GW1-2021-04551_Well Construction - GW1_20210429

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
14*A ZONES
D.T. CHALMERS, JR. P E r15.1NNERICAS
OM TO DESCRIPTION
Q�
Well Contractor Name 4146AAPR 2 9NCWelIContractorCertificationNumber �i"lvfn�3tionProce�SingUnFROM NGORIIMPLG t aidos lo�K I MATERIAL
- .
AMETER
CATLIN Engineers and Scientists DWG 5scron 0 ft.1 17 R. 2 Sch.40 PVC
u .,. __
Company Name 1b0U1'ER CASING foF;multi-cased wells bit iLINER"if a
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: N/A
List a/1 applicable well permits(i.e.County,State, Variance,Injection,etc.) R. R. in.
ft.
3.Well Use(check well use): R. in.
17.iscREEN`
Water Supply Well: FROM To DIAMETER I SwrSIZE I TFncKNess MATERIAL
El Agricultural ❑Municipal/Public 17It. 27R. 2 in. Slot.010 I Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft.
❑Industrial/Commercial ❑Residential Water Supply(shared) FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 rt. 6 ft. Concrete Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 6 rt. 15.5 ft. Bent.Pellets Surface Pour
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 15.5 ft. 27 X Medium Sand Torpedo Sa d
❑Experimental Technology ❑Subsidence Control ft. ft.
ibr
20DRI GLLINCLO attach additions`►sFieefs'ifnecessh'� ,;_
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soillrock type,grain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
4.Date Well(s)Completed: 02/05/21 Well ID#: MWA ft. ft.
rt. rt. 5 �O
5a.Well Location:
Colon Hobby
HobbyStore
R.
Facility/Owner Name Facility ID#(ifapplicable)
R.
12127 Hwy42 W,FUQUAY-VARINA,NC 27526
ft. fc.
Physical Address,City,and Zip 211tEMARKS it
WAKE
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: n
(if well field,one lat/long is sufficient)
35.562762 N -78.871793 W 2/15/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or ❑Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
15A NCAC 02C.0100 or 1 JA NCAC 02C.0200 Well Construction 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 information and explain the nature of
the repair tinder#21 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: 27 (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@100) construction to the following:',
10.Static water level below top of casing: 20.53 (B,) Division of Water Resources,Information Processing Unit,
If water level is above casing,rise"+^ 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
r
13a.Yield(gpm) Method of test: 24c.For Water Svauly&In, 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
Jam" CATLIN
Engineers and Scientists
zzozze
WELL LOG I SHEET 1 OF 1
PROJECT NO.: 220229 STATE: NC COUNTY: WAKE LOCATION: FUQUAY-VARINA
PROJECT NAME: HOBBY STORE LOGGED BY: SEAN O'NEIL WELL ID:
DRILLER: D.T. CHALMERS JR. MW-1
NORTHING: 30759471 EASTING: 31517587 CREW: MATTHEW AUPPERLE
SYSTEM: NCSP NAD 83 USft BORING LOCATION: ROW Off Corner of Building T.O.C.ELEV.:
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: 21.5 TOTAL DEPTH: 27.0
START DATE: 2/5/21 END DATE: 2/5/21 124 HOUR DTW: NM WELL DEPTH: 27.0
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
a° (SW)-Grass to 0.2 feet BLS. 0.0 -
a' 1.5 Tan,f.SAND
(CL)-Orange,Sandy CLAY grading to Clay with sand —
lenses from 2.0-4.0'BLS.
5.0 -
5 —
10 0.9 D = 6.0
15
U
a
c
L
Cn
10.0 10 0
(SM)-Orange to gray,Silty SAND. HCO
e s 117 D
s
' f
15.0 15.0
s (SIP)-Orange f.to med.SAND 15.5
s 1° 5.5 D
10
17.0
20.0 20.0
7 (SM)-Tan,Silty SAND. HCO _
22.0 (SP)-Orange,f.to med.SAND s( ,
(SW)-White cse.SAND L
�c
25.0
a s 7 2.5 Sat. ' f
6 27.0
27.0 27.0 27.0
BORING TERMINATED AT DEPTH 27.0 ft
I
i
Portland Cement EM Bentonite Pellets #2 Medium Sand

Post Office Box 10279
Wilmington, North Carolina 28404-0279
fit
�� 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 Boring Log
Hobby Store
12127 Hwy 42 W., Fuquay-Varina, NC 27526
Incident Number: 42046
CATLIN Project No.: 220229
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 J. O'Neil, PE
Project Manager
Enclosures
Boring Log and Well Construction Record