GW1 - Onslow Dec-Nov 2017

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#:
List all applicable well construction permits (i.e. County, State, Variance, ele.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
0 Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 11/14/17 Well ID#
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under#21 Remarks)
5a. Well Location:
PANTRY - 3075
MW-2
Facility/Owner Name Facility ID# (if applicable)
2868 PINEY GREEN ROAD JACKSONVILLE 28544
Physical Address, City, and Zip
ONSLOW
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34° 42' 58.83" N 77° 19' 19.78"
6. Is (are) the well(s): t7Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or tNo
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 of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: (ft.)
For multiple wells list all depths if different (example- 3@a 200' and 2Q100')
10. Static water level below top of casing: 7•0 (ft.)
limner level is above casing, use "+"
11. Borehole diameter: 7•0
(in.)
12. Well construction method: AUGER
(i.e. auger, rotary, cable, direct push, etc.)
12.0
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
446005
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft•
2.0 fl•
2.0 in.
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2.0 ft.
12.0 ft.
2.0 1n'
.010
SCH 40
PVC
ft.
ft.
in.
lS. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft.
1.0 fl•
PORTLANDBENTOMTE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1.5 ft,
12.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain size, etc.)
0.0 ft'
12.0 ft•
BROWN/TAN SILTY SANDY CLAY
ft.
ft.
rt.
ft.
; e'n. d .
r-c,,
ft.
ft.
-.,-. A,,..t" .- . - .
ft.
ft.
DEC to 0 l 2017
ft.
ft.
ft.
ft.
tt1FUi'i11 N)fl })recik°"s`ily 1•1
`i (
21. REMARKS
BENTONITE SEAL FROM 1.0 TO 1.5 FEET
a
22. Cerlificatim • /��
Signature of a re eII Contractor
11/22/17
Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with ISA NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that o
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
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.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, information Processing Unit,
1617 Mail Service (tLtAIR I N 2i 699-�166/177
24b. For Iniection Wells: In addition to sending thecorrili tQilfRiddress in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
DEC 1 1 2017
Division of Water Quality, Underground InjectionControl Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
Wate Q
24c. For Water Supply & Iniection am Oiling the form to
the address(es) above, also subfin t t gwithin 30 days of
completion of well construction to the t RigiNahlafffigEnt of the county
where constructed.
Form GW-1
Noah Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Colony. State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑ Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
G3Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 11/14/17 Well ID#
❑Groundwater Retnediation
OSalinity Barrier
❑Stormwater Drainage
❑ Subsidence Control
❑Tracer
Other (explain under #21 Remarks)
5a. Well Location:
PANTRY - 3125
Facility/Owner Name
MW-4
Facility ION (if applicable)
116 PINEY GREEN ROAD JACKSONVILLE 28546
Physical Address, City, and Zip
ONSLOW
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
34° 47' 08.76" N 77° 22' 44.12" w
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill out known well con.srruetion information and explain the nature (lithe
repair under t:11 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 12.0 (ft.)
For multiple wells list all depths ifdiffere» r (example- 3 rt 200' and 2 !00')
10. Static water level below top of casing: 7•0 (ft.)
!f water lerel is above casing, use "+ "
11. Borehole diameter: 7,0 (in.)
12. Well construction method: AUGER
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 fi.
2.0 ft.
2.0
in.
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2.0 ft'
12.0 rL
2.0 in.
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 fr.
1.0 ft.
PORTLPNOBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1.5 Ir.
12.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (aria h additional sheets if necessary)
FROM
0,0 fL
ft.
TO
12.0 ft.
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
BROWN/BLACK/TAN SILTY SANDY CLAY
H.
ft.
fr.
ft.
ft.
ft.
ItiThrm , a
1,61
ft.
fr.
DEC ID 2017
R.
21. REMARKS
ft.
BENTONITE SEAL FROM 1.0 TO 1.5 F'EE`�l J4r
22. Certification.,/41
Signature of e ell Contractor
11/22/17
Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with /5A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
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.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center,
Raleigh, NC 27699-1617
24b. For Infection Wells: InNddil¢IVE he address in 24a
above, also submit a copy of this form within 3��mpletion of well
construction to the following: nn CC
Division of Water Quality, UrGigGot1ngIn Control Program,
1636 Mail Service Center, Rale erg
27699-1636
24c. For Water Supply & Inie1>{ila)V I aj1,ditton to sending the form to
the address(es) above, also subnn tt,9Yol' trit0ttt�¢ti4n within 30 days of
completion of well construt C y§f Nepartment of the county
where constructed. On eglonal Office
FormGWI
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised /tus. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, Stare, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
Monitoring ❑Recovery
Injection Well:
❑Aquiter Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 11/14/17
5a. Well Location:
PANTRY - 3125
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
Well ID#
MW-3
Facility/Owner Name Facility 1D# (if applicable)
116 PINEY GREEN ROAD JACKSONVILLE 28546
Physical Address, City, and Zip
ONSLOW
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34° 47' 08.76" N 77° 22' 44.12"
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
!f this is a repair, fill out known well construction information and explain the nature oldie
repair under 021 remarks section or on the back of this'brut.
S. Number of wells constructed: 1
For multiple injection or non -Water supply wells ONLY with the sante construction, you can
submit one form.
9. Total well depth below hind surface: 12.0 (ft.)
For multiple wells hst all depths ifdifferent (example- 3 cer200' and 2 tr 100')
10. Static water level below top of casing: 7•0 (ft.)
!Prater level is above casing, use "+ ••
11. Borehole diameter: 7•0 (in.)
12. Well construction method: AUGER
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type. Amount:
Form (iW-1
For Internal Use ONLY:
4460
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft•
2.0 ft•
2.0 in.
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2.0 ft•
12.0 ft•
2.0 '"'
.010
SCH 40
PVC
ft.
ft.
in.
IS. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft•
1.0 ft.
PORTLAND5ENTOMTE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1.5 ft•
12.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.0 ff•
12.0 ft•
BROWN/BLACK/TAN SILTY SANDY CLAY
ft.
ft.
ft,
ft.
' r'i '-
ft.
ft.
r---cr
x_"
Y < i.n tt Lau `A A
ft.
ft.
9
ft.
ft.
GEC U 20'
ft.
ft.
infra •:t"v:1flfl Pr{'i;P.?;Wi
21. REMARKS Li1J( ?.1'� j
BENTONITE SEAL FROM 1.0 TO 1.5 FEET
11
22. Certification:
Signature of Certified Well Contractor
11/22/17
Date
Hy signing this farm. 1 hereby certtt& that the well(s) was (Were) constructed in accordance
with 1 SA NCAC 02C .0100 or i5A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
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.
SUBMITTAL INSTUCTiONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this.iorm within 30 days of completion of well
construction to the following: CEIVED/NCDENN/DWR
Division of Water Quality, Underground injection Control Program,
1636 Nlail Service Center Raleigh, NC 27699-1636�t
24c. For Water Simply & IniectionNeils Tn a di1io�MS�nding the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to Vnoepclu'It,y fntshih department of the county
where constructed. �t Y Regional
h
Operations Section
North Carolina Department of Environment and Natural Resources - Division of Water Q iality on Regional Office Revised Jan. 2013
7
g .1nh

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
D.T. Chalmers, Jr.
Well Contractor Name
4146A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
List all applicable well permits (i.e. County, State, Variance, Injection, etc)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
❑ Residential Water Supply (single)
0 Residential Water Supply (shared)
Non -Water Supply Well:
® Monitoring 0 Recovery
Injection Well:
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
0 Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Return)
❑ Groundwater Remediation
0 Salinity Barrier
0 Stormwater Drainage
0 Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed. 08/02/17 Well ID#: USTPW647-MWO5
5a. Well Location:
MCB. Camp Lejeune
Facility/Owner Name
Facility ID# (if applicable)
, JACKSONVILLE
Physical Address, City, and Zip
ONSLOW
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
k--1I461 N -^l69 w
6. Is (are) the well(s): ®Permanent or OTemporary
7. Is this a repair to an existing well: OYes or No
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 of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you
can submit one form.
9. Total well depth below land surface: 12 (ft.)
For multiple wells list all depths in different (example- 3 200'and 2@I002
10. Static water level below top of casing: 2.98 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 2 (in.)
12. Well construction method: 4.25" H.S.A
(Le. auger, rotary, cable, direct push, etc)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For internal Use ONLY: '
446737
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
ft
ft.
ft.
15. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DAMETER
THICKNESS
MATERIAL
0 fur
2 rt.
2 In.
Sch. 40
PVC
16. OUTER CASING (for twilit -eased wefts) OR LINER Of applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2 ft
12 rt
2 in,
Slot .010
Sch. 40
PVC
ft
ft
in,
1& GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft
ft.
_
0 rt
0.5 n.
ft.
ft.
19. SAND/GRAVEL
PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
0.5 rt.
l/R1r6.1edium
Sand #2 Medium Sand
ft
ft.
20. DRILIdNG LOG(attach addldonalaheeta if neceassay)
FROM
TO
DESCRIPTION (color, hardness, soilfrock type, grain size, etc.)
ft
!t
ft
!t
tile._ft
!t
Ssilo
ft.
ft
��
it.P
,E
ft.
P•••11 ECGE1 C
ft
NOV 1 4 2017
21.REMARKS
)ntormatierL2Lo.^.t SiCig Usip
DWQ/ OG
22. Certification:
W!
I1
Signature of Certified Well Contractor t
11/8/2017
Date
By signing this form, I hereby certify that the well(s) ens (were) constructed in accordance with
15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of
this record has been provided to the wet! owner.
23. Site diagram or additional well details:
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.
SUBMITTAL INSTRUCTIONS
24a. For AU Wells: Submit this font
construction to the following:
ti I.
%tiatldMM of well
Division of Water Resources, InformaijimsProseming Unit,
1617 Mail Service Center,11Qiihr, 2617
24b. For Injection Wells ONLY: In addition to sending the form to the
address in 24a above, also submit a cop of this o +jBRi✓s of
completion of well construction to the ffet.13"' 4
Operatioans � ifiice
Division of Water Resources, Unckydrn11it�9iijectto on rot Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Syppyv & Injection Wells:
Also submit one copy of this form within 30 days of completion of well
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

J . CATLIN
Engineers and Scientists
217089.03_12-8055.18 SHEET 1 OF 1
WELL
LOG
PROJECT NO.: 217089.03 12-80 1>f: NC
COUNTY: ONSLOW
LOCATION: JACKSONVILLE
PROJECT NAME: PSW 647 SITE ASSESSMENT
REPORT
LOGGED BY: K.PRESSLEY
_
WELL ID:
USTPW647-
MWO5
DRILLER: D.T. Chalmers, Jr.
NORTHING: 356346
EASTING: 2499479
CREW:
SYSTEM: NCSP NAD 83 (USft)
BORING LOCATION:
_
T.O.C. ELEV.:
DRILL MACHINE: CME 45B TRACK
METHOD: 4.25" H.S.A.
0 HOUR DTW: 3.0
TOTAL DEPTH: 12.0
START DATE: 8/2/17
END DATE: 8/2/17
24 HOUR DTW: N/A
WELL DEPTH: 12.0
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
(Ppm)
LAB
o
s
o
G
SOIL AND ROCK
DEPTH DESCRIPTION
WELL
DETAIL
0.0 LAND SURFACE
0.0
0.0
-
0.0
D
".
° 3 laden
_
-
_ 2.0
0.5
_.
-
‘Surficial organic soil /
(SC) - Brown grading to dark brown, f„ clayey SAND,
no HCO
6.0
5.0
—
_
i
2
3
3
0.0
Sat.
(SP) - Tan, f., POORLY GRADED SAND, no HCO
S.0
a`a-
- 6v
_ C
—
-
-
12.0::
—"
— fi
=
_
—_
12.0
j
j
/
(CL) -Gray, sandy LEAN CLAY, no HCO
12.0
Sat.
10.0
-
-
1
0
2
1
0.0
12.0
—
-voivb
_
BORING TERMINATED AT DEPTH 12.0 ft
��esi%/4C,�
�v 2if
ZQ � j
fat ,_ �
Pfri/hPee
5A k
-
—
-
—
Bentonite Pellets#2 Medium Sand

CATLIN
Engineers and Scientists
November 8, 2017
North Carolina Department of Environmental Quality
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: NC Well Construction and/or Abandonment Record(s)
PSW 647 SITE ASSESSMENT REPORT
JACKSONVILLE, North Carolina
CATLIN Project No.: 217089.03_12-805 5.18
To Whom It May Concern:
Post Office Box 10279
Wilmington, North Carolina 28404-0279
Telephone: [phone]
Fax: [phone]
www.catlinusa.com
CATLIN Engineers and Scientists (CATLIN) recently constructed and/or abandoned well(s) at the
above referenced site. Attached to this letter are completed North Carolina Well Construction Records
and/or North Carolina Well Abandonment Records with associated Attachment(s) for the above
referenced site located at in JACKSONVILLE, North Carolina.
If you have any questions or require any additional information, please feel free to contact us at (910)
452-5861.
Sincerely,
/' efL---
Michael E. Mason, P.E.
Project Manager
Enclosures
S:IGINTIPROJECTSIDAVENPORT1216105_12-808 5.18_PSW 647 ASSESSMENT RPT.GPJ.«DrawingFileSpec»
RFCFIfr
.cAmpDFNR/D►y
NOV 2O1n-7
Water WlJdli(
Wii Operation,wriY K,
r :.H
r4'N

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor information:
D.T. Chalmers, Jr.
Well Contractor Name
4146A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
0 Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Well:
® Monitoring
0 Recovery
Injection Well:
0 Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
0 Experimental Technology
❑ Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑ Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 10/02/17
5a. Well Location:
MCB, Camp Leieune
Facility/Owner Name
wellUSTPW647-MWO6
Facility ID# (if applicable)
, JACKSONVILLE
Physical Address, City, and Zip
ONSLOW
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
zjy,1��160CfCJ"I1 N
6. Is (are) the well(s): ®Permanent or OTemporary
7. Is this a repair to an existing well: Oyes or No
If this is a repair, fill out known well construction information and explain the nature of
the repair under 1121 remarks section or on the back of this form.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you
can submit one form.
9. Total well depth below land surface: 12
For multiple wells list all depths in different (example- 3@200' and 2@1009
10. Static water level below top of casing: 3.16 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 2 (in.)
12. Well construction method: 4.25" H.S.A.
1
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft
rt
ft
ft.
15. INNER CASING OR TUBING (geothermal closed-loopl
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 it
2 ft
2 in.
Sch. 40
-
PVC
16, OUTER CASING (for intlti-cased wells) OR LINER Of applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft
in.
ft
ft
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2 ft
12 rt.
2 a
Slot .010
Sch. 40
PVC
ft.
ft
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft
ft
0 ft.
0.5 ft.
ft.
ft
19. SAND/GRAVEL
PACK (if
applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
0.5 ft
1R2rAledium
Sand #2 Medium Sand
ft
ft
20. DRILLING
LOG (attach additional
sheets 1f necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, gain size, etc.)
ft.
ft
ft
ft
et.
ft
ft
s es)
ft
ft
ftpipicoNN
11.411
ft.
ft
CE.1V1 r .
21. REMARKS
NOV 14 2n17
22. Certification:
)7'441/
Signature of Certified Well Contractor -
DV C)/11C)Ci
.)
11/8/2017
Date
By signing this form, l hereby cernfy that the wells) xns (were) constructed in accordance pith
15A NCAC 02C .0100 or 15A NCAC 02C.0200 Well ConstnrcRon Standards and that a copy of
this record has been provided to she well owner. Vjt/
23. Site diagram or additional well details: ((�� /ktp/A/�f
You may use the back of this page to provide additional well site detaildetadVeutp
construction details. You may also attach additional pag Af V essary. Q/0/11?
2p
of complet of well
construction to the following: )� Oper ��/j
'l/n at/o rY 6)6,
Division of Water Resources, inform bg�o�e it g,j. it,
1617 Mail Service Center, Raleigh, N ,§Q . 1
24b. For Injection 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
completion of well construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Svppiv & Injection Wells:
Also submit one copy of this form within 30 days of completion of well
construction to the county health department of the county where constructed.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form withiN6da
Adapted from Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised 2-22-2016

WELL
LOG
1-�TLIN
Engineers and Scientists
217089.03_12.805 5.18 SHEET 1 OF 1
PROJECT NO.: 217089.03_12-80S1O: NC
COUNTY: ONSLOW
LOCATION: JACKSONVILLE
PROJECT NAME: PSW 647 SITE ASSESSMENT
LOGGED BY: K.PRESSLEY
WELL ID:
REPORT
DRILLER: D.T.' Chalmers, Jr.
USTPW647-
NORTHING: 356369_
EASTING: 2499467
CREW:
MWO6
SYSTEM: NCSP NAD 83 (USft)
BORING LOCATION:
T.O.C. ELEV.:
DRILL MACHINE: CME 45B TRACK
METHOD: 4.25" H.S.A.
0 HOUR DTW: 3.2
_
TOTAL DEPTH: 12.0
START DATE: 10/2/17
END DATE: 10/2/17
24 HOUR DTW: N/A
WELL DEPTH: 12.0
DEPTH
BLOW
0.5ft
COUNT
0.5ft
0.5ft
OVA
(Pm)s
LAB.0.5ft
o
o
G
SOIL AND ROCK
DEPTH DESCRIPTION
WELL
DETAIL
0.0 LAND SURFACE
o.o
0.0
''t �.
°
° s \Surifical organic laden soil -_
:'�' 0.5
0.0
D
7' :
(SC) - Brown grading to dark brown, f., clayey SAND,
no HCO
_
2.0
1
i.
on
No
i.
5.0
2
0.0
s.0
_
.:':.,.
3
3
Sat.
..
•
(SP) - Tan, f., POORLY GRADED SAND, no HCO
—
>
oa
E
m •..
.:.
— ./
oar:::
;',,A:
::
10.0
-
12.0
°
2
1
0.0
Sat.
%
(CL) -Gray, sandy, LEAN CLAY, no HCO
12.0
—
—
_
12.0
p
NE
m
_
leg
_:,:::
=
-
-
BORING TERMINATED AT DEPTH 12.0 ft
Noy
4
bkii v e--0
s S i
� %,P�'6'O/`'O/'d/
,j
0,27
12.0
%Yqi®/kip
—
Bentonite Pellets El #2 Medium Sand