413447_Well Construction - GW1_20130513

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #:
1. WELL CONTRACTOR:
D.T. Chalmers
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington North Carolina 28405
City or Town State Zip Code
( 910) - 452-5861
Area code - Phone number
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) CHATEAU-TMWO1
3. WELL USE (Check One Box): Monitoring ® MunicipaVPublic 0
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation ❑ Other ❑ (list use).
DATE DRILLED: April 15 2013
4. WELL LOCATION:
(Street Name, Numbers, Community. Subd vision, Lot No., Parcel, Zip Code)
CITY: Jacksonville COUNTY: Onslow
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley ®Flat ❑Ridge ❑Other:
LATITUDE 34.6214 DD
LONGITUDE' 77.4851 DD
Latitude/longitude source: ® GPS ❑ Topo. map
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.)
5. FACILITY (Name of the business where the well is located.)
N/A N/A
Facility Name Facility ID # (if applicable)
Street Address
Jacksonville
NC
City or Town State
Ms. Jenni Reed
Contact Name
Attn: GF/ EMD/ EQB/ 12 Post Lane
Zip Code
Mailing Address
Camp Lejeune
City or Town
(910)- 451-5068
Area code - Phone number
NC
State
6. WELL DETAILS:
a. TOTAL DEPTH: 10
28542-0004
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casin • 0-9 FT.
(Use "4." if Above Top of Cgasing)
ht
413447
d. TOP OF CASING IC 0.00 FT Above Land Surface*
* Top of casing terminated attor below land surface may require
a variance In accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): WA METHOD OF TEST: WA
f. DISINFECTION: Type WA Amount: N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth
Thickness/
Diameter Weight Material
Top 0 Bottom 0 Ft. 2 in. Sch. 40 PVC
Top Bottom Ft. in.
Top Bottom Ft. in.
8. GROUT:
Top
Top
Top
9. SCREEN:
Top 0
Top
Top
Depth
Bottom Ft.
Bottom Ft.
Bottom Ft.
Depth
Bottom
Bottom
Material Method
Diameter Slot Size Material
10 Ft. 2 in. Slot .010 in. PVC
Ft. in. in.
Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top 1 Bottom
Size Material
10 Ft. #2 Medium Torpedo Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
12. REMARKS: fl
TEMPORARY TYPE II MONITORING WEL
AFTER SAMPL
Formation Description
z..
lllif��l'
I DO HEREBY CERTIFY T THIS WELL WAS CONSTRUCT sr IN ACCORDANCE WITH
15A NCAC 2C, WELL CON $Wt1CTION STANDARnc AND THAT A COPY OF THIS
RECORD HAS BEEN PROvVISI],,ED TO THE WELL OWNER
ez
SI TtlREOF CERTIFIED WELL CONTRACTOR
D.T. Chalmers
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW-1 b
Rev. 2/09

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #: 4146A
1. WELL CONTRACTOR:
D.T. Chalmers, Jr.
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington North Carolina 28405
City or Town State Zip Code
( 910) - 452-5861
Area code - Phone number
2. WELL INFORMATION
SITE WELL ID # (if applicable): CHATEAU-TMW 01
STATE WELL PERMIT # (if applicable): N/A
COUNTY WELL PERMIT # (if applicable): N/A
DWQ or OTHER PERMIT # (if applicable): N.A..
WELL USE (Check Applicable Use): IX] Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use):
3. WELL LOCATION:
COUNTY: Onslow QUADRANGLE NAME:
NEAREST TOWN: Jacksonville
(StreeVRoad Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code
TOPOGRAPHIC / LAND SETTING
❑Slope ❑Valley I$IFlat ❑Ridge ❑Other:
(Check appropriate setting)
LATITUDE: 34.6214 DD
LONGITUDE: 77.4851 DD
Latitude/longitude source: ® GPS ❑ Topo. map
(Location of well must be shown on a USGS topo map and attached to
this form if not using a GPS.)
4a. FACILITY - The name of the business where the well is located. Complete 4a and 4b.
(If a residential well, skip 4a; complete 4b, well owner Information only)
FACILITY ID #(if applicable) N/A
NAME OF FACILITY:
STREET ADDRESS:
Jacksonville
North Carolina
City or Town State
4b. CONTACT PERSONIWELL OWNER:
NAME: Ms. Jenni Reed
STREET ADDRESS: Attn: GF/ EMD/ EQB/ 12 Post Lane
Zip Code
CATLIN PROJECT NO.: 213047
5. WELL DETAILS:
a. Total Depth: 10 ft. Diameter: 2 in.
b. Water Level (Below Measuring Point): 0.9 ft,
Measuring point is 0.0 ft. above land surface
6. CASING:
Length Diameter
a. Casing Depth (if known): 0 ft. 2 in
b. Casing Removed: 0 ft. N/A in
7. DISINFECTION'
N/A
(Amount of 65% to 75% calcium hypochlorite used)
B. SEALING MATERIAL:
Neat Cement Sand Cement
Cement 20 Ib. Cement Ib.
Water gal. Water gal.
Bentonite
Bentonite Ib.
Type: Slurry_ Pellets_
Water 5 gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPL/,�G p,E,�f{ OF MATERIAL:
Pulled all well material! streeu�j.��a
sample then tremie toy' Ian surface with
grout. ). MAY l 3 2013
and
ment
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of
this form showing total depth, depth and diameter of screens (if any)
remaining in the well, gravel interval, intervals of casing perforations,
and depths and types of fill materials used.
11. DATE WELL ABANDONED 4/15/2013
I DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS R6EORD HAS BEEN PROVIDED TO THE WELL OWNER,
S 2--?v/3
NATUREDF CERTIFIED ELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who personally abandons his/her residential well
in accordance with 15A NCAC 2C .0113
D.T. Chalmers, Jr.
PRINTED NAME OF PERSON ABANDONING THE WELL
Modified from
Form GW-30
Rev. 5/10

LOG2
_seers
Engineers and Scientists
wELL 3g°' SHEET 1 OF 1
PROJECTNO.: 213047
STATE: NC COUNTY: Onslow
LOCATION: Jacksonville
PROJECT NAME: Chateau Rd.
LOGGED BY: Jeff Becken
WELL ID:
CHATEAU -
TMWO1
DRILLER: D.T. Chalmers
NORTHING: 3833873
EASTING:
272167
CREW:
SYSTEM: UTM NAD83 (ft)
BORING LOCATION:
T.O.C. ELEV.: 67.0
DRILL MACHINE: CME-45B (track)
METHOD: H.S.A.
0 HOUR DTW: 0.9
TOTAL DEPTH: 10.0
START DATE: 04/15/13
FINISH DATE: 04/15/13
24 HOUR DTW: N/A
WELL DEPTH: 10.0
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
(PPm)
LAB
o
s
o
G
SOIL AND ROCK
DEPTH DESCRIPTION ELEVATION
WELL
DETAIL
0.0 LAND SURFACE 67.0
0.0
Sat.
W
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FILL MATERIAL W/FABRIC FIBER ON TOP.
8.0 59.0
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s
e
3.0
—
2
2
2
2
0.0
-
-
8.0
a
2
3
4
4
0.0
..::
8.5 (SP) - Drk. tan, f. SAND. Uniform. V. loose. 58.5
(SP) - Med. brown w/med. tan, f. SAND.
Uniform. Loose.
10.0 57.0
10.0
_
_
Boring Terminated at Elevation
in f. SAND.
Temporary Well.
MAY
13Y:.
57.0 ft
1
1 3 2013
-------
c
2
a
a
#2 Medium Sand