GW1-2021-06623_Well Construction - GW1_20211007

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
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1.Well Contractor Information:
4� 914►WX1ERZ6NE9
D.T. CHALMERS JR. FROM TO DESCRIPTION
Well Contractor Name O 202� ft. ft.
4146A �Cj (, ''ll ft. rt.
r Umber 5�TINPTER-GA:SING'0KW BI1slG eo hernial clined`loo
N CATLINC Well En Contractor i eeerstandion uScientists nIaC�'3kro�-NN p e t'On ��M 0 ft. 5 ft. DIAMEI R S h 40 PVC
Company Name &6To-0! c-A.SINGrfo,4!m`ulri-c'.0rddwdls 6itIO iER'ifa ic'atile
FROM TO I DIAMETER I THICKNESS MATERIAL
2.Well Construction Permit#: N/A ft. ft. in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
ft. R. in.
3.Well Use(check well use):
Ai1YsGaEEitt
Water Supply Well: FROM To DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 ft. 15 it. 1 in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cool ing Supply) ❑Residential Water Supply(single) t. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) W8rGR017T
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
Non-Water Supply Well: rL rt.
®Monitoring ❑Recovery 0 ft. 0.5 ft. Bent.Pellets Surface Pour
injection Well: ft. ft
❑Aquifer Recharge ❑Groundwater Remediation i19YSANiiGI2A�Er1rPAGICTiGa icetile
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM iO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 0.5 a. 16 fl. Natural Backfill
L20..DRILL'INGYIYOGTe�taehTa'ddilion'�i11sh'ee`rt.'tif:necesse
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soii/rock type,grain size etc.
❑Geothermal eating/Cooling Return) ❑Other(explain under 921 Remarks)
4.Date Well(s)Completed: 06/16121 Well ID#: P4-TW07
5a.Well Location:
ft.
Facility/Owner Name Facility IDN(if applicable)
R.
MCAS CHERRY POINT,CHERRY POINT,NC 28533
ft. fL
Physical Address,City,and Zip
�2'ltRE111i+iRiCS
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)
34.90762753 N -76.88991092 W 9/29/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): O Permanent or M Temporary By signing this form,i hereby certify that the well(s)was(were)constructed in accordance with
15A NCAC 01C.0100 or I5A NC4C 01C.0200 Well Construction Standardv 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:coder 921 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 rt 00'and 2@100) construction to the following:
10.Static water level below top of casing: 1 1.88 (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: 2 (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: DPT completion of well construction to the following:
(i.e.auger,rotary,cable,direct putsh etc.) Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Seri ice Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Sypaly&lniection Wells:
Also submit one copy of this form within 30 days of completion of well
13b.Disinfection Amount: construction to the county health department of the county where constructed.
type:
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Adapted from Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

9WO CATLIN
Engineers and scientists
WELL LOG zlaoal.oa SHEET 1 OF 1
PROJECT NO.: 218041.04 STATE: NC COUNTY: CRAVEN LOCATION: CHERRY POINT
PROJECT: PIT 4 (72GW50) AREA-LNAPL LOGGED BY: S. C'HASTEEN WELL ID:
DELINEATION DRILLER: D.T. CHALMERS JR. P4-TW07
NORTHING: 428035 1 EASTING: 2632567 CREW: C. FUTRAL
SYSTEM: NCSP NAD 83 USft BORING LOCATION: T.O.C.ELEV.: 25.30
DRILL MACHINE: Power Probe METHOD: DPT 0 HOUR DTW: NM TOTAL DEPTH: 16.0
START DATE: 6/16/21 END DATE: 6/16/21 24 HOUR DTW: 11.9 WELL DEPTH: 15.0
BLOW COUNT OVA o L SOIL AND ROCK WELL
DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPM) LAB. s c DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 25.3 0.0
0.0 ' ' ' TOPSOIL 0.0 0.5
Direct Push 75.3 M 1.0 24.3
(SC)-Dark tan grading to dark gray and black,Clayey
SAND
2.0 0.
0
Direct Push 161.8 M
4.0 4.0 21.3 _
HCO
Direct Push 66.3 M 5.0
6.0
Direct
Push 330.8 M
8.0 8.0 17.3
8.0 (SP)-Light gray,vf.to f.SAND with some clay lenses
Direct Strong HCO
Push 846.5 W
of -
oa -
10.0
Direct 397 2 W
Push
12.0 -
Direct 280.3 W
Push
14.0
Direct Push 368.7 W 15.0
16.0 16.0 9.3 16.0
BORING TERMINATED AT ELEVATION 9.3 ft in vf.to
f.SAND with some clay lenses
1"PVC Well set to 15.0'BLS.
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Bentonite Pellets Q Native Backfill
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