WA-749_38592_CA_LTRRPT_20230511

1044 Washington Street
Raleigh, NC 27605
[phone]

www.CatlinUSA.com
Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA

E N V I RO N M E N TA L | C I V I L | G E O T E C H N I C A L

Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA | Charleston, SC

May 11, 2023

North Carolina Department of Environmental Quality
Division of Waste Management
UST Section
Attn: Ms. Liz Price
127 Cardinal Drive Ext.
Wilmington, NC 28405

Re: Letter Report
Bazemore Grocery
730/732 Mt. Olive Road
Windsor (Republican), NC 27983
Incident Number: 38592
Risk Classification: H0175D
CATLIN Project No. 220298

Dear Ms. Price,

CATLIN Engineers and Scientists (CATLIN) is pleased to provide you with this letter report
documenting field activities performed in general accordance with CATLIN proposal number
220298.04P, prepared February 17, 2023. Services were authorized by the North Carolina
Environmental Quality (NCDEQ) Task Authorization (TA) #04, accepted February 18, 2023, and
Contract Number N122019D. The approved scope of services for this Task Authorization
included:
• Update the site-specific Health and Safety Plan (HASP) for drilling operations;
• Install three Type II monitoring wells up to 15 feet below land surface (BLS);
• Survey the Top of Casing (TOC) elevations of the newly installed monitoring wells relative
to an existing well;
• Gauge the monitoring wells approximately 30 days after installation; and
• Prepare a letter report documenting the findings.

The Former Bazemore Grocery (Bazemore Grocery) site is located at 730/732 Mt. Olive Road,
Windsor (Republican), Bertie County, NC (See Figures in Attachment A). CATLIN conducted
field activities on March 22, 23, and 30, 2023 in accordance with the approved TA. During field
activities, monitoring well MW-3 was discovered on the northeast corner of the former Bazemore
Grocery building (see Figure 2 in Attachment A). It was determined that this well was previously
installed as part of the investigation for former Incident Number 10440. While on-site, CATLIN
personnel also gauged this well to determine if light-non aqueous phase liquids (LNAPL; aka free-
product) were present.
Potential hazards were evaluated before beginning field work and documented on Daily Activities
Sheets and/or Logs, provided in Attachment B. Site photographs are presented in Attachment C.

May 11, 2023
Page 2 of 3
NCDEQ; 38592_Bazemore Grocery CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023
Monitoring Well Installation

On March 22 and 23, 2023, two borings were advanced to 15 feet BLS and one boring was
advanced to 13 feet BLS for monitoring well construction by a North Carolina Certified Well
Contractor, utilizing hollow stem augers and a Diedrich D-50 drill rig. Cuttings generated during
drilling activities were spread on-site.

The wells (MW-22, MW-23, and MW-24) were constructed of new, threaded PVC casing and
screen. No glues or cements were used in joining PVC components. New nitrile gloves were worn
while handling all well materials. The wells were constructed with a pointed PVC sediment trap,
10 feet of 2-inch diameter, 0.010-inch slotted PVC well screen and approximately five feet
(MW-22 and MW-24) and three feet (MW-23) of 2-inch diameter solid PVC riser to the surface.
The annular space was filled with coarse sand pack to approximately two feet above the well
screen and bentonite chips to within one foot (MW-22 and MW-24) and one-half foot (MW-23) of
the ground surface. The bentonite chips were poured from the surface while simultaneously
pouring water to facilitate hydration. The wells were finished with a concrete pad and flush-mount
steel wellhead and locking well cap. After installation, the monitoring wells were developed by
over-pumping. The TOC elevations were measured in relation to a preexisting well (MW-3) using
traditional survey methods (Rod and Level).

Monitoring well construction information is summarized on Table 1 (Attachment D) and a site map
with monitoring well location is illustrated on Figure 2 (Attachment A). TOC reduced level notes
are provided in Attachment B. Site photographs are presented in Appendix C. The well logs and
Well Construction Records were submitted to NCDEQ on April 4, 2023; copies are provided in
Attachment E.
Groundwater Gauging

On March 30, 2023, CATLIN personnel returned to the site collect depth to water and LNAPL
measurements. The monitoring wells were gauged using an electronic oil/water interface probe.
To prevent cross contamination, the probe and cabling were decontaminated according to
manufacturer’s recommendations between use in each well. The daily log (including gauging
data) is included in Attachment B. Gauging procedures were performed in general accordance
with NCDEQ Guidelines and Environmental Protection Agency (EPA) Region 4 Operating
Procedures.

Depth to water ranged from 2.54 feet below top of casing (BTOC) (MW-3) to 6.89 feet BTOC
(MW-23). LNAPL was measured in monitoring well MW-24 at 0.89 feet thick and in MW-22 at
0.17 feet thick. The depth to water in MW-20R was measured above the screened interval. Based
on groundwater elevations calculated for this monitoring period, groundwater flow direction is
towards the southwest.
Recommendations

CATLIN recommends conducting a mobile multi-phase extraction (MMPE) utilizing wells MW-
20R, MW-22, and MW-24 as extraction points event followed by groundwater sampling
approximately 30 days after the conclusion of the MMPE event.

May 11, 2023
Page 3 of 3
NCDEQ; 38592_Bazemore Grocery CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023
CATLIN Engineers and Scientists will proceed upon notification of your approval. Should you
have any questions or require additional information, please contact us at [phone].

Sincerely,

Sean O’Neil, PE
Project Manager
Attachments:
A Figures
B Field Sheets and Reduced Level Notes
C Site Photographs
D Table
E Well Logs and Well Construction Records

NCDEQ; 38592_Bazemore Grocery CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

ATTACHMENT A FIGURES
FIGUREPROJECTTITLE
1BAZEMORE GROCERY730/732 MOUNT OLIVE RD
WINDSOR, NC SITE VICINITY MAP
SITE LOCATION
MOUNT OLIVE RD
REPUBLICAN RD
NC 308
Copyright:© 2013 National Geographic Society, i-cubed
2,000 0 2,000 4,0001,000
Feet
³
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY38592220298MAY 2023 AS SHOWN KMC/SJO
FIGUREPROJECTTITLE
2BAZEMORE GROCERY730/732 MOUNT OLIVE RD
WINDSOR, NC SITE MAP
!>
!>
!>!>
!>
MOUNT OLIVE RD
MW-20R
!>MW-24
MW-22
MW-23
MW-3
Source: Esri, Maxar, Earthstar Geographics, and the GIS User Community
30 0 30 6015
Feet
³
Parcel Boundary
Approximate Location of Former UST Basin
NOTES: 1. Tank locations were obtained from previous reportsprepared by other consultants and are approximate.2. Well locations were obtained during field activities conducted by CATLIN.
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY38592220298MAY 2023 AS SHOWN KMC/SJO
LEGEND
Monitoring Well(Type II)!>
Approximate 2020Excavation Area
FIGUREPROJECTTITLE
3BAZEMORE GROCERY730/732 MOUNT OLIVE RDWINDSOR, NC
GROUNDWATER ELEVATION –MARCH 30, 2023
!>
!>
!>!>
!><MOUNT OLIVE RD
MW-20R*(57.27)MW-24(55.67)
MW-22(55.62)
MW-23(55.57)
MW-3(59.46)59.00
56.00
57.00
58.00
Source: Esri, Maxar, Earthstar Geographics, and the GIS User Community
30 0 30 6015
Feet
³
Parcel Boundary
Approximate Location of Former UST Basin
NOTES: 1. Tank locations were obtained from previous reportsprepared by other consultants and are approximate.2. Well locations were obtained during field activities conducted by CATLIN.3. The groundwater elevation contour interval is 1.00 feet.
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY38592220298MAY 2023 AS SHOWN KMC/SJO
LEGEND
Gauged Monitoring Well (Type II)!>
4. * = Well depth to water measured abovethe screened interval; elevation not usedfor contouring puposes
GroundwaterElevation (Feet)(##)
Groundwater FlowDirection
Groundwater Contour<

NCDEQ; 38592_Bazemore Grocery CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

ATTACHMENT B FIELD SHEETS AND REDUCED LEVEL NOTES
Page 1 of 3
CLIENT'S CATLIN
NAME:PROJECT:
CATLIN PROJECT #:PHASE:
INSTRUMENT #:
ELEVATION (TBM):DATE:3/23/2023 ROD #:UNITS (FT./M): FEET
TOP
BOTTOM5.314.525.534.935.965.055.324.52
FIELD NOTES BY:DATE:3/30/2023 INSTRUMENT BY:
NOTES REDUCED BY:DATE:4/19/2023 ROD PERSON:
HI - (-) = ELEV.* A sketch must be provided with the level notes.
T.MIZELLE
G. HILL C.STRATTON
0.00
(+) = MID at TBM or BM (TOP - BOTTOM) * 100 = DISTANCE
TBM + (+) = HI (TOP + BOTTOM)/2 = MID (-)
66.91 0.00
30 0 66.91
29 0
28 0 66.91 0.00
27 0 66.91 0.00
66.91 0.00
26 0 66.91
25 0
0.00
24 0 66.91 0.00
23 0 66.91 0.00
66.91 0.00
22 0 66.91
21 0
0.00
20 0 66.91 0.00
19 0 66.91 0.00
66.91 0.00
18 0 66.91
17 0
0.00
16 0 66.91 0.00
15 0 66.91 0.00
66.91 0.00
14 0 66.91
13 0
0.00
12 0 66.91 0.00
11 0 66.91 0.00
66.91 0.00
10 0 66.91
9 0
0.00
8 0 66.91 0.00
7 0 66.91 0.00
66.91 0.00
6 0 66.91
5 0
0.00
4 0 80 4.92 61.99 4.92 MW-3
3 38 91 5.50 61.41 5.51 MW-24
2 34 60 5.23 61.68 5.23 MW-22
1 0 79 4.91 66.91 62.00 4.92 MW-3
62.00
POINT ANGLE
(degrees)
DISTANCE
(feet)MID (-)(+)
REDUCED LEVEL NOTES
NCDEQ - SLP Bazemore Grocery
220298
BENCH MARK DESC.:MW-3
HI ELEV. (feet)CHECK (T+B)/2 NOTES
Page 2 of 3
CLIENT'S CATLIN
NAME:PROJECT:
CATLIN PROJECT #:PHASE:
INSTRUMENT #:
ELEVATION (TBM):DATE:3/23/2023 ROD #:UNITS (FT./M): FEET
TOP
BOTTOM5.645.425.164.985.645.43
FIELD NOTES BY:DATE:3/30/2023 INSTRUMENT BY:
NOTES REDUCED BY:DATE:4/19/2023 ROD PERSON:
HI - (-) = ELEV.* A sketch must be provided with the level notes.
T. MIZELLE
G. HILL C. STRATTON
0.00
(+) = MID at TBM or BM (TOP - BOTTOM) * 100 = DISTANCE
TBM + (+) = HI (TOP + BOTTOM)/2 = MID (-)
67.53 0.00
30 0 67.53
29 0
28 0 67.53 0.00
27 0 67.53 0.00
67.53 0.00
26 0 67.53
25 0
0.00
24 0 67.53 0.00
23 0 67.53 0.00
67.53 0.00
22 0 67.53
21 0
0.00
20 0 67.53 0.00
19 0 67.53 0.00
67.53 0.00
18 0 67.53
17 0
0.00
16 0 67.53 0.00
15 0 67.53 0.00
67.53 0.00
14 0 67.53
13 0
0.00
12 0 67.53 0.00
11 0 67.53 0.00
67.53 0.00
10 0 67.53
9 0
0.00
8 0 67.53 0.00
7 0 67.53 0.00
67.53 0.00
6 0 67.53
5 0
0.00
4 0 67.53 0.00
3 0 21 5.54 61.99 5.54 MW-3
2 304 18 5.07 62.46 5.07 MW-23
1 0 22 5.53 67.53 62.00 5.53 MW-3
62.00
POINT ANGLE
(degrees)
DISTANCE
(feet)MID (-)(+)
REDUCED LEVEL NOTES
NCDEQ - SLP Bazemore Grocery
220298
BENCH MARK DESC.:MW-3
HI ELEV. (feet)CHECK (T+B)/2 NOTES
Page 3 of 3
CLIENT'S CATLIN
NAME:PROJECT:
CATLIN PROJECT #:PHASE:
INSTRUMENT #:
ELEVATION (TBM):DATE:3/30/2023 ROD #:UNITS (FT./M): FEET
TOP
BOTTOM5.534.936.105.905.314.525.534.93
FIELD NOTES BY:DATE:3/30/2023 INSTRUMENT BY:
NOTES REDUCED BY:DATE:4/19/2023 ROD PERSON:
HI - (-) = ELEV.* A sketch must be provided with the level notes.
N. NEWMAN
G. HILL
0.00
(+) = MID at TBM or BM (TOP - BOTTOM) * 100 = DISTANCE
TBM + (+) = HI (TOP + BOTTOM)/2 = MID (-)
66.91 0.00
30 0 66.91
29 0
28 0 66.91 0.00
27 0 66.91 0.00
66.91 0.00
26 0 66.91
25 0
0.00
24 0 66.91 0.00
23 0 66.91 0.00
66.91 0.00
22 0 66.91
21 0
0.00
20 0 66.91 0.00
19 0 66.91 0.00
66.91 0.00
18 0 66.91
17 0
0.00
16 0 66.91 0.00
15 0 66.91 0.00
66.91 0.00
14 0 66.91
13 0
0.00
12 0 66.91 0.00
11 0 66.91 0.00
66.91 0.00
10 0 66.91
9 0
0.00
8 0 66.91 0.00
7 0 66.91 0.00
66.91 0.00
6 0 66.91
5 0
0.00
4 0 60 5.23 61.68 5.23 MW-22
3 359 79 4.92 61.99 4.92 MW-3
2 68 20 6.00 60.91 6.00 MW-20R
1 0 60 5.23 66.91 61.68 5.23 MW-22
61.68
POINT ANGLE
(degrees)
DISTANCE
(feet)MID (-)(+)
REDUCED LEVEL NOTES
NCDEQ - SLP Bazemore Grocery
220298
BENCH MARK DESC.:MW-22
HI ELEV. (feet)CHECK (T+B)/2 NOTES

NCDEQ; 38592_Bazemore Grocery CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

ATTACHMENT C SITE PHOTOGRAPHS
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 22, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of site, facing east.
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 22, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of drilling setup at MW-24, facing east.
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 22, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of drilling MW-24.
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 23, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of site, facing west.
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 23, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023
View of MW-3, facing south.
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 23, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of drilling MW-22, facing northwest.
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 23, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of finished MW-23, facing northeast.
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 23, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of finished MW-23, facing southwest.
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 30, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of site, facing east.

View of MW-3, facing south.
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 30, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of MW-20R, facing east.

View of MW-23, facing southwest.
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 30, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of MW-24, facing east.

View of LNAPL from MW-24.

MW-24
ATTACHMENT C SITE PHOTOGRAPHS – MARCH 30, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

View of MW-22, facing southeast.

View of LNAPL from MW-22.

NCDEQ; 38592_Bazemore Grocery CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

ATTACHMENT D TABLE
Page 1 of 1
TABLE 1
WELL CONSTRUCTION AND HISTORICAL WATER LEVEL GAUGING DATA
Well ID
Date
Installed
(mm/dd/yy)
Date Water
Level
Measured
(mm/dd/yy)
Well
Casing
Depth
(ft. BLS)
Screened
Interval
(x to y ft.
BLS)
Bottom of
Well
(ft. BLS)
Top of
Casing
Elevation*
(ft.)
Free Product
Thickness**
(ft.)
Depth to
Water from
Top of
Casing (ft.)
Groundwater
Elevation (ft.)Comments
MW-3 04/22/93 03/30/23 1 1-11 11 62.00 NMT 2.54 59.46
03/23/21 100.00 4.67 6.70 96.90
03/30/23 60.91 NMT 3.64 57.27 Ɨ
MW-22 03/23/23 03/30/23 5 5-15 15 61.68 0.17 6.19 55.62
MW-23 03/23/23 03/30/23 3 3-13 13 62.46 NMT 6.89 55.57
MW-24 03/22/23 03/30/23 5 5-15 15 61.41 0.89 6.43 55.67
Ɨ = Water level was measured above the screened interval.
Incident Name and No.: Bazemore Grocery - 38592
ft. BLS = feet Below Land Surface
** = if free-phase product is present in a well, ground water elevation should be calculated by : [top of casing elevation - depth to water]+ [free product thickness x specific gravity of the fuel
type]
MW-20R construction data obtained from ECS (2018).
155-15501/28/20MW-20R
NMT = No Measurable Thickness
MW-3 construction data obtained from GRI (2014).
* = Top of casing elevations remeasured by CATLIN in March 2023 based on the historical MW-3 elevation of 62.00.
NCDEQ; 38592_Bazemore Grocery; T1_Well Construction & Gauging
CATLIN Project No. 220298
CATLIN Engineers and Scientists
May 2023

NCDEQ; 38592_Bazemore Grocery CATLIN Engineers and Scientists
CATLIN Project No. 220298 May 2023

ATTACHMENT E WELL LOGS AND WELL CONSTRUCTION RECORDS
03/22/23
HSA
4146A
5.7
MW-21
-77.059874
D. T. Chalmers, JR
36.082551
BERTIE
1
X
4/4/2023
8.25
Surface Pour
CATLIN Engineers and Scientists
X
2 Slot .010
730/732 MOUNT OLIVE RD., WINDSOR, NC 27983
Bent. Pellets3
5
N/A
3 15 # 2 Medium Sand
15.0
X 1
5 15 PVC
2
Sch. 40
0 Sch. 40 PVC
Well ID#:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
(if well field, one lat/long is sufficient)
N
6. Is (are) the well(s):
Yes
TemporaryPermanent or
or No7. Is this a repair to an existing well:
8. Number of wells constructed:
For multiple injection or non-water supply wells ONLY with the same construction, youcan submit one form.
9. Total well depth below land surface:
For multiple wells list all depths in different (example- 3@200' and 2@100')
W
(ft.)10. Static water level below top of casing:
If water level is above casing, use "+"
11. Borehole diameter:
MATERIAL
FROM
Residential Water Supply (shared)
Adapted from Form GW-1
ft.
ft.
ft.ft.
ft.ft.
ft.ft.
ft.ft.
ft.
ft.
(ft.)
(in.)
ft.
ft.ft.
ft.
ft.
ft.in.
in.
ft.
ft.
ft.ft.
ft.
ft.
13b. Disinfection type:
22. Certification:
Revised 2-22-2016
ft.NCDEQ-Bazemore Property
TO DIAMETER THICKNESS MATERIAL
FROM17. SCREEN DIAMETER SLOT SIZE MATERIALTHICKNESS
FROM TO MATERIAL
ft.ft.
ft.
ft.
FROM TO
18. GROUT
MATERIAL
19. SAND/GRAVEL PACK (if applicable)
1. Well Contractor Information:
This form can be used for single or multiple wells
Well Contractor Name
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Non-Water Supply Well:
Monitoring
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
15. INNER CASING OR TUBING (geothermal closed-loop)
Municipal/Public
Residential Water Supply (single)
ft.
ft.ft.
ft.ft.
ft.
ft.ft.
ft.
TO
EMPLACEMENT METHOD & AMOUNT
in.
in.
in.
EMPLACEMENT METHOD
Recovery
Injection Well:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance with15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a copy of
this record has been provided to the well owner.
If this is a repair, fill out known well construction information and explain the nature ofthe repair under #21 remarks section or on the back of this form.
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
13a. Yield (gpm)
FOR WATER SUPPLY WELLS ONLY:
Method of test:
Amount:
For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
FROM TO
24c. For Water Sypply & Injection Wells:Also submit one copy of this form within 30 days of completion of wellconstruction to the county health department of the county where constructed.
DIAMETER THICKNESS
FROM TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
21. REMARKS
20. DRILLING LOG (attach additional sheets if necessary)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
Signature of Certified Well Contractor Date
24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:
SUBMITTAL INSTRUCTIONS
Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-1617
Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-1636
16. OUTER CASING (for multi-cased wells) OR LINER (if applicable)
North Carolina Department of Environment and Natural Resources - Division of Water Resources
24b. For Injection Wells ONLY: In addition to sending the form to theaddress in 24a above, also submit a copy of this form within 30 days ofcompletion of well construction to the following:
WELL CONSTRUCTION RECORD
23. Site diagram or additional well details:
Aquifer Recharge Groundwater Remediation
Stormwater Drainage
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Salinity Barrier
Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed:
5a. Well Location:SEE
ATTAC
H
E
D
N/A
Unknown
0 1 Surface Pour
Surface Pour
Concrete
15.0
0.0
5.0
10.0
13.0
1
8
5
5
2
3
2
3
2
5
4
3
2
4
3
2
15.0
5.0
15.0
0.0
1.0
3.0
15.02" Sch. 40 PVC2" Slot .010Sch. 40 PVCD
M
W
Sat.
3.0
8.0
12.5
3.0
8.0
12.5
15.0
(CL) - Dark brown to tan, Sandy CLAY with interbedded
layers of f. sand
(CL) - Gray with red and orange mottling, Silty CLAY. V.
Strong HCO
(SW) - Gray to brown, F. to Cse. SAND
(CL) - Gray with red and orange mottling, F. to Cse.
Sandy CLAY. Strong HCO
BORING TERMINATED AT ELEVATION 84.4 ft in F.
and Cse. Sandy CLAY
96.4
91.4
86.9
96.4
91.4
86.9
84.4
3.5
857
2397
9999+
DRILL MACHINE:Diedrich D-50 METHOD:HSA
COUNTY:BERTIE
2573265 854551
T.O.C. ELEV.:
TOTAL DEPTH:
WELL DEPTH:
NC
SHEET
NM
5.7
DEPTH
1
99.41
15.0
15.0
0 HOUR DTW:
24 HOUR DTW:END DATE:3/22/23
OF1
BORING LOCATION:West side of building
BLOW COUNT
0.5ft
START DATE:3/22/23
0.5ft
WELL ID:
STATE:
MW-21NORTHING:
LOGGED BY:
DRILLER:
CREW:
0.5ft0.5ft
EASTING:
PROJECT NO.:220298
SYSTEM:NCSP NAD 83 (USft)
Bazemore GroceryPROJECT:C. STRATTON
D. T. Chalmers, JR
T. MIZELLE
LOCATION:WINDSOR
ENVIRONMENTAL, CIVILGEOTECHNICAL
Wilmington, Raleigh, Washington,Charleston
CATLIN BORING LOG 220298_NCDEQ SLP BAZEMORE GROCERY.GPJ CATLIN.GDT 4/4/23Concrete Bentonite Pellets #2 Medium Sand
0.0
WELL LOG
WELL
DETAIL
SOIL AND ROCK
DESCRIPTIONLAB.DEPTH
MOIS
0.0 LAND SURFACE
LOG ELEVATION
99.4
OVA
(ppm)
220298
03/23/23
HSA
4146A
5.85
MW-22
-77.059911
D. T. Chalmers, JR
36.082491
BERTIE
1
X
4/4/2023
8.25
Surface Pour
CATLIN Engineers and Scientists
X
2 Slot .010
730/732 MOUNT OLIVE RD., WINDSOR, NC 27983
Bent. Pellets3
5
N/A
3 15
15.0
X 1
5 15 PVC
2
Sch. 40
0 Sch. 40 PVC
Well ID#:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
(if well field, one lat/long is sufficient)
N
6. Is (are) the well(s):
Yes
TemporaryPermanent or
or No7. Is this a repair to an existing well:
8. Number of wells constructed:
For multiple injection or non-water supply wells ONLY with the same construction, youcan submit one form.
9. Total well depth below land surface:
For multiple wells list all depths in different (example- 3@200' and 2@100')
W
(ft.)10. Static water level below top of casing:
If water level is above casing, use "+"
11. Borehole diameter:
MATERIAL
FROM
Residential Water Supply (shared)
Adapted from Form GW-1
ft.
ft.
ft.ft.
ft.ft.
ft.ft.
ft.ft.
ft.
ft.
(ft.)
(in.)
ft.
ft.ft.
ft.
ft.
ft.in.
in.
ft.
ft.
ft.ft.
ft.
ft.
13b. Disinfection type:
22. Certification:
Revised 2-22-2016
ft.
TO DIAMETER THICKNESS MATERIAL
FROM17. SCREEN DIAMETER SLOT SIZE MATERIALTHICKNESS
FROM TO MATERIAL
ft.ft.
ft.
ft.
FROM TO
18. GROUT
MATERIAL
19. SAND/GRAVEL PACK (if applicable)
1. Well Contractor Information:
This form can be used for single or multiple wells
Well Contractor Name
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Non-Water Supply Well:
Monitoring
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
15. INNER CASING OR TUBING (geothermal closed-loop)
Municipal/Public
Residential Water Supply (single)
ft.
ft.ft.
ft.ft.
ft.
ft.ft.
ft.
TO
EMPLACEMENT METHOD & AMOUNT
in.
in.
in.
EMPLACEMENT METHOD
Recovery
Injection Well:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance with15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a copy of
this record has been provided to the well owner.
If this is a repair, fill out known well construction information and explain the nature ofthe repair under #21 remarks section or on the back of this form.
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
13a. Yield (gpm)
FOR WATER SUPPLY WELLS ONLY:
Method of test:
Amount:
For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
FROM TO
24c. For Water Sypply & Injection Wells:Also submit one copy of this form within 30 days of completion of wellconstruction to the county health department of the county where constructed.
DIAMETER THICKNESS
FROM TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
21. REMARKS
20. DRILLING LOG (attach additional sheets if necessary)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
Signature of Certified Well Contractor Date
24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:
SUBMITTAL INSTRUCTIONS
Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-1617
Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-1636
16. OUTER CASING (for multi-cased wells) OR LINER (if applicable)
North Carolina Department of Environment and Natural Resources - Division of Water Resources
24b. For Injection Wells ONLY: In addition to sending the form to theaddress in 24a above, also submit a copy of this form within 30 days ofcompletion of well construction to the following:
WELL CONSTRUCTION RECORD
23. Site diagram or additional well details:
Aquifer Recharge Groundwater Remediation
Stormwater Drainage
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Salinity Barrier
Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed:
5a. Well Location:SEE
ATTAC
H
E
D
N/A
Unknown
0 1 Concrete
# 2 Medium Sand
Surface Pour
Surface Pour
NCDEQ-Bazemore Property
15.0
0.0
5.0
10.0
13.0
5
4
3
2
3
4
HOLE
3
3
2
POST
3
3
3
15.0
5.0
15.0
0.0
1.0
3.0
15.02" Sch. 40 PVC2" Slot .010Sch. 40 PVCD
M
W
Sat.
4.0
8.0
4.0
8.0
15.0
(ML) - Gray to brown, Sandy SILT. HCO
(CL) - Gray to brown with red mottling, Silty CLAY.
HCO
(SC) - Lt. gray to whhite grading to brown with red
mottling, Clayey SAND with interbedded silty clay at
depth. HCO
BORING TERMINATED AT ELEVATION 84.7 ft in
Clayey F. and Cse. SAND
95.7
91.7
95.7
91.7
84.7
276
2853
3256
956
DRILL MACHINE:Diedrich D-50 METHOD:HSA
COUNTY:BERTIE
2573254 854529
T.O.C. ELEV.:
TOTAL DEPTH:
WELL DEPTH:
NC
SHEET
5.9 NM
N/A
DEPTH
1
99.68
15.0
15.0
0 HOUR DTW:
24 HOUR DTW:END DATE:3/23/23
OF1
BORING LOCATION:NW corner of building
BLOW COUNT
0.5ft
START DATE:3/23/23
0.5ft
WELL ID:
STATE:
MW-22NORTHING:
LOGGED BY:
DRILLER:
CREW:
0.5ft0.5ft
EASTING:
PROJECT NO.:220298
SYSTEM:NCSP NAD 83 (USft)
Bazemore GroceryPROJECT:C. STRATTON
D. T. Chalmers, JR
T. MIZELLE
LOCATION:WINDSOR
ENVIRONMENTAL, CIVILGEOTECHNICAL
Wilmington, Raleigh, Washington,Charleston
CATLIN BORING LOG 220298_NCDEQ SLP BAZEMORE GROCERY.GPJ CATLIN.GDT 4/4/23Concrete Bentonite Pellets #2 Medium Sand
0.0
WELL LOG
WELL
DETAIL
SOIL AND ROCK
DESCRIPTIONLAB.DEPTH
MOIS
0.0 LAND SURFACE
LOG ELEVATION
99.7
OVA
(ppm)
220298
03/23/23
HSA
4146A
6.65
MW-23
-77.059736
D. T. Chalmers, JR
36.082473
BERTIE
1
X
4/4/2023
8.25
Surface Pour
CATLIN Engineers and Scientists
X
2 Slot .010
730/732 MOUNT OLIVE RD., WINDSOR, NC 27983
Bent. Pellets1
3
N/A
1 13
13.0
X 0.5
3 13 PVC
2
Sch. 40
0 Sch. 40 PVC
Well ID#:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
(if well field, one lat/long is sufficient)
N
6. Is (are) the well(s):
Yes
TemporaryPermanent or
or No7. Is this a repair to an existing well:
8. Number of wells constructed:
For multiple injection or non-water supply wells ONLY with the same construction, youcan submit one form.
9. Total well depth below land surface:
For multiple wells list all depths in different (example- 3@200' and 2@100')
W
(ft.)10. Static water level below top of casing:
If water level is above casing, use "+"
11. Borehole diameter:
MATERIAL
FROM
Residential Water Supply (shared)
Adapted from Form GW-1
ft.
ft.
ft.ft.
ft.ft.
ft.ft.
ft.ft.
ft.
ft.
(ft.)
(in.)
ft.
ft.ft.
ft.
ft.
ft.in.
in.
ft.
ft.
ft.ft.
ft.
ft.
13b. Disinfection type:
22. Certification:
Revised 2-22-2016
ft.
TO DIAMETER THICKNESS MATERIAL
FROM17. SCREEN DIAMETER SLOT SIZE MATERIALTHICKNESS
FROM TO MATERIAL
ft.ft.
ft.
ft.
FROM TO
18. GROUT
MATERIAL
19. SAND/GRAVEL PACK (if applicable)
1. Well Contractor Information:
This form can be used for single or multiple wells
Well Contractor Name
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Non-Water Supply Well:
Monitoring
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
15. INNER CASING OR TUBING (geothermal closed-loop)
Municipal/Public
Residential Water Supply (single)
ft.
ft.ft.
ft.ft.
ft.
ft.ft.
ft.
TO
EMPLACEMENT METHOD & AMOUNT
in.
in.
in.
EMPLACEMENT METHOD
Recovery
Injection Well:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance with15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a copy of
this record has been provided to the well owner.
If this is a repair, fill out known well construction information and explain the nature ofthe repair under #21 remarks section or on the back of this form.
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
13a. Yield (gpm)
FOR WATER SUPPLY WELLS ONLY:
Method of test:
Amount:
For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
FROM TO
24c. For Water Sypply & Injection Wells:Also submit one copy of this form within 30 days of completion of wellconstruction to the county health department of the county where constructed.
DIAMETER THICKNESS
FROM TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
21. REMARKS
20. DRILLING LOG (attach additional sheets if necessary)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
Signature of Certified Well Contractor Date
24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:
SUBMITTAL INSTRUCTIONS
Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-1617
Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-1636
16. OUTER CASING (for multi-cased wells) OR LINER (if applicable)
North Carolina Department of Environment and Natural Resources - Division of Water Resources
24b. For Injection Wells ONLY: In addition to sending the form to theaddress in 24a above, also submit a copy of this form within 30 days ofcompletion of well construction to the following:
WELL CONSTRUCTION RECORD
23. Site diagram or additional well details:
Aquifer Recharge Groundwater Remediation
Stormwater Drainage
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Salinity Barrier
Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed:
5a. Well Location:SEE
ATTAC
H
E
D
N/A
Unknown
0 0.5 Concrete
# 2 Medium Sand
Surface Pour
Surface Pour
NCDEQ-Bazemore Property
13.0
0.0
5.0
10.0
2
WOH
4
2
1
2
3
1
3
3
WOH
3
13.0
3.0
13.0
0.0 0.5
1.0
13.02" Sch. 40 PVC2" Slot .010Sch. 40 PVCD
W
Sat.
13.0
(SC) - Tan to gray, Clayey F. and Cse. SAND. Slight
HCO from 5.0-7.0' BLS
Brown to tan with red mottling from 10.0-12.0' BLS with
HCO
BORING TERMINATED AT ELEVATION 87.5 ft in
Clayey Cse. SAND
87.5
10.1
67
895
DRILL MACHINE:Diedrich D-50 METHOD:HSA
COUNTY:BERTIE
2573305 854523
T.O.C. ELEV.:
TOTAL DEPTH:
WELL DEPTH:
NC
SHEET
6.7 NM
N/A
DEPTH
1
100.51
13.0
13.0
0 HOUR DTW:
24 HOUR DTW:END DATE:3/23/23
OF1
BORING LOCATION:NE corner of building
BLOW COUNT
0.5ft
START DATE:3/23/23
0.5ft
WELL ID:
STATE:
MW-23NORTHING:
LOGGED BY:
DRILLER:
CREW:
0.5ft0.5ft
EASTING:
PROJECT NO.:220298
SYSTEM:NCSP NAD 83 (USft)
Bazemore GroceryPROJECT:C. STRATTON
D. T. Chalmers, JR
T. MIZELLE
LOCATION:WINDSOR
ENVIRONMENTAL, CIVILGEOTECHNICAL
Wilmington, Raleigh, Washington,Charleston
CATLIN BORING LOG 220298_NCDEQ SLP BAZEMORE GROCERY.GPJ CATLIN.GDT 4/4/23Concrete Bentonite Pellets #2 Medium Sand
0.0
WELL LOG
WELL
DETAIL
SOIL AND ROCK
DESCRIPTIONLAB.DEPTH
MOIS
0.0 LAND SURFACE
LOG ELEVATION
100.5
OVA
(ppm)
220298