GW1--05610_Well Construction - GW1_20240916

WELL CONSTRUCTION RECORD ,
For Internal Use ONLY:
This form can be used for single or multiple wells '
1.Well Contractor Information: '
14.WATER ZONES
Austin Fowler FROM TO DESCRIPTION
Well Contractor Name ft. ft. {.
4366A ft. ft.
NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-loop)
FROM ." • .TO DIAMETER . THICKNESS MATERIAL
CATLIN.Engineers and Scientists . . . .0 ft. -2.1 ft. . . 3 in. Sch.40 . PVC
Company Name 16.OUTER CASING(for multi-cased wells)OR LINER(if applicable
FROM TO . DIAMETER THICKNESS MATERIAL
. 2.Well Construction Permit#: N/A ..
ft. ft. in.
List all applicable well permits(i.e.County,State,Variance,Injection,etc.)
. ft. ft. ' in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: - • _FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
•
❑Agricultural • .• ❑Municipal/Public - -2.1 it, . 2.-9 ft. 3 . in. Slot.010 Sch.40 . PVC
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ft. . ft. . in. . .
❑Industrial/Commercial 0 Residential Water Supply(shared) 18.GROUT
FROM TO • MATERIAL EMPLACEMENT METHOD&AMOUNT- .
❑Irrigation
Non-Water Supply Well: ft. a.
Monitoring. . ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge 0 Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
0 Aquifer Storage and Recovery ' 0 Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 0 ft. 2.9 it. #2 Medlurri Sand Surface Pour -
❑Experimental Technology 0 Subsidence Control ft. ft. . . .
20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑TIacer FROM TO DESCRIPTION(color,hardness,soil/rock type.Frain size.etc.)
❑Geothermal(Heating/Cooling Retum) • 0 Other(explain:under#21 Remarks) ft. R.
4.Date Well(s) W
Completed: 08/22/24 Well ID#:.HF2 M -03 ft. ft. Se�
ft. ft. �O
- 5a.Well Location: ft 10,i pig,‘..k
. ft.
USDA Forest Service •
ft. P�
Facility/Owner Name Facility ID#(if applicable) • -: -
ft.
12305 Hampton Rd,Rougemont, NC 27572,Rouqemont,NC 27572 . -
R. R.
Physical Address,City,and Zip
•
21.REMARKS
DURHAM •
County Parcel Identification No.(PIN) . •
5b.Latitude and Longitude iri degrees/minutes/seconds.or decimal degrees: 22.Certification:
(ifwell.freld,one lat/long is sufficient) , .
• 36.2177142688 N -78.8648445576 . w . ��9'�-�z 9/6/2024.
. Signature
of
Certified Well Contractor Date
• 6.Is(are)the well(s): I81Permanent or OTemporary By signing this form,I hereby certifi�that the well(s)was(were)-corstgrcted in accordance with
15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Constnr'tian$lanrlar�7is;a'n�7 l&,t a,-copy,o,�.,
. 7.Is this a repair to an existing well: O Yes or ®No this record has been provided to the well owner. '1........1....„,L., ;l tiA p'A
If this is a repair,fill out known well construction information and explain the nature of
the repair under#21 remarks section or on the back ofthis form. 23.Site diagram or additional well details: • SEP 1 n Fub1�4
'You may use the back of this page to provide additional well site detailsor
8.NumbFor er
of wells njection oconr osttr constructed:-
r :y wells ONLY with the same eonslrkction,youconstruction details. You may also attach additionall,hapes,i£ne�egsac4�r��:-�r 1 Jr
can submit one form. SUBMITTAL INSTRUCTIONS ''c+cc,. � t2,
9.Total well depth below land surface: . 2.9 (ft.) 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'and 2@1002 construction to the following'.,
' 10.Static water level below top of casing: 2.7 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 4.25 (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,sable,direct push,etc.) i.
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 Supply&Injection 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
' 1

•
ENVIRONMENTAL,CIVIL
INELL LoG . GEOTECHNICAL CATLIN
i Wlminglon,Raleigh,Washington,
Charleston Engineers and Scientists
224088
I SHEET 1 OF 1
PROJECT NO.: 224088 STATE: NC COUNTY: DURHAM I LOCATION: Rougemont
PROJECT: LOGGED BY: Cameron Stratton WELL ID:
USDA Durham County
• DRILLER: Austin Fowler HF2 MW-03
NORTHING: 898302 EASTING: 2040191 CREW: Rayce Harrelson
SYSTEM: NCSP NAD 83 (m) DRILL MACHINE: CME 55 TRACK T.O.C.ELEV.: 572.40
VERT.DATUM: NAVD88 (USft) METHOD: HSA 0 HOUR DTW: 2.7 TOTAL DEPTH: 2.9
START DATE: 8/22/24 END DATE: 8/22/24 24 HOUR DTW: 2.7 WELL DEPTH: 2.9
DEPTH BLOW COUNT OVA LAB o L SOIL AND ROCK -2.1 _ WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) •
• s G DEPTH DESCRIPTION ELEVATION = DETAIL
. 0.0 Land Surface 572.4 = o.o
_ °cy (GW)-light brown,Sandy GRAVEL[WEATHERED 0.0 J
• j ROCK] - oo-:.
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2.9 - °O( 2.9 569.5 -
2.9 r. 2.9
BORING TERMINATED BY AUGER REFUSAL AT
ELEVATION 569.5 ft IN:SANDY GRAVEL -
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