GW1-2021-06619_Well Construction - GW1_20211007

E
WELL CONSTRUCTION RECORD For Internal U ONLY: I
This form can be used for single or multiple wells
1.Well Contractor Information:
D.T. CHALMERS, JR. � �F4XwATER>201�FS
� _wq FROM 7'O DESCRIPTION
Well Contractor Name ft. ft. 4
4146A
NC Well Contractor Certification Number ��`C�'S' pn )s15NER CASINGfOReTUBINGw'eo7heSmdltc`Ios�`d Ioo
FROM I TO I DIAMETER I THICKNESS MATERIAL
CATLIN Engineers and Scientists\t�{� ati�JR 0 ft.1 5ft-I j 1 SCh.40 PVC
Company Name �16iCOlTfERC'A`SING for!'ul[i-cased.wells.0Rf1,r14ER da rcaMe
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. rL in.
3.Well Use(check well use): 917ZscxEEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THCKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 R. 15 ft 11 in. Slot.010 SCh.40 PVC
El Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) rt. R in.
❑Industrial/Commercial ❑Residential Water Supply(shared) K81f6ROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
a. rt.
Non-Water Supply Well:
®Monitoring ❑Recovery 0 rt. 0.5 it. Bent.Pellets Surface Pour
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 0-9XSMtiJGRAVEi�fPA'G7cTi'ta IcaWe
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I TD I MATERIAL EMPLACEMENT METHOD
ft I ft.
❑Aquifer Test ❑Storrnwater Drainage
❑Experimental Technology ❑Subsidence Control 0.5 rL 16 ft.I Natural Backfill
Ir20.DRII LINGSLYOG�atfaehTa`ddi ifioonal 1_h`eee-&Cfinec
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soiUrmk type,main size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. 8.
4.Date Well(s)Completed: 06/16/21 Well ID#: P4-TW01 rt rt O
ft. rL S ��
Sa.Well Location:
h. ft.
ft.
Facility/Owner Name Facility II?#(if applicable)
ft.
MCAS CHERRY POINT,CHERRY POINT,NC 28533
R. ft.
Physical Address,City,and Zip
1<25iREM'e1`RICS.
CRAVEN
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)
34.9088775 N -76.89031303 W 9/29/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ❑Permanent or M Temporary By signing this form,/hereby certify that the m ell(s)was(were)constructed in accordance with
15A NCAC 02C.0100 or 15A NC4C: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 name of
the repair under#2I remarks section or on the back of this 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: 15 (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@I00) construction to the following:
10.55 ft, Division of Water Resources,Information Processing Unit,
10.Static water level below top of casing: ( ) ,,
Ifwater level is above casing,use"+" 1617 Mail Se 'ice Center,Raleigh,NC 27699-1617
11.Borehole diameter: 2 (in.) 24b.For Iniection 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: DPT 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 Supply&Iniection 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

I
WELL LOG �w CATLIN
j Engineers and Scientists
218041.04 SHEET 1 OF 1
PROJECT NO.: 218041.04 STATE: NC I COUNTY: CRAVEN LOCATION: CHERRY POINT
PROJECT: PIT 4 (72GW50) AREA-LNAPL LOGGED BY: S. CHASTEEN I WELL ID:
DELINEATION DRILLER: D.T. CHALMERS JR. P4-TW01
NORTHING: 428487 1 EASTING: 2632437 CREW: C. FUTRAL
SYSTEM: NCSP NAD 83 USft BORING LOCATION: T.O.C.ELEV.: 22.37
DRILL MACHINE: Power Probe METHOD: DPT 0 HOUR DTW: NM TOTAL DEPTH: 16.0
START DATE: 6/15/21 END DATE: 6/15/21 24 HOUR DTW: 10.6 WELL DEPTH: 15.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM s G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE; 22.4 0.0
O.O 0 TOPSOIL 0.
' 0.5
Direct 1.1 M 1.0 21.4 -
Push
(SM)-Tan,vf.to f.Silty SAND -
2.0 ' a
o "
e e -
t -
Direct 14 M n.
Push -
4.0 4.0 18.4
(SP)-Gray,vf.to f.SAND
Direct 1.8 M 6.0
Push
6.0
Direct Push 10.1 M
8.0 -
Direct Push 365.1 M -
o>
10.0 12.4 o a _
10.0
Strong HCO cn.c
= n
Direct Push 427.5 W
12.0 12.0 10.4
Direct 10 8 W
Push
14.0 -
Direct 10.6 Sat. 15.0
Push
16.0 16.0 6.4 16.0
BORING TERMINATED AT ELEVATION 6.4 ft in vf.to
f.SAND
1"PVC Well set to 15.0'BLS.
I^
Bentonite Pellets Native Backfill