GW1-2023-00569_Well Construction - GW1_20230109

WELL CONSTRUCTION RECORD Em menwu:ONLY
This fmm can Ise uxd far.40e a ma4l,wells
1.Well Contractor Information:
M WATFRZONFS
Austell Fowler FROM TO DEScwrno\`
Well Contractor Name n. n
4366A n n.
NC Well Contractor Cemfication Number
FROM DI\MIEIER 1MCICWSS MATERIAL
CATLIN Engineers and Scientists oft oftl 2&1 2 i.1 Sch.40 1 PVC
Company Name I&OUTER CA9NO W olri-cued"I 0R LDiOI f ka61e
rxuv m ulanTER rrnrK�T.< MLnrxlAl.
2.Well Construction Permit 8: N/A ❑ r,
bst all applicaNe well permed fi e.Cou,*,Starr, Pmianre./ryecnon eraJ
n. a
3.Well Use(check well me):
n.scar:P.ry
Water Supply Well: FROM 1 10 DLYUFn-R SLOTSIZE off(KNI I' nWIRta.
❑Agricultural ❑Mlmicipal/Public 2 n. 12 ft 2 Slot.010 Sch. 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) n a
❑Industrial/Commercial ❑Residential Water Supply(shared) la GROUTn
FR(111 TO \L\R:RIAL &ANIOT
❑litigation 0.0 n. 0.5 o. Concrete Surface Pour
Non-Water Supply Well:
E Monitoring ❑Recovery 0.5 it 1 rt Bent.Pellets Surface Pour
Injection Wen: n. n.
❑Aquifer Recharge ❑Grourdweter Remediation is.MAN
i
raov IXfa Mrzm md
•Aqufer Storage and Recovery ❑Salinity Baner u F.mLa<ealF,cr nitzmoo
#2 Medium Sand Surface Pour
❑Aquifer Test ❑Stormwater Drainage 1 n. 12 n.
❑Experimental Technology ❑Subsidence Control n. n
20.DRILLPIG LOG artac0 ad8rfoeY a4eeb if eecnury
❑(eothetmal(Closed Loop) [I Tracer FWAI ro Dill wrnOv ,11k1l atir,z
•Cseothermal(Heating/Cooling Reran) ❑Other(explain under all Remarks) n. n.
4.Date Welds)Completed: 12/29/22 Wen ID#: VW.01 n n n Sa.Well Location: N/A
—
n n.
QUALITY TURF
Fazility/Owner Name FacilitylDa(if applicable) Gn
n
3698 NC-53,BURGAW,NC 28425
n. n.
Physical Address,City,and Zip —
zl.ilP1F1ARKS _
PENDER N/A _
County Parcel Identification No.(PINI
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 Certification: -
(if well field,one tat long is sufficient)
34.5917529 N -77.885351 W 1 213 0/2 0 2 2
SignaztaeofCerrified Well Contractor Daze
6.Is(am)the well(s): mPermaaent or ❑1 emponry A gnoig rlu.s fonn/here&ix a6 shot the xdl(s)•'as(were)crnutncwd ai accord.uY
%SA MA('02('.0100 or 15A MA('02('0200 We/((ourncuon.Garrlurdt and lira a copy of
7.Is this a repair loan existingwen: Oyes or ®No this.rdhasbeenpnoodrdto ehewdlowmr.
Iflhis is a repair,fill om.brown well construmton irt/ormmim mul explain the nature of
the repair under=11 remoris 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
S.Number of wells constructed' 1 construction details. You may also attach additional pages if necessary.
for multiple oyecrron or ran-weer stgydy wells ONLYwdh the t,one oautrucdon,you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 12.0 (B.) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple nxkv list all depths in different(example-3@p 20(1'and 2@100) construction to the following:
10.Static water level below top of casing: 2.65 (g,) Division of Water Resources,Information Processing Unit,
lfwvaerlevel it ahmv caring are " 1617 Mad Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8.25 010 246.For Injection 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 wen construction to the following:
rre.auger,rotary,caNc.dire'Pugh 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 Sypph,&Injection Wells:
Also submit one copy of this form within 30 days of completion of well
13b.Disinfection type: Amount: concoction 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

WELL LOG ENV RONMENiAL CIVIL
GEOTECHNICAL CATLIN
ane.rm Engineersand Scientists
map SHEET 1 OF 1
PROJECT NO.: 222289 1 STATE: NC I COUNTY: PENDER LOCATION: BURGAW
PROJECT: QUALITY TURF DIESEL FUEL SPILL LoGGEDBY: Corey Futral WELL ID:
HWY 53 1 DRILLER: Austin Fowler MW-01
NORTHING: 308239 1 EASnNG: 2335461 CREW:
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Center of Excavation T.O.C.ELEV.: NM
DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HOUR DTW: 2.7 TOTAL DEPTH: 12.0
START DATE: 12/29/22 END DATE: 12/29/22 124 HOUR DTW: NM WELL DEPTH: 12.0
DEPTH BLOW COUNT OVA LAB o L. SOIL AND ROCK WELL
0.5fl 0.5fl 0.5fl 0.5ft (PPM) If G DEPTH DESCRIPTION DETAIL
�0.0 LAND SURFACE 00
0.0 (SP)-Gray,F.S4ND(FILL) D'D> ¢ 0.5
Wet/Saturated at 4'BLS
$ 1.0
Lithdogy obtained from drill cuttings
2.0
" Stan, NM M
5.0
ISM-Gray,F.to Med.SAND with tr.shell frags. u
'? Saturated of
N�
LiVldogy obtained from drill cuttings irN
10.0 ' 10.0
(CFI)-Gray,Highly Plastic CLAY
2 1
2 NM W
t
12.0 12.0 uo
z.o
BORING TERMINATED AT DEPTH 12.0 Ifin highly
plastic CLAY
>d:. Concrete Bentonite Pellets E3#2 Medium Sand

N
® MW01
LEGEND
® Monitoring Well
(Type II)
Excavation Limits
Parcel Boundary
Source. Esri, Maxar, Earthstar Geographic 0 nitry
20 10 0 20 40
Feet
�MCT TURF Q 1 E FIGURE
UALITY
CATLIN FUEL SPILL SITE MAP
3698 NC HWY 53 E
BURGAW, NC 1
Engineers and Scientists
INDIDEMND. MNO. LUTE SCAIE DRAWN WY HENED BY
96860 222289 JAN 2023 AS SHOWN KMCBJA