GW1-2021-00816_Well Construction - GW1_20210215

WELL CONSTRUCTION RECORD For Inmrnal Ux ONLY
Thu form can be used tor.wek or moh,k wells
1.Well Contractor Information:
D.T. CHALMERS, JR. most m DF_uwr tON
Well Contractor Name h. R
4146A n. R
NC Well Contractor Certification Number
FROM TO DIAAffM OfnrTO z MAhlt1AL
CATLIN Engineers and Scientists 0 R 2 R 2 I. Sch.40 PVC
Company Name
FROM Rh DLesoTFR TwcwThss xL1TFRIAL
2.Well N/A Construction Permit M: R R. in.
List all appllcahle well perm2v(i_e_(•ounty,Slule, l'urmncv.injection etc.)
R R
3.Well Use(check well use):
Water Supply Weft: Most[ TO Du� slarstff Tm� tvNmuR
❑Agricultural ❑MumcipatPublic 2h. 12 h. 2 in. Slot.010 I Sch.40 PVC
❑Geothermal(Heatm&Coobng Supply) ❑Residential Water Supply(single) a R
❑Industrial/Comnnercial ❑Residential Water Supply(shared) FxaM TO numu,u. FAeuCEFtiMMFTFthDautoONr
❑Irrigation
Non-Water Supply Well: 0 R 0.5 it. Concrete Surface Pouf
®Monitoring ❑Recovery 0.5 R 1.5 ft Bent.Pellets Surface Pour
Injection Well: R R
O Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Stooge and Recover OSahmn'Barrier FROM TO s
❑Aquifer Test O Stmmwater Drainage 1.5% 12 Medium Sand Torpedo
❑Experimental Technology O Subsidence Control R rt
❑Geothermal(Closed Loop) OTmcer FROM TO oN c rocs rope. nsia ar.
❑Geothermal(Heating,'Coaling Return) ❑Wier(explain under a21 Remarks) R R
4.Date Well(s)Completed: 01121121 Well ID#: MW-01
Sa.Well Location: IwoVV
Alke Wurmock Wack Grocery a
tam R
R
Facility/Owner Name Facility DO(if applicable)
n
8268 NC 27 West,LILLINGTON,NC 27546
Physical Address.City,and Zip R R
HARNETT
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: . 22.Certification:
(if well field,one lac long is sufficient)
35.344498 N -78.93823 iv 1/2712021
s = C '; eofCmified Wdl Canuxta Dae
6.Is(are)the wee(s): OPermanent or OTemponry d tlr ngrunK F lh,.i/nnn.lhereh,crrn(v thutdreweflf,m ./were/amnmouahn uen,nknce wah� W MA('02('DIOOor15.4N(:4('02( 0200W,1l('m,s1n n.oS,..4irdaarrcldurtaropyuf
7.Is this a repair to an existing well: OYes or 01No rhtsr[pkAhu..heenprmrdeJtf)ihewellmwr
/fthms is a reMo,,Ill out,bunion well cemvirri,lum tnformmrm urel erplam t�.c•,r Ne of '`-
the repuv unler=21 remarky secium or on the herc'k of thiv form. J 23.Site diagram or additioml well details:
You may use the back of this page to provide additional well site details or will
8.Number of wells constructed: 1 construction details. You may also amch additional pages if necessary.
Fro multiple oyea m ur son-weer supply well.ONLY with the same construction,tru,
con s,dvmt ua Jorm. SL13MITTAL INSTRUCTIONS
9.Total well depth below land surfaces 12 (ft.) 24a.For AN Wells: Submit this form within 30 days of completion of well
For multiple wells 1i..t all depthv in different(example-3nu&2bs)'and 2a.100') construction to tTe following_
10.Static water level below,top of casing: 2.70 (g•) Division of Water Resources,Information Processing Unit,
11 iou,,level l..uh.,uamg 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.Wefi construction method: HSA completion of well construction to the following:
pier urger,nnup.ruble,direct pu.h etc.) Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
Igpml 24c.For Water Svodv&Infection Wells:
13a.Yield Method of test: 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'-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22.2016

CATLIN
WELL LOG - �s nren 1
SHEET 1 OF 1
PROJECT NO.: 220239 STATE: NC COUNTY: HARNETT LOCATION: LILLINGTON
PROJECT NAME: LOGGED BY: COREYFUTRAL WELLID:
WOMACK GROCERY DRILLER: D.T. CHALMERS, JR.
MW-01
NORTHING: 580318 FASTING 2018361 CREW: TREVOR MIZE:LLE
SYSTEM: NCSP NAD 83 (USft)_ BORING LOCATION: -20 on East side of Budding Near Diesel AST T.O.C.ELEV.:
DRILL MACHINE: CME_45B TRACK METHOD: HSA 0 HOUR DTW: 2.7 TOTAL DEPTH: 12.0
START DATE: 1121121 END DATE: 1/21/21 24 HOUR DTW: N/A WELL DEPTH: 12.0
DEPTH BLOW COUNT OVA LAB o poi SOIL AND ROCK WELL
asaosa asa cse, (PPm) s G DEPTH DESCRIPTION DETAIL
1,1 LAND SURFACE _- - 1— -
5 o n
- -- o AS�LT °° �- 0.5
IT-
I(GlM-ABC STONE with F SAND yy�i
j ' (SVV)-Tan vdth orange.F. SAND ll'ti 1.5
2C 20
(CL)-Tan to gray with orange.Sandy moderatley plastic 'I
3.0 — -- CLAY
` - 1.4 MA i M
(s8.0
A
0.3 -
ISM)-Red to orange.Silty F.SAND
100
1SWge. F. SAND
12.0 _ 120 12.0
12.D
BORING TERMINATED AT DEPTH 12.0 ft in F SAND
T —
Ponland Cement eenton,te Pellets 42 Metlwm Sand