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HomeMy WebLinkAboutGW1-2023-01698_Well Construction - GW1_20230213 WELL CONSTRUCTION RECORD For Internal Use ONLY This form can be used for single or multiple wells 1.Well Contractor Information: D.T.Chalmers, JR F WATER ZONES FROM To DFscRu>[ION Well Contractor Name ft. ft. 4146A ft. ft. NC Well Contractor Certification Number 15.INNER CASING OR TUBING eolheRmal dined 1 FRO\I TO D14Stf,rF THICKNESST MATERIAL CATLIN Engineers and Scientists 0 ft.1 5 ft. 2 i..1 Sch.40 1 PVC Company Name 16.OUTER CASING 1for multi-cased wells OR LINER if a icable FRMI TO DI4VIFTFR TI11f KNFSS M6ATERI:AL 2.Well Construction Permit#: N/A n. ft. in. List all applicable well permits(i.e.County,State, Variance,Injection,etc.) ft. ft. in. 3.Well Use(check well use): n.scREEN Water Supply Well: FROM TO DIANTETER I SLOTSIZE THICKNESS MATERIAL ❑Agricultural OMunicipal/Public 5 a. 20 n 2 irt. Slot.010 Sch. 40 PVC ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ❑Industrial/Commercial ❑Residential Water Supply(shared) I&GROUT _ FROM TO MIA111ou IA II'LACENIENT METHOD&.i,Uul S1 ❑Irrigation 0 a. 1 n. Concrete Surface Pour Non-Water Supply Well: — 1 Sent.Pellets Surface Pour 3Monitoring ❑Recovery Injection Well: 0 Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK ira dkable FROM TO A TI R1At EM1IPLACENIENTMETHOD ❑Aquifer Storage and Recovery D Salinity Barrier — ❑Aquifer Test O Stortnwater Drainage 4 n. 20 n. Torpedo Sand — ❑Experimental Technology ❑Subsidence Control u. ft. 20.DRE LLING LOG attach additional sheets if necessary) 0Geothermal(Closed Loop) ❑Tracer FROM TO ha'dn's soivrod t'f e gain s­.etc ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) n. n. — 4.Date Wells)Completed: 02/01/23 Well ID#: MW-7 It. n. -1 ` O rt. Sa.Well Location: — NCDEQ-HALL S STORE 00-0-00009410 I.. P Facility/Owner Name Facility ID#(if applicable) rt. 9830 HIGH HOUSE RD,SALEMBURG,28385 n. n. Physical Address,City,and Zip — 21.REMARKS _ SAMPSON 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) 35.11382 N -78.53753 W '�/ 2/3/2023 Signature of Certified Well Contractor Date 6.is(are)the well(s): ®Permanent or ❑Temporary By signing this jorvn,/hereby tern fi-that the well(s)was(were)conslnrcled m acconkmce with I9A MAC 02C.0100 or 15A NCAC 02C.0100 Well Cowiruetion Standards and that a copy of 7.Is this a repair to an existing well: Oyes or ®No this record has been provided to the well owner. If this is a repair,fill out known well construction information anti explain the nature of the repair wider s2I 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 njectron or non-water supply wells ONLY with the same eonsducdon,you SUBMITTAL INSTRUCTIONS can submit one form. 9.Total well depth below land surface: 20.0 (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@200'antd 2@I001 construction to the following: 10.Static water level below top of casing: 13.42 (g,) Division of Water Resources,Information Processing Unit, Ifwater 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 SvoDly&Infection 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 Wnmglon,Raleigh,Washington, cbmustonWELL LOG Engineers and Scientists 220282oz64 SHEET 1 OF 1 PROJECT NO.: 220284 STATE: NC COUNTY: SAMPSON LOCATION: SALEMBURG PROJECT: 220284 LOGGED BY: C. Black WELL ID: DRILLER: D. T. Chalmers JR MW_7 NORTHING: 496674 1 EASTING: 2138301 CREW: L. Hamilton SYSTEM: NCSP NAD 83 USft BORING LOCATION: South of MW-2 T.O.C.ELEV.: 99.96 DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HHOUR DTW: 18.6 TOTAL DEPTH: 20.0 START DATE: 2/1/23 END DATE: 2/1/23 124 HOUR DTW: 13.4 WELL DEPTH: 20.0 BLOW COUNT OVA o o SOIL AND ROCK WELL DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPM) LAB. Is c DEPTH DESCRIPTION ELEVATION DETAIL 0.0 LAND SURFACE 100.0 0.0 0.0 (SP)-Gray to dark gray,F.SAND 0.0 5 6 6 NM M = 1.0 6 U a v 3.0 J97.0 n (CH)-Brown to white,Silty highly plastic CLAY. Slight N HCO from 10.0-1 3.0'BLS 4.0 5.0 5.0 5 NM M 4 10.0 2 5 5 NM M 8 oQ> oa 60 13.0 87.0 �t ; (SW)-Orangish brown,F.to Cse.SAND with IT.silt •' from 18.0-20.0'BLS. 15.0 j 3 •�•}t 4 4 N M W a s 18.0 ; 4 6 5 3 ;a•t 20.0 20.0 80.0 20.0 20.0 BORING TERMINATED AT ELEVATION 80.0 ft in Med. to Cse.SAND w/IT.silt Portland Cement Bentonite Pellets El#2 Medium Sand nnw-a V N 0 ED -. u a t. Od MW-3 3 MW-1 FORMER 2,000-GAL. j'GASOLINE USTS FORMER 500-GAL. KEROSENE UST MW-5 MW=6 r FORMER 1�—�500-GAL.UST FORME DISPENSER \FORMER ISLAND MW.-2 4,000-GAL. ®MW-7 USTS LEGEND ® Monitoring Well (Type II) Water Line NtGt-,AOvgE RD Approximate Location of Former UST System Parcel Boundary Source: Esn, Maxar. Earthstar Geographics.and the GIS User Community NOTE:Well and tank locations were obtained from previous reports prepared by other consultants and are approximate. 30 15 0 30 60 Feet PROJECT TITLE FIGURE HALL'S STORE ATLIN 9830 HIGH HOUSE RD SITE MAP CSALEMBURG, NC 1 Engineers and Scientists INCIDENT N0. JOB N0. DATE SCALE I DRAWN BYICHECKED By 42022 220284 FEB 2023 AS SHOWN KMC/BJA