GW1-2021-06662_Well Construction - GW1_20211007

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information: .
--I WATERZONES ".1 a ..s.v_x: r: .:??*••w.:;s'..3'$ice+ r>
D.T. CHALMERS, JR. O r ,.t.t)k FROM TO DESCRIPTION
Well Contractor Name O�T � VJe
4146A
NC Well Contractor Certification Number 15kINNER'C1aSING0R`:TUBINGi 6othermnldosedrloo ?/;,i c` °
\01C�r` FROM TO DIAMETER TtUCIQVESS =MATERIAL
CATLIN Engineers and Scientists Oft! 10 n. 2 Sch.40 1 PVC
Company Name '16:,OUTERPGASINGf'for:niulti°caseUt ells'uOR1UINER"if n licable K�' ,� ug'>�*a
FROM TO DIAMETER IMCKNESS MATERIAL
2.Well Construction Permit#: NSA R. ft in.
List all applicable well permits(i.e.County.State, Variance,injection,etc.)
fL ft in.
3.Well Use(checkwell use): _
17:-.:SCREEN,; _`� _•: .,:.; err„ :. .n{3: �'x-rt..y
Water Supply Well: FROM To DIAMETER SLOT SIZE 'THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 10 a. 20 ft. 2 in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.Gf OUT' :- •.
FROM TO MATERIAL EMPLACEMENT h IETHOD&AMOUNT
❑Irrigation 0 ft. 1 ft Portland Cement Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 1 ft. 8.5 ft Bent.Pellets Surface Pour
Injection Well: ft. ft
❑Aquifer Recharge ❑Groundwater Remediation 19.SaYDI6RAVELvPA"CKirfn6''lica'ble . 7 ".':
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I Eh PLACEMENT METHOD
❑Aquifer Test ❑Stomlwater Drainage 8.5 ft. 22 rt. $2 Medium Sand Torpedo Sand
❑Experimental Technology ❑Subsidence Control ft. FL
:20.-DRILliING�LOG1 iitt5ch addifidnl sheet`s'�ifrie`cessa _ _
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soil/rock type,wain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) R. ft.
4.Date Well(s)Completed: 08/11/21 Well ID#: MW-01 R. ft. ��
a. ft �O
Sa.Well Location: �N
ft. fc P
Larry L Ricks Cheek Road Grocery
PFacility/Owner Name Facility ID#(if applicable)
5801 CHEEK ROAD,DURHAM,NC 27704
n. rt
Physical Address,City,and Zip
21.:1REDIA11KS;
ORANGE
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)
36.029161 N -78.773363 W 8/31/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): M Permanent or ❑Temporary By signing this form•1 hereby certifi,that the well(s)was(were)constructed in accordance with
15A NCAC 02C.0100 or 15A NC AC 02C.0200 Well Constructton Standards and that a copy of
7.Is this a repair to an existing well: ❑Yes or ®No this record has been provided to the well owner.
If this is a repair,fill out known well construction in/ormation and explain the nature of
the repair under 121 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
can submit one form. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 20 (ft.) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths in tii erent(example-3 200'and 2@100) construction to the following:
10.Static water level below top of casing: DRY (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: 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 Syaply&Infection Wells:
Also submit one copy of this form within 30 days of completion of well
13b.Disinfection type: Amount: construction to the county heal I th 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
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I
CATLIN
WELL LOG Engineers and scientists
z2,°°' SHEET 1 OF 1
PROJECT NO.: 221007 STATE: NC I COUNTY: ORANGE LOCATION: DURHAM
PROJECT: CHEEK ROAD GROCERY LOGGED BY: O. DAYNES WELL ID:
DRILLER: D.T. CHALMERS JR. MW-01
NORTHING: 30727057 1 FASTING: 31348406 CREW: E. SWAIN
SYSTEM: NCSP NAD 83 USft BORING LOCATION: W.of Former UST BASIN T5) T.O.C.ELEV.:
DRILL MACHINE: CME 45B TRACK METHOD: HSA 10 HOUR DTW: DRY TOTAL DEPTH: 22.0
START DATE: 8/11/21 END DATE: 8/11/21 124 HOUR DTW: N/A WELL DEPTH: 20.0
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
o.5 ASPHALT 0.0 -
0.8 4 a (GW)-ABC STONE — 1.0
4 s 6.6 D (SC)-Tan,well graded SAND w/Clay. HCO
3.5
(CL)-Lt.gray,Micaceous CLAY w/little sand. Faint
HCO a
0
5.0 t
2 2 4 41.6 MW-01 D N
6 (5-7')
8.5 s.s
(SM)-Red grading to brown,Micaceous Silty SAND
10.0 10.0
5
13
27 1.7 D
30
qil
o�
oa
15.0 s0
In
s 14 m
z5 1.3 D
44
20.0 20.0
e
17 W
28
32
22.0 22.0 22.0
BORING TERMINATED AT DEPTH 22.0 ft in Silty
micaseous SAND/SAPPROLITE
I
Portland Cement Bentonite Pellets a#2 Medium Sand

1044 Washington Street
CATLIN Raleigh, North Carolina 27605
Telephone: [phone]
Engineers and Scientists
www.catlinusa.com
October 1, 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 Records and Boring Logs
Cheek Road Grocery
5801 Cheek Road
Durham, North Carolina 27704
Incident Number: 33873
CATLIN Project No.: 221007
To Whom it May Concern,
CATLIN Engineers and Scientists (CATLIN) recently constructed one (1) monitoring
wells 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, P.E.
Project Manager
Enclosures
Boring Logs and Well Construction Records
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