GW1-2022-05686_Well Construction - GW1_20220426

220 Old Dairy Road
CATLIN Wilmington, NC 28405
Engineers and Scientists [phone]
www.CatlinUSA.com
April 26, 2022
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
NCDEQ- M&M Grill
217 E. South Main St.
Littleton, North Carolina 27850
CATLIN Project No.: 221233
Incident No.: 47687
To Whom it May Concern,
CATLIN Engineers and Scientists (CATLIN) recently constructed three (3) monitoring
wells at the above referenced site. Attached to this letter are the completed North
Carolina Well Construction Records with associated Attachments for the site in Littleton,
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 D. Futral, CWC
Project Manager Project Geologist
Enclosures
Well Construction Records, Well Logs, and Site Map
ENVIRONMENTAL CIVIL GEOTECHNICAL
Wilmington, NC I Raleigh, NC Washington, NC I Atlanta, GA I Charleston, SC

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 ft. ft
4146A ft. rr
NC Well Contractor Certification Number IS.INNER CASING OR TUBING(geothermal closed-loo
FROM TO DIAMETER T1llCKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft. 35 ft. 2 in.I Sch.40 1 PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER if applicable
N/A FROM TO DIAMETER TIUCRNESS MATERIAL
2.Well Construction Permit#: 0 ft. 35 ft. 4 in. Sch.40 PVC
List all applicablewellpeimits 6.e.County,State, Variance,Injection,etc)
ft. ft. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE TIBCKNESS MATERIAL
❑Agricultural ❑Municipal/Public 35 It. 45ft. 2 in. Slot.olo Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ff fr. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METIIOD&AMOUNT
❑Irrigation 0 rr. 0.5 It. Portland Cement Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 0.5 ft. 33 It. Bent.Pellets Surface Pour
Injection Well: rt. rt.
❑Aquifer Recharge ❑Groundwater Rcmcdiation 19.SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL EMPLACEMENTMETHOD
❑Aquifer Test ❑StonnwaterDrainage 33 f- 45;0 Medium Sand Torpedo Said
❑Experimental Technology ❑Subsidence Control ft ft.
20.DRILLING LOG attach additional sheets if necessar
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION"color,hardness soil/rock rype,grainsizc,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks) ft. ft.
4.Date Well(s)Completed: 04/20/22 Well ID#: MW-01 D fr. fr. -
ft. ft.
5a.Well Location:
ft. ft.
Khaled Elmawy M&M GRILL ft
Facility/Owner Name Facility ID#(if applicable)
ft.
217 E.South Main Street,LITTLETON,NC 27850
ft. IT
Physical Address,City,and Zip
21.REMARKS
HALIFAX
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(ifwell field,one lat/longis sufficient)
36.435911 N -77.909063 w C -� 4126/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or ❑Temporary By signing this form,I hereby certify that the welf(s)was(were)constructed in accordance with
15ANCAC 02C.0100 or 15ANCAC 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 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 pro-ride additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages ifnccessary.
For multiple injection or non-wader supply we11s ONLYwith the same construction,you
can submit one form. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 45.0 (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: 16.31 (g) Division of Water Resources,Information Processing Unit,
Ifwate-level is above casing use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 12.25 (in,) 24b.For Injection 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 ofwell 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 Svuuly&Injection 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-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

WELL LOG CATLIN
Engineers and Scientists
221233 SHEET 1 OF 1
PROJECT NO.: 221233 STATE: NC COUNTY: HALI FAX LOCATION: LITTLETON
PROJECT: M&M GRILL LOGGED BY: T. Park WELL ID:
DRILLER: D.T. CHALMERS, JR. MW-01 D
NORTHING: 2320948 EASTING: 979359 CREW: E. SWAI
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Middle of the UST basin T.O.C.ELEV.: 100.04
DRILL MACHINE: CME 45B TRACK METHOD: Mud ROtar /HSA 0 HOUR DTW: 16.3 TOTAL DEPTH: 45.0
START DATE: 4/19/22 END DATE: 4/20/22 24 HOUR DTW: NM WELL DEPTH: 45.0
DEPTH BLOW COUNT OVA LAB M a SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (ppm) s c DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 100.0 0.0
0.07 ' 7 5 53 D (GW)-Gray to brown,Sandy GRAVEL well graded 0.0 = 0.5
6 a� -
4 3.0 97.0 -
4.0 3 (CL)-Brown,Sandy Clay. HCO
1 woh 32 W =
7.0 93.0 -
(ML)-Orange to green SILT. HCO. _
Driller note:Cave in began due to lost circulation, _
10.0 switched to HSA =
woh
1 2 177 W =
15.0
1 2 593 M a 3 _ a
-o
18.0 82.0
s -L
(ML)-Orange to red SILT
N -V
20.0
2 3 182 W
5
25.0 2
3 5 131 W =
7
30.0 2 =
a 7 112.4 M =
- 10
33.0 67.0 33.0
(ML)-Tan to orange with green and white,SILT with tr. -_
35.0 3 weathered quartz 35.0 35.0
- a „ 97.1 M
10
38.5 3 0;
5 7 g 12.0 M
oa
o�
�t
fV�
43.0 2
5 s 10.1 D
45.0 8 45.0 55.0 45.0 45.0
BORING TERMINATED AT ELEVATION 55.0 ft in SILT
EjPortland Cement 0Bentonite Pellets El#2 Medium Sand

5� N
■
MW-01
f _
� ®MW-02 5
MW-1 D � v�NMP`N (
MW-04
LEGEND
® Monitoring Well
(Type II)
OMonitoring Well
(Type III)
Approximate Location
of Former UST Basins
Parcel Boundary Source: E rs axa, GeoEye, Ear, ar Geog�riap cs, CNES/Airbus IDS,USDA, USGS1wAoGRID, IIG�N and the GIS User Community
NOTES:
1. UST locations were obtained from previous reports
prepared by other consultants and are approximate. 20 10 0 20 40
2.Well locations were obtained during field activities Feet
conducted on August 19,2021.
PROJECT TITLE
M & M GRILL FIGURE
ATLIN 217 E SOUTH MAIN ST SITE MAP
CLITTLETON, NC
Engineers and Scientists
INCIDENT N I JOB NO. DATE SCALE DRAWN BY/CHECKED BY
38688 221233 APR 2022 AS SHOWN KMC/BJA