GW1-2022-03540_Well Construction - GW1_20220324

P
WELL CONSTRUCTION RECORD For Internal U ONLY j
This form can be used for single or multiple wells j
1.Well Contractor Information:
%-J4'kVVATER ZONES I..
Austin Fowler FROM TO DESCRIPTION
Well Contractor Name ft ft.
4366A ft. fL
NC Well Contractor Certification Number III S.1INNER-CASING OR;TUBING'eoihermal,d''used loo
FROM TO DIAMETER TMCKNESS MATERIAL
CATLIN Engineers and Scientists 0 rL 1 10 f,.l 2 i..l SCh.40 1 PVC
-
Company Name 41'6T6UTERCASWG focmu -cas.lfie.d—wdls ORrLTIYER ife livable .
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: NSA fL rl in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
k IL in.
3.Well Use(check well use): 7SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 10 fL 20 ft. 2 i in. Slot.010 SCh.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL n. in.
•Industrial/Commercial ❑Residential Water Supply(shared) ii GROUT +
FROM 2 r f TO MATERIAL ENIPLACEMENT METHOD&AMOUNT
•Irrigation
Non-Water Supply Well: t. n.
®Monitoring •Recovery t. 8 rl Bent.Pellets Surface Pour
Injection Well: ft. it.
❑Aquifer Recharge ❑Groundwater Remediation ffi797§ANDf6R3kVELIP79CKr('f is ble"
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test •Stormwater Drainage 8 ft 20 Medium Sand Torpedo Sa d
D Experimental Technology ❑Subsidence Control rt. rt.
207DRII;liING+I:OG'at�ae6+addition'al�,shee�if necessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color hardness soillrock type.min s ze etc.
D Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft.
ft.
4.Date Well(s)Completed: 03/11/22 Well ID#: MW-03 ft
ft rt. S �O
5a.Well Location: �N
fL rL , P
NCDEQ-Linda Blalock
Facility/Owner Name Facility ID#(if applicable) ft.
ft
1200 N.BROAD ST,FUQUAY-VARINA,NC 27526
rL rL
Physical Address,City,and Zip _
.;zI REMAkKg "ni <_i TWO
WAKE
County Parcel Identification No.(PIN) DO I WO M
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one lat/long is sufficient)
36.699612 N -78.80119 W 3/21/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): M Permanent or O Temporary By signing this form.1 hereby verb'that the well(s)was(were)constructed in accordance with
iSA NCAC 02C.0100 or i5A NCAC 02C.0200 Well Consinuction Suardards 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 information 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.
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: 20.'0 (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@1009 construction to the following:
10.Static water level below top of casing: 14.57 (g,) Division of Water Resources,Information Processing Unit,
If 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 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) Method of test: 24c.For Water Supply&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 Envirormient and Natural Resources-Division of Water Resources Revised 2-22-2016

i
WELL LOG CATLIN
Engineers and Scientists
zzuss SHEET 1 OF 1
PROJECT NO.: 221196 STATE: NC I COUNTY: WAKE LOCATION: FUQUAY-VARINA
PROJECT: HARRINGTON PROPERTY LOGGED BY: Nate Newman WELL ID:
DRILLER: Austin Fowler MW-03
NORTHING: 2059100 1 EASTING: 673218 CREW: Trevor Mizelle
SYSTEM: NCSP NAD 83 USft BORING LOCATION: North of former 1,00o- anon UST Basin T.O.C.ELEV.: 100.51
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: 14.6 TOTAL DEPTH: 20.0
START DATE: 3/11/22 END DATE: 3/11/22 124 HOUR DTW: N M WELL DEPTH: 20.0
DEPTH BLOW COUNT OVA LAB o a SOIL AND ROCK WELL
0.5ft 0.5ft 0.5tc 0.5ft (PPm) Is G DEPTH DESCRIPTION ELEVATION DETAIL
I
0.0 LAND SURFACE! 100.5 0.0
'a CONCRETE 0.0 Ad
d'%,• 0.8 99.8
(SC)-Brown to tan,Clayey SAND Ad.
Grading to red and tan at 10'BLS Ad•
2.0
U
i a
o
5.0 t
N
2
4 7 1.4 D N
9
8.0
10.0 10.0
8
,s 16 ,s 2330 (1a1zj M
I
oa
15.0
�t
tV N
NOR OR D 390 w 16.0 84.5
(SP)-White to gray,SAND
17.0 83.5
(CL)-Brown to gray,Sandy CLAY
20.0 20.0 aos 20.0 20.0
BORING TERMINATED AT ELEVATION 80.5 ft in
Sandy CLAY f
i
i
ra;: Concrete Im Bentonite Pellets 0#2 Medium Sand