GW1-2022-09622_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 I TO DESCRIPTION
Well Contractor Name ft. fL
4146A ft. fL
NC.Well Contractor Certification Number 15.INNER CASING OR TUBING thermal closed-loo
FROM TO DIAMETER THICKNESS I MATERIAL
CATLIN Engineers and Scientists 0 fL 1.0 m - 2 in.1 Sch-40 I PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER if a licahte
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: N/A fL fL in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
ft. fL in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 10 ft. 25 ft. 2 in. SIOt.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL R. in.
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL a lPLACEMENTMETHOD&AMOUNT
❑Irrigation 0 ft. 1 ft. Concrete Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 1 ft. 9 rt. Bent.Pellets Surface Pour
Injection Well: - fL n
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
FROM TO MATERIAL EMPLACEMENTMETHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage 9 ft. 25 rt #2 Medium Sand Surface Pour
❑Experimental Technology ❑Subsidence Control fL ft.
20.DRILLING LOG attach additional sheets if necessary
❑Geothermal(Closed Loop) ❑Tracer FROM To I DESCRIPTION color,hardness soil/rock tvpe,wainsiu etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) n. fL
ft rt.
4.Date Well(s)Completed: 09/27/22 Well ID#: MW-10
!t
ft. rt. / �O
5a.Well Location: fL
0-034535 ��
rt.
NCDOT-MARS HILL MAINT.FACILITY Pr.y
Facility/Owner Name Facility ID#(if applicable) fL
P p
536 ROY fL EDWARDS LANE,MARS HILL,28754 O C T 2 1 ZOZ
Physical Address,City,and Zip fL II
21.REMARKS.
MADISON N/A Irt{yrsnaUon Prccloe�Lh*
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if hell field,one Iat/Iong is sufficient)
35.827478 N -82.536351 W 10/7/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or ❑Temporary By signing this form,I hereby cert fi,that the irell(s)was(were)constructed in accordance with
15A N(AC 02C.0100 or 15A NCAC 02C.0200 Well Constnretion 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 otvtter.
If this is a repair;fill,auI known well construction information and explain the nature of
the repair under,tl21 remarks section or on the back of this jorrn. 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,yotr SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 25.0 (ft.) 24a.For All Wells: Submihthis form within 30 days of completion of well
For multiple wells list all depths in different(example-3 a200'and 2@1009 construction to the following,
10.Static water level below top of casing: 13.14 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
I
11.Borehole diameter: 8•25 (in.) 24b.For Iniection Wells ONLY: In addition to sending the form to the
address in 24a above,also sdbmit 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,directpush,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 SvaDly&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 CATLIN 1Mlminlgton,Raleigh,Washington,
Ctiarleiston Engineers and Scientists
WELL LOG- 2I1223 SHEET 1 OF 1
PROJECT NO.: 221223 STATE: NC_ COUNTY: MADISON LOCATION:.MARS HILL
PROJECT: NCDOT MARS HILL MAINTENANCE LOGGEDBY: I T. PARK WELL ID:
FACILITY DRILLER: D.T. CHALMERS JR. MVW-10
NORTHING: 7747681 EASTING: 951934 CREW: N. NEWMAN
SYSTEM: NCSP NAD 83 USft BORING LOCATION: SSE of Dispenser Island i T.O.C.ELEV.: 101.18
DRILL MACHINE:,Diedrich D-50 METHOD: HSA 0 HOUR DTW: 13.1 TOTAL DEPTH: 25.0
START DATE: 9/27/22 END DATE: 9/27/22 124 HOURIDTW: NM WELL DEPTH: 25.0
BLOW. COUNT OVA o o SOIL.AND ROCK WELL
DEPTH 0.5ft ft o.5 o.5ft 0.5ft (PPM) LAB. S c DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE, 101.2 0.0
0.0 10 (CL)-Brown to black,Silty CLAY with tr,rocks 0.0
7 4 NM D — 1.0
4
4.0 97.2 0
(ML)-Brown,Clayey SILT with tr.rocks o
5.0
NM D
(V
2
8.0 93.2
(CL)-Brown,Silty CLAY with tr.rocks,'
9.0
10.0 10.0
5
4 8 8 NM M
15.0
3
' NM W
o;
oa
0
18.0 83.2
(ML)-Brown with black streaks,SILT with tr.clay N
20.0
3
5 7 10 NM W
i
25.0 25.0 I 76.2 25.0 25.0
BORING TERMINATED AT ELEVATION 76.2 ft in SILT
with clay
I
l
Portland Cement Bentonite Pellets #2 Medium Sand.
1

4'
Ivor � N
d
• "� ".rya':'. � r'
�WSW-1 w,
* ? �MW=4
(CNL)
10 ,
DIESEL- � ;
MW-8
fi GA
.P
U SITS
• CURRENT
Us
(CNL) � MW-1(I
MW-1
MW-7
(CNL)® ,(CNL) t,
r< MW-9
LEGEND
q (CNL) ® Active Monitoring
Well (Type II)
Damaged Monitoring
Well (Type II)
Active Non-Potable
OW Water Supply Well�
MW;6 -;► c Creek
F. Former Air Sparge/SVE
System Shed
� ' Approximate Location
O of LISTs
Parcel Boundary
'+ Source Esri. Mao
xar,G�oEye. Eartl star Geographies, r
b
USDA; USGS,AeroGRID. IGN.and the GIS User «•m MT urgillty
NOTES:
1. Well and tank locations were obtained from previous 60 30 0 60 120
reports prepared by other consultants and are approximate.
Feet
2. CNL= Could Not Locate
PROJECT TITLE
NCDOT MARS HILL FIGURE
ATLIN MAINTENANCE FACILITY SITE MAP
536 ROY EDWARDS LN
CMARS HILL, INC
Engineers and Scientists
' INCIDENT NO. lOB NO. DATE SCALE DRAWN BY/CHECKED BY
9715 221223 OCT 2022 AS SHOWN KMC/SJO