GW1-2021-07646_Well Construction - GW1_20211214

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
l 1.Well Contractor Information:
14.WATERZONFS
DT CHALMERS FROM TO DESCRIPTION
Well Contractor Name R. It.
4146-A u. n.
NC Well Contractor Certification Number 15.INNER CASING OR TUBING eothermal closed loo
FROM TO DIAMETER I111CKNESS MATERIAL
CATLIN Engineers and Scientists +2 ft 3 ft. 2 ia. Sch.40 1 PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER if a icable
FROST TO DIAMETER THICKNESS M:\TFRIAI,
2.Well Construction Permit#: N/A fr rL in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
ft, f. in
3.Well Use(check well use):
n.satmv
Water Supply Well: FROM TO DIn\ll_TF_R SI 01�IZF 1111KKINFSS I MATERIAL
❑Agricultural ❑Municipal/Public 3 ft 13 ft. 2-in. Slot 010 Sch. 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) t. ft.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FRO>I TO MATERIAL I EMPLACEMENT METHOD&AMOUNT
❑Irrigation OIL 1 ft. Concrete Surface Pour
Non-Water Supply Well: -
1 it. 2 n. Bent. Pellets Surface POUF
®Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if a icade
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To I MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 2 ft 13 #2 Medium Sand Surface pour
❑Experimental Technology ❑Subsidence Control ft. e.
20.DRILLING LOG tantach additional sheets if a aryll
❑Geothermal(Closed Loop) ❑Tracer FRO',I TO DESCRIPTION color,hardness s Lrock type,gram sis etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) n, ft.
4.Date Well(s)Completed: 11/01/21 Well ID#: MW07 rt r ♦+�j O
rt. rt. ;/`
5a.Well Location:
li.
NCDEQ JENNIFER'S SUBDIVISION N/A
A.
P _
Facility/Owner Name Facility ID#(if applicable)
n.
3198 MT MISERY ROAD,LELAND,NC,LELAND,NC
n. u.
Physical Address,City,and Zip -
21.REMARKS _
BRUNSWICK _
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)
34.304245 N -78.076427 W �� 12/10/2021
Sig re ofCertified Well Contractor Date
6.Is(are)the well(s): ®Permanent or O Temporary By signing This form,I hereby certify that the well(s)was(were)constructed in accordance with
1 SA 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: 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 under 421 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 SUBMITTAL INSTRUCTIONS
can.submit one form
9.Total well depth below land surface: 13.0 (ft,) 24a.For All Wells: Submit this form within 30 days of completion of well
Fiar 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: 9.2 (g,) Division of Water Resources,Information Processing Unit,
fI 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(45B) 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
24c.For Water Supply&Infection Wells:
13a.Yield(gpm) Method of test:
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

--7-Z CATLIN
WELL LOG Engineers and Scientists
zzozot SHEET 1 OF 1
PROJECT NO.: 220201 STATE: NC I COUNTY: BRUNSWICK LOCATION: LELAND
PROJECT: JENNIFER'S SUBDIVISION LOGGED BY: O DAYNES WELL ID:
DRILLER: T CHALMERS MW07
NORTHING: 3052818 FASTING: 31979261 CREW: E SWAIN
SYSTEM: NCSP NAD 83 ft BORING LOCATION: East side Of DrODerty line T.O.C.ELEV.:
DRILL MACHINE: CME-45B METHOD: HSA 10 HOUR DTW: 9.2 TOTAL DEPTH: 13.0
START DATE: 11/1/21 END DATE: 11/1/21 124 HOUR DTW: N/A WELL DEPTH: 13.0
BLOW COUNT OVA o o SOIL AND ROCK WELL
DEPTH o.5tt 0.5rt 0.5tt 0.5n (ppm) LAB. s G DEPTH DESCRIPTION DETAIL
2.0
0.0 LAND SURFACE _ c c
0.0 (SP)-Black.White.and Brown F.SAND,Poorly Graded a
1 v
a 5.0 D U 1.0
z
2.0
3.0
4.0_____ ::.
(CL)-Tan SANDY CLAY
5.0
z 6.0
z 4 10.0 D _
6 (CH)-Gray Fat CLAY w/Trace SAND
oa
oe
U)t
tV�
::.
(CL)-Tan SANDY CLAY
10.0 10.3
s (SP-SM)-Tan F.SAND w/Little SILT,Saturated
s 11.4 Sat.
12
15
13.0 rr 130 13.0 13.0
BORING TERMINATED IN SAND AT DEPTH 13.0 ft
Concrete Bentonite Pellets #2 Medium Sand

� a
MW-2
N
MW-5
MW-4
1
R�
t
.t
F-5R �l
F-1 MW-3
A Alt
�T F-4R ®MW-07
4' ,.
' MW-06
,N
y `..
LEGEND ` 't
® Monitoring Well r
(Type II)
Destroyed Monitoring ' "., z
Well (Type I I) .
❑ Approximate Location r,
of Former UST
❑ Parcel Boundary Source Esri Maxar.GeoEye,E h r uai tics. CNES'Airbus DS
USDA USGS.AeroGRID, IGN, th I= User�Community
NOTE:Well and tank locations were obtained from previous 60 30 0 60 120
prepared reports by other consultants and are approximate.
Feet
oRCJEcr rim
FIGURE
JENNIFER SUBDIVISION
ATLIN 3198 MT MISERY ROAD SITE MAP
LELAND, NC
Engineers and Scientists
Cg NO I NCIDENT j DATE SG4re DRAWN BYICHECKED BY
220201.02 5305 DEC 2021 AS SHOWN KMC/BJA

i
CATLIN 220 Old Dairy Road
Wilmington,
� ngton, NC 28405
Engineers and Scientists [phone]
www.CatlinUSA.com
December 10, 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
Jennifer Subdivision
3198 Mt. Misery Rd., Leland, NC 28451
Incident Number: 5305
CATLIN Project No.: 220201.02
To Whom it May Concern,
CATLIN Engineers and Scientists (CATLIN) recently installed two (2) monitoring wells at
the above referenced site. Attached to this letter are the completed North Carolina
Well Construction Records with associated Attachments for the above referenced site
in Leland, North Carolina.
If you have any questions or require additional information, please feel free to contact
us at [phone].
Sincerely,
Benjamin J. Ashba P.G. Corey Futral, CWC
Project Manager Project Geologist
Enclosures
Well Construction Records. Well Logs, and Site Map