'�a -
Direct Push 0.4 D ( )-Brown to MLgray,SILT with tr.sand;lots of gravel _
throughout
2.0 -
Direct 0.5 D 3.0 -
Push (CH)-Gray to dark gray with red and purple mottling,
4.0 highly plastic CLAY. Very Hard
Direct Push 0 8 D
6.0
Direct 0 2 D 7.0
Push (ML)-Lt.gray to tan,Sandy SILT with tr.gravel
8.0
Direct 0 3 D
Push
10.0
oV _
oa
Direct 01 D 6.
Push _
n )
12.0
Direct Push 0 2 D111111 -
14.0 �a.o _
(CH)-Gray with orange mottling,highly plastic CLAY -
- — Direct Push 0.2 . D with fractured crystalline rock at depth
16.0
Direct 2 D 0.
Push -
18.0 -
Direct
Push 0.5 M
c. 20.0 - -
Direct NM M
Push 22.0
23.0 23.0 23.0
BORING TERMINATED AT DEPTH 23.0 ft in highly
plastic CLAY with fractured crystailin rock at depth
V PVC set to 22.0'BLS Sampled(TMW-01)and
Abandoned.
FNative Bac�ll
I