GW1-2022-01894_Well Construction - GW1_20220210

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
14.WA=ZONES
Austin Fowler FROM I To I DESCRIPTION
Well Contractor Name k. k.
4366A k. k.
NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-Ioo
FROM I TO DIAMETER -INCKNESS MATERIAL,
CATLIN Engineers and Scientists 0 ft. 3 k. 2 in. Sch.40 1 PVC
Company Name 16.OU7ER CASING for multi-cased wells OR LINER if applicable)
FROM To DIAMETER I THCKNESS I MATMAL
2.Well Construction Permit#: N/A k. k. in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
ft. k. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM To UTAME FER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 3 it. 13 o. 2 in. Slot.010 SCh.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. li. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) I&GROUT
FROM FO 11k FERJAL EMPLACE.MENF METHOD&AMOUNT
❑Irrigation 0 1 ft Concrete Surface Pour
i
Non-Water Supply Well: t.
®Monitoring ❑Recovery 1 i. 2 ILBent.Pellets Surface Pour
Injection Well: ft. a.
❑Aquifei Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK Lf applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I To I 11 ATERIAL FVII'L.v 1%1i:NT NIFTI IOD
❑Aquifer Test ❑StormwaterDrainage 2tt. 13#J Aledium Sand Torpedo Sa d
❑Experimental Technology ❑Subsidence Control rt' it.
20.DRII1 ING LOG attacb additional sheets if necesu
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,sod rock tcpe,qainsin,etc
❑Geothertttal(Heating/Cool in Return) ❑Other(explain under#21 Remarks)
4.Date Well(s)Completed: 11/1812l Well ID#: MW-01
Sa.Well Location:
ti. tt.
NCDEQ- Lumberton Mobile N/A P�
Facility/Owner Name Facility 1D#(ifapplicable)
fi.
,Lumberton,NC 283360
Physical Address,City,and Zip -
21.REMARKS _
ROBESON N/A
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)
34.671828 N -79.007903 W i 2/3/2022
Signature of Certified Well Contractor Date
6.Is(are)the w e II(s): O Permanent or O Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
1 SA N(AC 01C.0100 or 1 SA 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 of this form. 23.Site diagram or additional Nell 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 sane construction,you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 13.0 (g•) 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: 7.38 (ft,) Division of Water Resources,Information Processing Unit,
Ifwaer level is above casing,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,directpush,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&Iniection Wells:
Also submit one copy of this form\\ithin 30 days of completion of well
131). 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

CATLIN
Engineers and Scientists
WELL LOG 220237 SHEET 1 OF 1
PROJECT NO.: 220237 STATE: NC COUNTY: ROBESON LOCATION: Lumberton
PROJECT: Lumberton Mobile LOGGED BY: O DAYNES WELL ID:
DRILLER: A FOWLER MW-01
NORTHING: 3354973 EASTING: 1997624 CREW: CATLI N
SYSTEM: NCSP NAD 83 ft BORING LOCATION: -10 feet north of B-1 T.O.C.ELEV.: NM
DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HOUR DTW: 8.6 1 TOTAL DEPTH: 13.0
START DATE: 11/18/21 END DATE: 11/18/21 124 HOUR DTW: 7.4 1 WELL DEPTH: 13.0
BLOW COUNT OVA o o SOIL AND ROCK WELL
DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPm) LAB. s G DEPTH DESCRIPTION DETAIL
0.0 LAND SURFACE 0.0
0.0 ASPHALT o.o -
5 4 , 4.1 D � ISM)-Orange to Gray F.to Med.SILTY SAND U'a = 1.0
11 g
u
ti 2.0
(V
3.0
5.0
4
6 12 21.7 M
14 6.5 _
(SP)-Orange and Gray F. SAND, Poorly Graded
pU _
o(a
00
Nt
fV U
10.0
5
6 5 4.1 Sat.
4
13.0 13.0 _ 13.0 13.0
BORING TERMINATED AT DEPTH 13.0 ft in SAND
i
ElPortland Cement Bentonite Pellets #2 Medium Sand