GW1-2022-09621_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
4146A
NC Well Contractor Certification Number 15.INNER CASING OR TUBING eothermal closed-loo
FROM TO DIAMETER 1T 11('KNESS M11ATF321AL
CATLIN Engineers and Scientists 0 rt. 10 ft. 2 in.I Sch.40 1 PVC
Compan}Name 16.OUTER CASING for multi-cased wells OR LINER if a icable
FROM TO I DIAMETER I THICKNESS M1IATERIAL
2.Well Construction Permit#: N/A e. o. in.
List all applicable well permits(i.e.County,Stare, Variance,Injection,etc.)
ft. ft. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM To I DIAMETER I SLOTSIZE I TMCKNESs I MATERIAL
❑Agricultural ❑Municipal/Public 10 it. 25 ft. 2 i.. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. rt. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) Is.(;Rol T
FNu�I W M1IATLRIAL ENIPLACEMENTMEMOD&Ah10LNT
❑Irrigation 0 ft. 1 ft Concrete Surface Pour
Non-Water Supply Well:
1 rt. 9 rt. Bent.Pellets Surface POUF
®Monitoring [I Recovery
Injection Well: ft. ft
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK it a icable
❑Aquifer Storage and Recovery ❑Salinity Barrier FRONT TO MATERIAL EM1IPLACEMEMn�.'rt-toD
❑Aquifer Test ❑StormwaterDrainage 9ft- 25 ft] #2 Medium Sand Surface Pour
❑Experimental Technology ❑Subsidence Control ft ft.
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness.soil/rock tvpe,mm s- ct,i
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) a. n.
4.Date Wells)Completed: 09/27/22 Well ID#: MW-8 n. u. `..le!� O
Sa.Well Location:
NCDOT-MARS HILL MAINT.FACILITY 0-034535
rt.
Facility/Owner Name Facility ID#(if applicable)
536 ROY EDWARDS LANE,MARS HILL,28754
a. n.
Physical Address,City,and Zip
21.REMARKS
MADISON N/A - ti a i3n Prx I"
County Parcel Identification No.(PIN) r
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 (ertification:
(if well field,one lat/long is sufficient)
35.827629 N -82.536402 W cj 10/7/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or 0Temporary
Br signing this farm,!hereby certiji,shut the we11/s)was(were)constructed in accordance with
1SA NCAC 02C.0100 or 15A ArC AC 02C.0100 Weff 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-2/remarks•.section or on the buck of this form. 23.Site diagram or additional well derails:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed- construction details. You may also attach additional pages if necessary.
For multiple uyection or non-water supply wells ONLY with the same construction,you
can submit one form. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 25.0 (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 W00'and 2@100) construction to the following.
10.Static water level below top of casing: 13.26 (g,) Division of Water Resources,information Processing Unit,
/f 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 Synoly&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-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

ENVIRONMENTAL,CIVIL
GEOTECHNICAL
Wd CATLIN
rrigton,Raleigh.WashFglOn,
G'�tm Engineers and Scientists
WELL LOG 221223 SHEET 1 OF 1
PROJECT NO.: 221223 STATE: NC COUNTY, MADISON LOCATION: MARS HILL
PROJECT: NCDOT MARS HILL MAINTENANCE LOGGEDBY: T. PARK WELL ID:
FACILITY DRILLER: D.T. CHALMERS JR. MW_8
NORTHING: 774829 1 EASTING: 951921 CREW: N. NEWMAN
SYSTEM: NCSP NAD 83 USft BORING LOCATION: NE of Dispenser Island T.O.C.ELEV.: 103.61
DRILL MACHINE: Diedrich D-50 METHOD: HSA 10 HOUR DTW: 13.3 1 TOTAL DEPTH: 25.0
START DATE: 9/27/22 END DATE: 9/27/22 124 HOUR DTW: NM I WELL DEPTH: 25.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5e 0.5ft 0.5n (PP►►t) Is G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 103.E 0.0
0.0 10 (GW)-Asphalt and gravel 0.0
13 18 NM D ° 1.0 102.6 - 1.0
7 (ML)-Brown to red,Clayey SILT
4.0 99.6
(SM)-Red to brown,Silty SAND with IT.day o
5.0
t L
2 3 n
4 NM D N
5
8.0 95.6
(ML)-Brown,Sandy SILT with tr.clay
9.0
10.0 10.0
2
2 3 NM M
5
13.0 _ 90.6
(SM)-Dark brown with red,Silty SAND
15.0
3
3 3 NM W
4
of
oa
0
18.0 85.6 05
(SC)-Brown,SAND with day N
HCO oder starting at 29 BLS
20.0
z
2 4 N M Sat.
s
25.0 25.0 78.6 25.0 25.0
BORING TERMINATED AT ELEVATION 78.6 ft in F.
SAND with clay
Portland Cement IN Bentonite Pellets El#2 Medium Sand