GW1-2021-06617_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:
#tbXV1'ATER'ZONFS
D.T. CHALMERS, JR. FROM To DESCRIPTION
Well Contractor Name
4146A ki e.
NC Well Contractor Certification Number �13fI1VNERTG4SIIVG:OR'S 17BING eo nermalrctosed400
FROM TO DIAMETER THICKNESS I MATERIAL
CATLIN Engineers and Scientists 0 rL 5 rt. 1 in.i Sch.40 PVC
Company Name 66XOl1TERCASING roi�molh-cas.'d.w`ells.OR�i7ER.i(a ieatAe
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: N/A ft. rt. in.
List all applicable well permits(i.e.Counry,State, Variance,Injection,etc.)
ft. ft. in.
3.Well Use(check well use): 211!C9CaEEN
Water Supply Well: FROM TD DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 ft. 15 ft. 1 in. Slot.010 Sch.40 PVC
❑Geothenmal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. n. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) tISTGROIJi
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
rt. rt.
Non-Water Supply Well:
0 rt. 0.5 rt. Bent.Pellets Surface Pour
®Monitoring ❑Recovery
Injection Well: a. rL
❑Aquifer Recharge ❑Groundwater Remediation 1119'§SAND/GRAVEfV GKl-i[,a ieaMe
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TOI MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft. ft
❑Experimental Technology ❑Subsidence Control 0.5 n. 16 n. I Natural Backfill
V220'JD_AfflVING':LTOG of'Tfa`cATe`dd l_jrn ITsh�if V7es a
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color hardness soiVrock in size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft rL
4.Date Well(s)Completed: 06/16/21 Well ID#: P4-TW16 rt. rL
Sa.Well Location: S �N
y n.
Facility/Owner Name Facility ID#(if applicable)
R.
MCAS CHERRY POINT,CHERRY POINT,NC 28533
a.Physical Address,City,and Zip rL
iz llIRWAXRK5
CRAVEN
County Parcel Identification No.(PIN) OraO
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one latAong is sufficient) �V Q
34.90814859 N -76.88934271 w L49/29/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ❑Permanent or M Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: OYes or ®No this record has been provided to the well owner.
Ifthts is a repair,fill out known well construction information and explain the nature oJ'
the repair under 421 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.
Tor multiple injection or non-wager supply wells ONLY with the same construcllon,you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 15 (B,) 24a.For All Wells: Submit this form within 30 days of completion of well
Tor multiple wells list all depths in diJfercm(example-3 a 00'and 2 a 100) construction to the following:
10.Static water level below top of casing: 9.52 (ft,) Division of Water Resources,Information Processing Unit,
Ifwcner 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 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&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.
I
Adapted from Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

f
WELL LOG CATLIN
Engineers and scientists
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: J. WILSON WELL ID:
DELINEATION DRILLER: D.T. CHALMERS JR. P4-TW16
NORTHING: 428228 1 EASTING: 2632733 CREW: C. FUTRAL
SYSTEM: NCSP NAD 83 USft BORING LOCATION: T.O.C.ELEV.: 22.97
DRILL MACHINE: Power Probe METHOD: DPT 0 HOUR DTW: NM TOTAL DEPTH: 16.0
START DATE: 6/16/21 END DATE: 6/16/21 124 HOUR DTW: 9.5 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 23.0 0.0
0.0 TOPSOIL 0.0 0.5
Direct Push 0.0 D (CL)-Dark brown,Silty and Sandy CLAY _
U
2.0 L
o
v -
Direct 3.0 20.0
Push 0.0 D -
(SP)-Gray,f.SAND
4.0 4.0 19.0
with interbeded day lenses
Direct 16 D 5.0
Push
6.0
Direct 98 D
Push
8.0 8.0 15.0
Slight HCO
Direct 65 W
Push
of
oa '
10.0
in
= U
�N
Direct Push 15 Sat.
12.0
Direct Push 0.0 Sat.
14.0 -
Direct Push 0.0 .Sat. : 15.0 _
16.0 16.0 7.0 16.0
BORING TERMINATED AT ELEVATION 7.0 ft in vf.to
f.SAND with some clay lenses
1"PVC Well set to 15.0'BLS.
Bentonite Pellets Native Backfill