GW1-2021-02631_Well Construction - GW1_20210809

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
14. ',Z1V
D.T. CHALMERS, JR. FRWAfER ZONES FROM To I DESCRIPTION
Well Contractor Name rL fl.
4146A ft. rt
NC Well Contractor Certification Number S501, 1153KAR'6XSINIS OICTUBIN'd(^etli'"il 1
FROM TO I MANETER Y�Mii I IA4,TFJU
0 ft, 10 fL 2 SCh.40 PVCAL
in.I
CATLIN Engineers and Scientists se,' i
Company Name 16.-OUTER
FROM TO DIAMETER IMCKNESS MATFIUAL
2.Well Construction Permit#: N/A ft. ft. in.
List all applicable well permits(i.e.County,Stale, Variance,Injection,etc.) I
ft IL I in.
3.Well Use(check well use): 17.;S C R E E N,�Z,x...,w WW„ '1VV,
Water Supply Well: FROM I To DIAMETER I sLoTsa 7 McKNEss I MATERIAL
•Agricultural OMunicipal/Public 10 ft. 39.5 ft. 21 in. Slot.010 I SCh.40 1 PVC
•Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ft A. in.
' �
13 Industrial/Commercial 0 Residential Water Supply(shared) Jit.-GROUT.',
FROM TO MATERIAL EMPLACEMENT 1%01TIOD&AMOUNT
0 Irrigation 0.5 ft. 7 ft. Portland Cement Surface Pour
Non-Water Supply Well:®Monitoring ORecovery 7 ft 9 IL Bent.Pellets Surface Pour
Injection Well: ft. ft.
*Aquifer Recharge 0 Groundwater Remediation 1 q.i SANW/GRXVEJL:1PAi3KAi EN 661 it A]ift'z "AW 2.w"o
0 Aquifer Storage and Recovery 0 Salinity Barrier FROM TO MATERIAL EWLA METHOD
*Aquifer Test 0 Stormwater Drainage 9 ft. 40 W Medium Sand Torpedo Sa id
*Experimental Technology 0 Subsidence Control
attach addition jl'jh_&gtj iir-ge-eess iffy)
20-DRILLING LOG'f1 X ft&fi
DGeothermal(Closed Loop) 0 Tracer FROM TO DESCRIPTION(color.hardness.soil/rock type,wain si2e.etc)
0 Geothermal(Heating/Cooling Return) 0 Other(explain Linder#21 Remarks) IL ft
00
4.Date Well(s)Completed: 07/01/21 Well ID#: MW-01 f, ft to
ft ft 15 11�:
�O
5a.Well Location: F -
NCQEQ �, N
c
Facility/Owner Name Facility ID#(if applicable) ft.
ft
3215 Hawkins Avenue,SANFORD,NC ft. fiLl
Phvsical Address,City,and Zip
21.REMARKS '70' A_LEE
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)
35.530715 N -79.186684 W 8/3/2021
Signature of Certified Well Contractor Date
6.Is(are)the well(s): 0 Permanent or OTemporary By signing this form,I hereby cerlifi,that the well(s)was(were)constructed in accordance with
JSA NC4C 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: [3Yes or ®No this record has been provided to the well meter.
If this is a repair,fill out known well construction information and explain the nature Of
the repair under#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
SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 40 (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: 12.17_(ft.) Division of Water Resourc:es,Information Processing Unit,
lfwater level is above casing,use 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8 (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: H.S.AUGERS completion of well construction to the following:
(i.e.auger,rotary,cable,direcipush,etc.) Division of Water Resources,Underground Injection Control Program,
.
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service mce Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Svvyly&ln*ection 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 Forni GW-I North Carolina Department of Environment and Natural Resources-Division ofWater Resources Revised 2-22-2016

WELL LOG CATLIN
Engineers and Scientists
22I112a SHEET 1 OF 1
PROJECT NO.: 221124 STATE: NC I COUNTY: LEE LOCATION: SANFORD
PROJECT: FORMER SANFORD AUTO CENTER LOGGED BY: M. AUPPERLE WELL ID:
DRILLER: D.T. CHALMERS JR. Mw_01
NORTHING: EASTING: CREW: CATLI N
SYSTEM: BORING LOCATION: T.O.C.ELEV.:
DRILL MACHINE: CME 45B METHOD: H.S. AUGERS 0 HOUR DTW: N/A TOTAL DEPTH: 40.0
START DATE: 06/30/21 END DATE: 07/01/21 124 HOUR DTW2' .2 N/A WELL DEPTH: 40.0
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
SPHALT 0.0 —
2'��(CL)-DARK BROWN TO REDDISH,CLAY;MOIST—f—
3.0 3 (SP)-SAND ;
12 15 201.7 M -
a
15
t
6.5_________________________
(CL)-REDDISH BROWN,SILTY CLAY WITH SCHIST N — 7.0
8.0 3 TEXTURE
13 21 17.5 W s.o
32 10.0
so/ (ML)-REDDISH BROWN,MUDSTONE -
13.0 o.s 6.2 W
19.0
50/
20.0 0.1
o;
50/ o a
25.0 0.1 0.8 D N t `.
N N
26.0_____________
------------
(CL)-DARK BROWN,CLAY
50/
30.0 0.1 1.0 M
3a.o
35.0 D (ML)-MUDSTONE
40.0 :� 40.0
40.0 — BORING TERMINATED AT DEPTH 40.0 ft
Portland Cement Bentonite Pellets #2 Medium Sand

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MW-01
LEGEND •
® Monitoring Well
(Type II)
i
Water Lines
❑ Parcel Boundary
=ource: Esri,Maxar, GeoEye, Earthstar Geographics,CNES/Airbus DS,
U A. USGS,AeroGRID, IGN,and the GIS User Community
NOTE: Utilites were obtained from Lee County, NC GIS
and are approximate. 30 15 0 30 60
Feet
PROJECT
ORMER SANFORD TTLE FIGURE
F
ATLINAUTO CENTER SITE MAP
3215 HAWKINS AVE
Engineers and Scientists SANFORD, NC
INCIDENT NO. JOB N0. DATE SCALE DRAWN BY/CHECKED BY
29012 221124 JULY 2021 AS SHOWN KMU/BJA