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Home My WebLink AboutGW1-2021-01897_Well Construction - GW1_20210429 WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can be used for single or multiple wells 1.Well Contractor Information: 14.WATER ZONES D.T. CHALMERS JR. FROM TO DESCRIMM Well Contractor Name 4146A NC Well Contractor Certification Number / Q, J� 15 INNER CASING ORTI'BING eothermal closed-loo C�. Sg\�(� FROM TO U1:1\IE.lFR ll Ilch\Ia` \I\ II:I\I. CATLIN Engineers and Scientists �� y �c�. 12.5 ft. 12.5 e. 2 �,. Sch. 40 PVC Company Name ;C� �g+�- 16.OUTER CASING for multi-cased wells OR LINER if a licable FROM TO DOMESER THICKNESS VATERIAL. 2.Well Construction Permit#: N/A � � ft. it. in. List all applicable well permits(t.e.County,State, VAWce,Injection,etc.) - ft. 3.Well Use(check well use): n.s(REEN Water Supply Well: I r,O\1 TO DI\\11 IER SLOTSVE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public 12.5 rt. 22.5 it. 2 in. Slot.010 Sch.40 PVC ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in. ❑Industrial/Commercial ❑Residential Water Supply(shared) I&GROUT FROM TO \1\IERI.AL EMPLACE\tE\T METHOD R A.\IOC,r ❑Irrigation Of(. 0.5 1t. Portland Cement Surface Pour Non-Water Supply Well: - 90Monitoring ❑Recovery 0.5 it. 10 it Bent.Pellets Surface Pour Injection Well: u. u. ❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK ifs licable ❑Aquifer Storage and Recovery ❑Salinity Barrier FRO\l TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑Stormwater Drainage 10 It. 25# Medium Sand Torpedo Said ❑Experimental Technology ❑Subsidence Control e. rt. 20.DRILLING LOG tattasch additional sheets if necessary) ❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION I color,hardness sod rock is pe,grain sin,etc 1 ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 4.Date Well(s)Completed: 02/24/21 Well ID#: MW-01 n• h. C C=�- ft 5a.Well Location: A �� Ruth Daniels Shorty's Site Facility/Owner Name Facility @#(if applicable) - R. 202 S.CHURCH ST.,KENLY,NC Physical Address,City,and Zip 21.REMARKS JOHNSTON County Parcel Identification No.(PIN) 5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: t (if well field.one[at/long is sufficient) 35.595133015 N -78.126242943 W � ll�l� 3/8/2021 Signature of Certified Well Contractor Date 6.Is(are)the well(s): ®Permanent or O Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in u-0 rdame"11h 15A N(AC 02C.0100 or 15A N(AC 02C.0200 Well Consiruction 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. Ifthis is a repair,fill out known well construction information and explain the nature of the repair under#21 remarks section or on the back ofthis 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-water supply wells ONLY with the same construction,you SUBMITTAL INSTRUCTIONS can submit one form. 9.Total well depth below land surface: 22.5 (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 a200'and 2@100) construction to the following: 10.Static water level below top of casing: 17.85 (ft.) Division of Water Resources,Information Processing Unit, Ifwater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 8.25 (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 SvaDly&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-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016 Z�`" CATLIN WELL LOG Engineers and Scientists zzozs, SHEET 1 OF 2 PROJECT NO.: 220231 STATE: NC COUNTY: JOHNSTON LOCATION: KENLY PROJECT: SHORTY'S SITE LOGGED BY: COREY FUTRAL WELL ID: DRILLER: D.T. CHALM_ERS, JR. MW-01 NORTHING: 672730 1 EASTING: 2259835 CREW: TREVOR MIZELLE SYSTEM: NCSP NAD 83 USft BORING LOCATION: —30'FROM S.CHURCH ST.NEAR TANK BASIN T.O.C.ELEV.: DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HOUR DTW: 17.9 TOTAL DEPTH: 25.0 START DATE: 2/24/21 END DATE: 2/24/21 124 HOUR DTW: N/A WELL DEPTH: 22.5 DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL 0.5ft 0.5ft 0.5n 0.5n (PPM) s G DEPTH DESCRIPTION DETAIL 0.0 LAND SURFACE o 0 (CH)-Tan with orange mottling grading to gray with tan 0.0 — 0.5 and orange mottling,Sandy highly plastic CLAY 3.0 , 2 2 3.5 M 4 5.0 (CH)-Brown grading to tan with red mottling,Silty Sapprolitic highly plastic CLAY a Mod.HCO from 5.0-10.0'BLS Very Strong HCO from 10.0-15.0'BLS (V 8.0 5 13 22 1,163 D zs 10.0 12.5 13.0 26 52 58 2,401 ((13-15') D 15.0 (CL)-Brown to tan and red,Silty slightly plastic CLAY. Slight HCO 17.0 0 U (CH)-Brown grading to tan with red mottling,Silty o 0 Sapprolitic highly plastic CLAY. Slight HCO r 18.0 NN 12 zo 26 2,667 W zs 20.0 (ML)-Tan to brown with red matting,Clayey Sapprolitic SILT. Strong HCO ElPortland Cement MBentonite Pellets El#2 Medium Sand WELL LOG CATLIN Engineers and Scientists zzoz3t SHEET 2 OF 2 PROJECT NO.: 220231 STATE: NC COUNTY: JOHNSTON LOCATION: KENLY PROJECT: SHORTY'S SITE LOGGED BY: COREY FUTRAL WELL ID: DRILLER: D.T. CHALMERS JR. MW-01 NORTHING: 672730 EASTING: 2259835 CREW: TREVOR MIZELLE SYSTEM: NCSP NAD 83 USft BORING LOCATION: —30'FROM S.CHURCH ST.NEAR TANK BASIN T.O.C.ELEV.: DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HOUR DTW: 17.9 TOTAL DEPTH: 25.0 START DATE: 2/24/21 END DATE: 2/24/21 124 HOUR DTW: N/A WELL DEPTH: 22.5 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 (ML)-Tan to brown with red motting,Clayey Sapprolitic SILT. Strong HCO(continued) 22.5 23.0 6 14 191.2 D 30 25.0 25.0 25.0 BORING TERMINATED AT DEPTH 25.0 ft Portland Cement Bentonite Pellets #2 Medium Sand