GW1-2022-09620_Well Construction - GW1_20221021

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 DESCRIPTION
Well Contractor Name n. ft.
4146A ft. ft.
NC Well Contractor Certification Number 15.INNER CASING OR TUBING eothermal closed moo
FROM TO DI,,VTFR THICKNESS MATERIAL
CATLIN Engineers and Scientists Ord 10-.1 2 in. Sch.40 1 PVC
Company Name 16.OUTER CASING for multi-cased wdls OR LINER(ifaPplicabIQ
FROM TO DIAMETER TfUCKNESS MATERIAL
2.Well Construction Permit#: N/A rt ft in
List all applicable well permits(t.e.County,State, Variance,Injection,etc.)
ft. ft. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE INICKNESS MATERIAL
❑Agricultural ❑Mmicipal/Public 10 ft. 25 ft. 2 in. Slot.010 Sch. 40 PVC
rm❑Geotheal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL ENPLACEMENT I IETHOD&ANIOUNT
❑Irrigation 0 ft. 1 ft. Concrete Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 1 ft. 9 ft. Bent.Pellets Surface Pour
Injection Well: rt. rt.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRA%'ELPACK ifa icable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM -f0 MATERIAL ENJPL.4CEME\'I'METHOD
❑Aquifer Test ❑StormwaterDrainage 9 ft. 25 rt. #2 Medium Sand Surface Pour
❑Experimental Technology ❑Subsidence Control ft. R.
20.DRILLING LOG attach additional sheets if necessa
❑Geothermal(Closed Loop) ❑Tracer FROM To DESCRIPTION color hardness,soUrock type,juam size etc
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. n.
4.Date Well(s)Completed: 09/27/22 Well ID#: MW-9 it. ft. �_e
n. ft. s eO
5a.Well Location: GN
NCDOT-MARS HILL MAINT. FACILITY 0-034535 ft ft. �►
Facility/Owner Name Facility ID#(if applicable) It. r-- %
536 ROY EDWARDS LANE,MARS HILL,28754
Physical Address,City,and Zip
21.REMARKS
MADISON N/A • Lh*
,f►;i�a Pr^c
County Parcel Identification No.(PIN) r'
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one lat/long is sufficient)
35.827293 N -82.536451 W 10/7/2022
Signature ofCemtified Well Contractor Date
6. IS(are)the w'ell(s): O Permanent or ❑Temporary By signing this form,I hereby certify that the well(s)was(were)constn+cled in accordance with
l9A N(AC 01C.0100 or]5A AYitC 02C.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 owner.
If this is a repair,fill out known well construction information and explain the nature of
the repair under 421 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 iryeciton or non-water supply wells ONLY with the same construcdon,you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 25.0 (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@1009 construction to the following:
10.Static water level below top of casing: 12.21 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use" " 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8.25 (in.) 24b.For Iniection 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
13a.Yield(gpm) Method of test: 24c.For Water SvDDIv&Iniection 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-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

ENVIRONMENTAL,CIVIL CATLIN
GEOTECHNICAL
Winwgm,Raleigh,Washngtw.
Chariest- Engineers and Scientists
WELL LOG 221223 SHEET 1 OF 1
PROJECT NO.: 221223 1 STATE: NC I COUNTY: MADISON LOCATION: MARS HILL
PROJECT: NCDOT MARS HILL MAINTENANCE LOGGEDBY: T. PARK WELL ID:
FACILITY DRILLER: D.T. CHALMERS JR. MW-9
NORTHING: 7747151 EASTING: 951910 CREW: N. NEWMAN
SYSTEM: NCSP NAD 83 USft BORING LOCATION: SW Property Corner T.O.C.ELEV.: 98.55
DRILL MACHINE: Diedrich D-50 METHOD: HSA 10 HOUR DTW: 12.2 TOTAL DEPTH: 25.0
START DATE: 9/27/22 END DATE: 9/27/22 124 HOUR DTW: N M WELL DEPTH: 25.0
DEPTH BLOW COUNT OVA LAB o a SOIL AND ROCK WELL
0.5ft o.5rt 0.5tt 0.5n (PPM) S c DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 98.6 0.0
0.0 6 (ML)-Brown,SILT with rock and tr.Gay 0.0
11 8 NM D - 1.0
6
4.0 94.6
(ML)-Brown,Clayey SILT with IT.rocks o
5.0 t
2 2 2 NM W N
fV
2
9.0
10.0 10.0
7
4 3 NM D
5
13.0 85.6
(ML)-Brown SILT
Sandy San
15.0
2
2 5 NM Sat.
5
o�
oa
111 0
18.0 80.6 nL
(SM)-Brown with black streaks,Silty SAND N N
20.0
3
5 6 N M Sat. .:
25.0 25.0 73.6 26.0 25.0
BORING TERMINATED AT ELEVATION 73.6 ft in Silty
SAND
Portland Cement Bentonite Pellets E]#2 Medium Sand