GW1-2021-00554_Well Construction - GW1_20210226

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple Hells
1.Well Contractor Information: REE1V
D.T. CHALMERS JR. FROM TO DESCRIPTION
Well Contractor Name FEB 2 0 Mt ft. ft.
4146A infonriation Processing L nit M. rt
NC Well Contractor Certification Number DWR Section 1�S1 NPER{ 5G`O"R>TtJ�IN e
FROM 1 TO DIAMETER I THICICJESS I MATERIAL
CATLIN Engineers and Scientists 0 ft.1 2 rt 2 in. Sch.40 PVC
Company Name 1116`:XO'i`�TEl"�A�.IPI
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: N/A a. ft. in.
List all applicable well permits(i.e.County,State, Variance,injection,etc.)
ft. ft. in.
3.Well Use(check well use):
Water Supply Well: FROM To DIAMETER SLOTSIZE TFRctwEss MATERIAL
❑Agricultural ❑Municipal/Public 2 rt. 12 ft. 2 in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. rt. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) &tGEO
FROM TO MATERIAL EN[PLACEMENT METHOD&AMOUNT
❑Irrigation 0 rt. 0.5 0. Portland Cement Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 0.5 rt. 1 rt. Bent.Pellets Surface Pour
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation9?rS 11YD/G�"RA'VIIP'AGI i • e
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EN[PLACEMENTMETHOD
❑Aquifer Test ❑Stormvater Drainage 1 rt. 12#J Medium Sand Torpedo Sa d
❑Experimental Technology ❑Subsidence Control n. rt.
O�D�t[11LINC} 1 tt c t 6 ts�tn
❑Geothermal(Closed Loop) ❑Tracer FROM I TO DESCRIPTION color,hardness.soil/rock twe,wain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed: 02/19/21 Well ID#: MW-01 ft.
n. a. S �O
5a.Well Location:
fit. fit. ,� P
William D.Brown,Jr. Halpern Ocean Isle Property
`t P
Facility/Owner Name Facility ID#(ifapplicable)
a.
1560 Market Place Blvd,Ocean Isle,NC 28469
Physical Address,City,and Zip
#21 S
BRUNSWICK
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one lat/long is sufficient)
33.903208 N 78.440829 W 2/22/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or O Temporary By signing this form,I herehv certifi,that the well(s)was(were)constructed in accordance with
ISA NCAC 02C.0100 or 15,4 NC.'AC 02C.0200 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: O Yes or ®No this record has been provided to the well owner.
if this is a repair,fill out known well construction information and explain the nature of
the repair under 921 remarks section or on the back oJthis form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed' 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-writer supply wells ONLY with the same construction,You
can submit one.form. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 12 (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 rr 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
11.Borehole diameter: 6 (in.) 24b.For Infection 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 Syaaly&Infection 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-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

Post Office Box 10279
Wilmington, North Carolina 28404-0279
��- CATLIN Telephone:[phone]
Engineers and Scientists Fax:[phone]
www.catlinusa.com
February 22, 2021
North Carolina Department of Environmental Quality
Division of Water Quality
Information Processing
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: North Carolina Well Construction Record and Boring Log
Halpern Ocean Isle Property
1560 Market Place Blvd., Ocean Isle, NC 28469
Incident Number: 24276
CATLIN Project No.: 220202
To Whom it May Concern,
CATLIN Engineers and Scientists (CATLIN) recently constructed one (1) monitoring well
at the above referenced site. The completed North Carolina Well Construction Record
and Boring Log are attached.
If you have any questions or require additional information, please feel free to contact
us at [phone].
Sincerely,
Benjamin J. Ashba P.G.
Project Manager
Enclosures
Boring Log and Well Construction Record

CAT LIN
Engineers and scientists
WELL LOG 220202 SHEET 1 OF 1
PROJECT NO.: 220202 STATE: NC COUNTY: BRUNSWICK LOCATION: Ocean Isle
PROJECT NAME: Halpern Ocean Isle Property LOGGED BY: COREY FUTRAL WELL ID:
DRILLER: D.T. CHALMERS JR. MW-01
NORTHING: 56233 1 EASTING: 2169708 CREW:
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Corner of CausewayDr.and Publix entrance in grass T.O.C.ELEV.:
DRILL MACHINE: CME 45B TRACK METHOD: HSA 10 HOUR DTW: N/A TOTAL DEPTH: 12.0
START DATE: 2/19/21 END DATE: 2/19/21 124 HOUR DTW: N/A WELL DEPTH: 12.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) s c DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
3 (SW)-Brown grading to dark gray and black,F.SAND. 0.0> - 0.5
Strong HCO 1.0
2.0 N
5.0
2 t
3 NM M "
3 3
o a
-0•a o
oa
9.0
(SW)-Dark gray to tan and brown,F.SAND. Strong
HCO. Sheen at 11.0'BLS.
3 ;�:•;i
'
a M Sat.N
5
12.0
12.0 12.0 12.0
BORING TERMINATED AT DEPTH 12.0 ft
Note:Well finished with well shield and well locking cap
Portland Cement Bentonite Pellets El#2 Medium Sand