GW1-2022-01556_Well Construction - GW1_20220120

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
14.WATER ZONES
D.T. CHALMERS, JR. FROM I To DESCRIPTION
Well Contractor Name o. ft
4146A ° ft
NC II Contractor Certification Number 15.INNER CASING OR TLBING eothermal doscd-1
FROM TO D1.4.ME D,I, TFIICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft.1 5 rt. 2 SCh.40 1 PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER if a icable
FROM TO DIAMETER 111ICKNESS \fATERI:\L
2.Well Construction Permit#: N/A
List all applicable well permits(i.e.County,Gate, Variance,Injection,etc.)
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DI vyth I Ill LU I11/1 retchM SS MATERIAL
OAgricultural ❑Municipal/Public 5 rt. 25 rt. 2 Slot.010 SCh. 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Suppl)(single)
❑Industrial/Commercial ❑Residential Water Supply(shared) I&GROUT
FROM Tt� AIATEfUVI ENIPLA(C F.MENTMETBODE.AMOL.
❑Irri ation Oil. 0.5 It. Concrete Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 0.5 it. 4 It Bent.Pellets Surface POUF
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if a icable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EA0'LACEMENT METHOU
O Aquifer Test ❑Stormwater Drainage 4 ft. 25 Medium Sand Torpedo Sa d
❑Experimental Technology ❑Subsidence Control ❑. It.
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM To LIU RIF 11ON cobs haidoess soil,-1,t.we,mram sit eta
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) n. a.
e-
4.Date Well(s)Completed: 01112/22 Well ID#: MW-07 u. u. `
e, -
It. It.
. 0 �O
5a.Well Location: GN
NCDEQ-Arthur Privette _ N/A
Facility/Owner Name Facility iD#(if applicable) -
n.
8541 NC HWN 42 South,RAMSEUR,NC
n. '
Phvsical Address,City,and Zip -
21.REMARKS
RANDOLPH N/A JA +
County Parcel Identification No.(PIN) Ccpag$1
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:(if wellfield.one lat/long is sufficient)
35.638885 N -79.622628 WLJ'16�� 1/18/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): M Permanent or ❑1 emporary Br signing this form,I hereby certify that the well(s)was(were)consinicied in accordance with
ISA NCAC 02C.0100 or 15A AUAC 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 tr ormation and explain the nature of
the repair under#21 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.
Por 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: 25.0 (g,) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells Itst all depths in different(example-3W00'and 2@100) construction to the following:
10.Static water level below top of casing: DRY (ft,) Division of Water Resources,Information Processing Unit,
If water lave/is abotc caving,use" " 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8•25 (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: 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
13a.Yield(gpm) Rfethod of test: 24c.For Water SvoDav&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.
Adapted from Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

WELL LOG CATLIN
Engineers and Scientists
zzozs, SHEET 1 OF 1
PROJECT NO.: 220291 STATE: NC I COUNTY: RANDOLPH LOCATION: RAMSEUR
PROJECT: LOGGED BY: O DAYNES WELL ID:
Arthur Privette DRILLER: D.T. CHALMERS JR.
NORTHING: 30981961 FASTING: 31484687 CREW: C STRATTON MVN-07
SYSTEM: NCSP NAD 83 USft BORING LOCATION: -30.0'NW from MW04 as proposed) T.O.C.ELEV.: 99.93
DRILL MACHINE: CME 45B TRACK METHOD: HSA 10 HOUR DTW: DRY TOTAL DEPTH: 25.0
START DATE: 1/12/22 END DATE: 1/12/22 124 HOUR DTW: NM WELL DEPTH: 25.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5rt 0.5tt 0.5rt (PPM) IS c DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE _ 99.9 0.0
0.0 (CL)-Orange Lean Clay 0.0 - 0.5
2
2 2 0.8 (0-2) D
EL
0
v
3.0-----------------------96.9
(ML)-Orange SILT w/Low Plasticity N
4.0
5.0 s.o
5
9 01 D
13
0.0 10.0 89.9
a (ML)-Tan SILT w/Little SAND
a 6 0.3 D
7
o;
15.0 1s.o sa.s oa
7 (ML)-Tan SILT w/Veining(Saprolite),HCO @ bottom t
10 12 1154 D of spoon and during the run fron 15.0'to 20.0' N`�
16
20.0 20.0 79.9
25 (ML)-Tan Silt(Saprolite)and Weathered Rock,HCO
1 748.9 D
1.0
25.0 25.0 74.9 25.0 25.0
BORING TERMINATED AT ELEVATION 74.9 ft in
SAPPROLITE and WEATHERED ROCK
- Portland Cement El Bentonite Pellets El#2 Medium Sand

A
� k N
w
a
t
MW-6 MA
W- 7
LOCATION OF ."'-
SUSPECTED UST � MW-4
MW-5
Y MW-3 s _
MW-2FL
w
' LOCATION OF
- • FORMER UST
S W-4
P
t WSW9
p P
r
LEGEND MW-1
® Monitoring Well
Active Potable yop SW-2.2
Water Supply Well
I Inactive Potable V r
Water Supply Well
Approximate Location
of Former USTs 1 ��
` t
Parcel Boundary Source-E--s xar. GeoEye E 5,�grap es. CNES/A'irbus DS
USDA USA eroGRID IGN,a • t GI= Us Community
NOTE: Well and UST locations were obtained from previous reports
prepared by other consultants and are approximate. 40 20 0 40 80
Feet
PROJECT TITLE
FIGURE
ARTHUR PRIVETTE
ATLIN 8541 NC HWY 42 SOUTH SITE MAP
RAMSEUR, NC
Engineers and Scientists
INCIDENT NO JOB NO j DATE SCALE DRAWN BY CHECKED BY
5124 220291 JAN 2022 AS SHOWN KMCISJO