GW1--05611_Well Construction - GW1_20240916

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells I
•
1.Well Contractor Information:
14.WATER ZONES
Austin Fowler FROM TO DESCRIPTION
Well Contractor Name R. ft. 1
i
. 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 • oft. 9.1 R. i 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(Le.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 - 9.1 r. . 39.1 ft. 3 in, Slot.010 Sch.40 PVC
0 Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) . ft.- ft. in. . ..
❑Industrial/Commercial 0 Residential Water Supply(shared) 18.GROUT
FROM TO - MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation -
R. •ft.
Non-Water Supply Well:
®Monitoring ❑Recovery 0 R. 2 it. Bent.Pellets Surface Pour
Injection Well: ra. : ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
'FROM TO MATERIAL .. EMPLACEMENT METHOD "
O Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage 2 a. 39.1 R. #2 Medium Sand Surface Pour .
ft. ft.
0 Experimental Technology ❑Subsidence Control 20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) 0 TIacer FROM TO DESCRIPTION(color.hardness,soil/rock type,grain size•etc.)
0 Geothermal(Heating/Cooling Return) -,. 0 Other(explain under#21 Remarks) .ft. ft. ' . .
4.Date Well(s)Completed: 08/26/24 Well'DMHFW2 MIN-02 : . ft. ft. ��
ft. ft. S �O
5a.Well Location: ei
ft. R. /' poor • •
USDA Forest Service -
Facility/Owner Name - . Facility lD# IP1‘.1 .(if applicable) ft.
ft.
• 12305 Hampton Rd,Rougemont,NC 27572,Rougemont,NC 27572- -
R. ft. '
Physical Address,City,and Zip
21.REMARKS
DURHAM
' County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds.or decimal degrees: 22-Certification:
(if well field,one latllong is sufficient)
36.2099113117 N -78.8815339644 w 9/6/2024 _
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or O Temporary' By signing this form,I hereby certify that the ivell(s)waspre7eonstructedjn accordance with
15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well CoristPuCta tafac1 rdsui(d tliaTtrcopy\of
7.Is this"a repair to an existing well: O Yes or ®No this record has been provided to the well owner. L. .41 "O y 7
Wit:
If this is a repair,fill otit known well construction information and explain the nature of SEP the repair under#21 remarks section or on the back of this form. 23.Site diagram or additional well details: 6 202d
You may use the back of this page to provide additional well site details of i0ell
8.Number of wells constructed:- 1 .. • construction details. You may also attach additMahpagi tif.-Wessa�yd .;r{ i
For multiple injection or non-water supply wells ONLY with the same construction,you Dt arc 7 T " ---
' can submit one form. - SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: - .'39.1 - (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@100) construction to the following:
10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
- I
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,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 Supply&Injection Wells:
Also submit one copy of this•forrli within 30 days of completion of well
13b.Disinfection type: Amount: construction to the county health department bf 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

ENVIRONMENTAL,CIVIL
GEOTECHNICAL cATLIN
wELL LoG . 1Mmington;Raleigh,Washington,
1 Charleston Engineers and Scientists
224088 SHEET 1 OF 2
PROJECT NO.: 224088 STATE: NC COUNTY: DURHAM LOCATION: Rougemont
PROJECT: LOGGED BY: Cameron Stratton WELL ID:
USDA Durham County DRILLER: Austin Fowler
NORTHING: 895335 EASTING: 2034951 CREW: Rayce Harrelson HFW2 MW-02
SYSTEM: NCSP NAD 83 (m) DRILL MACHINE: CME 55 TRACK T.O.C.ELEV.: 485.10
VERT.DATUM: NAVD88 (USft) METHOD: HSA 0 HOUR DTW: Dry TOTAL DEPTH: 40.0
START DATE: 8/26/24 END DATE: 8/26/24 24 HOUR DTW: Dry WELL DEPTH: 39.1
DEPTH BLOW COUNT OVA LAB o L SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (ppm) S G DEPTH DESCRIPTION ELEVATION DETAIL
0.9
0.0 Land Surface 484.2 0.0
(ML)-Red to brown,Clayey SILT ee
v
s$•
_ — • 2.0
U
- 9.1
_ —
to —
m`
7�U -
=V+ — ::
_ _
,;
.•
..
_ ,
..
..
__
••
. ..
...
.:
:.
.•
..
— _ •
_„•
_..:
— _:..
_•::•
_ _..:
1 ---- _ _,,
_::.
_ _:..
1 _
_...
_:...
_..
_..
_ _....
co. _ _
_ ,
— _..:
_...
. _..:
O _ ,. _ _.•:.
_,
_ ._..
Z _
ec _ ::
..
_:..
a _ _::.
_ .:
_..
Z — — _
. .
Q — , —
�••••••
ppp.�Bentonite Pellets F9#2 Medium Sand
i

ENVIRONMENTALIA/E I_ I_ I_OG ,CIVIL
GEOTECHNICAL CATLIN
Wilmington,Raleigh,Washington,
Engineers and Scientists
224088 SHEET 2 OF 2
PROJECT NO.: 224088 STATE: NC COUNTY: DURHAM I LOCATION: Rougemont
PROJECT: USDA Durham County LOGGED BY: Cameron Stratton WELL ID:
DRILLER: Austin Fowler HFW2 MW-02
NORTHING: 895335 EASTING: 2034951 CREW: Rayce,Harrelson
SYSTEM: NCSP NAD 83 (m) DRILL MACHINE: CME 55 TRACK i T.O.C.ELEV.: 485.10
VERT.DATUM: NAVD88 (USft) METHOD: HSA OHOUR DTW: Dry TOTAL DEPTH: 40.0
START DATE: 8/26/24 END DATE: 8/26/24 24 HOUR DTW: Dry WELL DEPTH: 39.1
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) S G DEPTH DESCRIPTION ELEVATION DETAIL
— (ML)-Red to brown,Clayey SILT(continued) — _
o a ::.
- - n
lh
o
ri-
F
Z —
o
F =Iv
Z
IW — —
o =iii
z - 39.1 445.1 - 39.1 = 39.1
o .
cD
N 40.0 BORING TERMINATED BY AUGER REFUSAL AT -
- ELEVATION 444.2 ft IN:SANDY SILT -
z _ -
CO
C
(\ —
h
—
L _ -
C
L -
-
Z
C I
cc
f- - 1 I -
r•
MN
.• Bentonite Pellets rl
#2 Medium Sand