GW1-2021-06820_Well Construction - GW1_20210404

WELL CONSTRUCTION RECORD For Irw ilUseONLY.
Tim farm can be used for sng:k or multwk wens
1.Well Contractor Information:
14.N A MR ZONn
Stefan Smith VIWM I to 1 tint-al►IO-4
Writ CoKraeetx Naerc
3576A .^
NC'lYrllConrat itorCcnifKatm Num
ber �r� . L L VROM ;4'
�� R TMICK�t[gg LM MATIR "
SASDACCO Incture r�=.'".•'J 'i� 0 n IL 2• h. SCIB-40 PVC
Caffouq Na MAM[Tn TRITKNM MATMAL
2.Well Construction Permit N ia'
l�n all.t1rph+uNr ttrl!lNrwrits li r.Cnuan..SrWr.1'ariarrr.I/�90t rr.'.) � � ^� � --'-
3.Will I'w(ebeck well Rue):
Water Supply Well: FROM TO I D InTxR I sI.OTIMIr I TWCU14MS MAT11111AL
❑Agncuhnral UMunicipR6'Public 4' n. 19' IL2a ia. .070 SCH-40 PVC
❑Geothermal tNeatingCooling Supph) ❑Residential Water Supph (single) ft. n
C)badustrial Cornntercial fJResidetKwl Water Supply(shared MOM TO MAT KtAkt, MTMVMOD it Asia.-tT
01trigallon 0 n. 2' n. Portland !Pour
Non-Water Supply Well:
MkIoniton ❑Rocoten
Injection
n, FL
DAquifer Recharge ❑Groundwater Reniediaticm It.AAN VQ,PACK
I'MOM 10 MATttR 1. N NT
D Aquifer Stomp andRecoten DSaIlmh Banter 3' n. 19, n. Sand 2
OAquifcr Teat ❑Stormwatcr Drainage
n. it.
❑E%pcnmcntal Technokylt 05ubsidnrc Control
M
DGoothennal(Closed Loop) ❑Tracer MOM TO DMAMTION rtsYr,lowlitom.wa'.wcs r &voi.a
OGeo iemtal(HeatingCooling Return) OOth"(explarn wrier 021 Rcrnalka) 0 n. 7' n. Sand
7' n. 11' tL Clayey sand
4.Date Well(s)Completed: 4-4-2 1 Well IDSMR2 11' ft. 14' n, Cemented sandy silt
5a.We"Illeatbin: 14' n. 19' n. Sandy silt
Former Circle K n. n.
Fac ilm O%Twr Nan i Fac ilih ins rif appihu bkt
3000 Jefferson Davis Hwy, Sanford, NC, 27332 n, FL
Fthtswal Address Cm..ud Zip
Lee 1 foot bentonite seal from 2 to 3 feet.
(.iwnh P.+ricl Idctacfccaliow No IPIN 1
tb.Latitude and Longitude in degreesrminatesfseconds nr decimal degrees: 22.Certification:
if wt ll fwtrl ntr Lit lom.rs stdlairaf)
35.416651 N 79.229389 W' � t 3/19/2021
Sigwu of Cc, hod Pik Contractor f roc
6.h(are)the well(s): SPermanent ur 11"emporap' th,iRa,ax An Ions.I herrbr errnfr thew tAr welNi!war Iwrfrl r-twivi weed w m-conAmir
with 154 NCAC O:f.0100 or I.tA NCAC a X.021M Wrd Costnwn 'ran SMwdrnds and dear a
7.Is tbif a repair to an existing well: Dl'es ur S No .,In of due reward hoc berm p m•idrd to Ow+.rll owwr.
I(aA+t+,„rrj�r+r.till+++r Ert,rxa rr!!r,.n+rrw tun In/urxwraau�wul rt(+i..aw the aarwr n/dM
rrryry wndrr t?/rraaarAi srt7iaw a rn doe bur!aJMris/orar. 23.Site diagram or addltimud well detaNs
You rna%use the back of this purge to provide a"Doml wtil site details or well
S.Number of welb constructed: 1 constnu iot details. You may also:attach adililiaod pages of ncucssan.
fi.r maltajilr aaln ram w wivi-wwWr iwjth wv4s ONLY wrth der wwr eoaviii 'NM.wrrr t wr
..%*bwut a.w huw- - SUBMITTAL INSTUMONS
9.Total well dgnb below land MrfaM 19 (ft.l 24a. For AN Wells Subrnt this 1'arni w itlnn 10 days of completion of well
Ftrr wraltr 4e wrllt ltsr all drjuAt tfdaJ}yrrnt arrrna«t,Ar-.re+e31X1'awd de?r IiNY! corturuction to the follottir*
10.Static water level below top et esshW 7 (ft.) Dn ifion of Water Remo reef.Information Precenitsg Usk.
f/whirr,lrtel a tatk.cr tairax.um"a' 1617 Mail Sc'rs'ice Center,Raleigh,N('276"-1617
11.Ber'elole diameter:8.2So Un.) 24b.For In leaks Welh ONLY: in adduan to sending the font to the adlism in
24aabo%e. also sabn»1 a coin of this fain within 10 days of completion of well
12.Wynn coustrwetMta Ra dm4.HSA construction to the folluw trig
a t c auger.roan.cable.diet pork ck i
DRfsbR of Water ResoRrres,Underground Injection Control Prograar,
FOR WATER St PPLY WELLS ONLY: 16A Mail Smice Center,Raleigh,NC 27699-1636
13a.Vidd(IW=)_,__--.-------._-__ Method of tmt: --- 1k.For Water 5RDD13&injection Wills:
-"- Also submit one copy of INs form within to "s of completion of
M.Disinfection type ._ Amount: well cormauctwn to the county beahb depanrthem of the county where
constructed
Fann C;W-I Nonli C analnu LNMvinntcnt tat Fm itunnrtu atd Natural Resoinecs"Dn avo of%%atcr Reson6 14%owd Atgoet 7_01+

CATLIN
WELL LOG Engineers and ScienUsfs
zzozss SHEET 1 OF 1
PROJECT NO.: 220239 STATE: NC COUNTY: HARNETT LOCATION: LILLINGTON
PROJECT NAME: WOMACK GROCERY LOGGED BY: COREY FUTRAL WELL ID:
DRILLER: D.T. CHALMERS JR. MW_01
NORTHING: 580318 1 EASTING: 2018361 CREW: TREVOR MIZELLE
SYSTEM: NCSP NAD 83 USft BORING LOCATION: -•20'on East side of Buil ing 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: 1/21/21 END DATE: 1/21/21 124 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 G DEPTH DESCRIPTION DETAIL
0.0 LAND_ SURFACE _ 0.0
ASPHALT _ 0'0a = 0.5
a'f (GWW)-ABC STONE with F.SAND
(SW)-Tan with orange.F.SAND 1.5
2.0 2.0 N
(CL)-Tan to gray with orange,Sandy moderatley plastic
CLAY
3.0
z 2 z z 1.4 MW-01 M
(51)
o�
oa
o0
�'c
(V�
8.0
8
t3 16 14 0.3 VV s 0 (SM)-Red to orange,Silty F.SAND
10.0
(SW)-Tan and orange,F.SAND
12.0 12.0 12.0 12.0
BORING TERMINATED AT DEPTH 12.0 ft in F.SAND
EjPortland Cement Bentonite Pellets #2 Medium Sand

Post Office Box 10279
Wilmington, North Carolina 28404-0279
CATLIN Telephone: [phone]
Engineers and Scientists Fax: [phone]
,www.catlinusa.com
April 13, 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 BoringLog
g
Womack Grocery
8268 NC 27 W, Lillington, NC 27546
Incident Number: 15452
CATLIN Project No.: 220239
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,
Sean O'Neil, PE
Project Manager
Enclosures
Boring Log and Well Construction Record