GW1-2022-10803_Well Construction - GW1_20221209

WELL CONSTRUCTION RECORD Fw nxma Ux ONLY
Ths form cell be used for smgk or muaipl.wells
1.Well Contractor Information:
Id.WATER ZONES
D.T. CHALMERS, JR. Rost To I DESr TION
Well Contractor Name n n
4146A " n
NC Well Contractor Certification Number 15.MER YTG OR TUBUSG t4ennal rloxd-too
FROM TO D,iMEThA TIIPRNESS I %L1i R1AL
CATLIN Engineers and Scientists 0.5 n. 15 u 2 m.1 SCh.40 1 PVC
Company Name 16.OUTER CASWG Mr mvltieased"M OR LINER ifa iode
FROM ToD1k%1EMR T111CRNF5$ M1L\TERIAL
2.Well Construction Pernik A: N/A 11 n
List all applicable well perms,(.e.COUNy,State, ✓arlari InfectIM eta)
a. rc
3.Well Use(check wen use): 17.SCREEN
Water Supply Wen: FROM I To I EakiHEWR SLOT SIZE nOCKNESs MATERIAL
❑Agricultural ❑Municipal/Public 15 o. 30 D. 2 Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) rt. n.
❑Industrial/Commercial ❑Residential Water Supply(shared) Ia GROUT 'n FIRM TO NIATER1AL I EM1IPLAMIEWNHEMOD&A00O
❑litigation 0.5n 1 a Concrete I Surface Pour
Non-Water Supply Wen:
®Monitoring ❑Recovery 1 R 14 ft. Bent.Pellets Surface Pour
Injection Wen: n D
❑Aquifer Recharge ❑Groundwater Remediation 19.SANDIGRAYEL PACK ifa siode
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO `fC1ERIAL F\mLACE%ffi Tb MOD
❑Aquifer Test ❑Stormwater Drainage 14 u.1 30 n.I Torpedo Sand Surface Pour
❑Experimental Technology ❑Subsidence Control n. ft
20.DRILLING LOG faft.rh additional Aw,if ntt
❑Geothermal(Closed Loop) ❑Tracer FROM To ❑esCRlf uu,v ,,,i„r mrdwss..,oFrwk ry .�cc.
❑Geothermal(Heating/Coaling Return) ❑Other(explain under#21 Remarks) n. a
4.Date We8(s)Completed: 11114122 Wen IDk: MWAR _O
n. n G
5a.Well Location:
n n.
NCDEQ-Former NP Sloan Inc 00-0-014927
Facility/Owner Name Facility HN fifappiicabld n.
n.
217 N I Ith St.,SANFORD,NC 27330 ft n
Physical Address,City,and Zip -
21.aemnrslcs _
LEE N/A
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)
35AS72 N -79.16159 W 11/23/2022
Signature ofCemi6ed Well Contractor Daze
6.Is(are)the wen(s): M Pernsa unt or 0Temporary
Br signing this form,/hereto•rernfivhanhe wellls/was(urn/ronnnrted m xwrda.,wth
ISA WAC 0IC.0100 or ISA NLAC 02C.0200 Well C•unrtmctian Smtdards aml that a ropy of
7.Is this a repair to an existing wen: O Yes or ®No this rerondhas been provided m the well awns,
Ifths u a repair,fill our/mown well construction information and explain the nature of
the reparr wider^21 remar.6s section or on the back of the 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 wens constructed: 1 com1ruetion details. You may also attach additional pages if necessary.
Fiat multiple uyecui or nson-wraer supply welts ONLY with the same conamucdon,you SUBMITTAL INSTRUCTIONS submit one form
9.Total well depth below land surface: 30.0 (ft.) 24a.For AS Wells: Submit this form within 30 days of completion of well
Far multiple wells list all depths in different(,xmnple-3@200'and 2@100) construction to the following:
10.Static water level below top of casing: (g,) Division of Water Resources,Information Processing Unit,
Ifwmer level is alxsve casing use"`" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.25 010 24b.For Infection Wens 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,d mil push ele.)
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 Symaly&Infection Wells:
Also submit one copy of this form within 30 days of completion of wen
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

WELL LOG ENVIRONMENTAL,CIVIL
GEOTEOHNICAL CATLIN
Engineersand 6clantlata
�1068 SHEET 1 OF 1
PROJECT NO.: 221068 1 STATE: NC I COUNTY: LEE LOCATION: SANFORD
PROJECT: LOGGED BY: C. BLACK WELL ID:
FORMER N.P. SLOAN INC DRILLER: D.T. CHALMERS JR.
NORTHING: 632283 EASTING: 1951898 CREW: C. STRATTON MW-1R
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Previous MW-1 location T.O.C.ELEV.: 103.85
DRILL MACHINE: Diedrich D-50 METHOD: HSA 1 0 HOUR DTW: NM TOTAL DEPTH: 30.0
START DATE: 11/14/22 END DATE: 11/14/22 124HOURDTw. NM WELL DEPTH: 30.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft o.5ft o.5ft o.5ft (PPM) s c DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 104.4 0 0
0.0 No SPIN Spoon samples collected from 0'-15' -0.5 _
Fill Material from previous excavation 7.0
No NM 3
sl*1 Poon
fi
m
14.0
15.0 15.0 99.4 1&0
3 5 (ML)-Dark red SILT with sand and gravel.Strong HCO
g 313.9 M
10
18.0 86.4
(MIL)-Dark Brown Sandy SILT with tr.day
20.0
3
7 a 320.8 M
12 oV
06 '
oa
23.0 e1.4 �t
(CL)-Dark Brown CLAY
25.0
11
g 17.8 M
zs
27.5 76.9
28-0 (CL)-Brown to N.brown,Silty CLAY with sand
4
5 g F142 W
30.0 10 30.0 74.4 30.0 30.0
BORING TERMINATED AT ELEVATION 74.4 ft in Silt'
CLAY with sand
Portland Cement III BentonNe Pellets ElM2 Medium Sand

t
l
N � N
z
b
A
Iry
! ' ® M W-6
I
' FORMER#: MW-2 I '.
4.000-GAL.
DIESEL LIST
MW-7 MW-5 — MW"3
" NL)
FORMER
MW 4 i 550-GAL.
® r f ( UST
/ •FORMER$50-.GAL: Y
MW-1R GASOLIUST , LEGEND s
MW-80 ® MW-10
MW-1 ® Destroyed Monitoring
Well(Type ll)
Abandoned Monitoring
FORME..R...ttttttS...!,��0�,0�0��GArL'!' ® Well(Type II)
GASOL EL UST ® Monitoring Well
M W-9 .*. (Type 1I)
Buried Water Lines
— Buried Sewer Lines
�y Buried Natural Gas Lines
— Buried Phone Lines
• Overhead Power Lines
'� # i ❑ Approximate Location
7y of Former UST System
Parcel Boundary
Source. Esn Maxar.Goo e Eertl
USDA. USGS,AeroGRID,IGI:!! nd th 'User Co munity
NOTES.
1.Well and tank locations were obtained from previous reports 40 20 0 40 60
prepared by other consultants and are approximate.
Feet
2. CNL=Could Not Locate
MWKT TIT" FIGURE
ER NP
FORMSANFORD OACN INC SITE MAP
CATLIN
Engineers and Scientists
INpBENT NO. JOB NO. OPTE 5^,RLE OMWN BYICBY
15981 221068 NOV 2022 AS SHOWN 10.IWC/1CBJA