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HomeMy WebLinkAboutGW1--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-:. o a :. 0 0( 2v—.. O QL •- U�•: (h to • )o D — — 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 - • — — P _ — — (! _ _ Z • • c v , h n _ I _ c t Q _ Z H - h- FTI#2 Medium Sand