GW1-2022-05683_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-Tackett Residence
13117 N. Roxboro St.
Rougemont, North Carolina 27572
CATLIN Project No.: 221052
Incident No.: 13145
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
Rougemont, 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 InternalU, 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 ft
NC Well Contractor Certification Number 1S.INNER CASING OR TUBING(geothermal closed-loo
FROM TO DIAMETER THICKNESS MATERLll.
CATLIN Engineers and Scientists 0 ft. 5 ft. 2 irt.I Sch.40 1 PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER if applicable
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: NSA ft. ft. ;n.
List all applicable well permits(i.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 THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5fr. 20ft. 2 in. SIOt.olo Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. fr. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT MET1IOD&AMOUNT
❑Irrigation 0 ft. 0.5 It. Portland Cement Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 0.5 ft. 3 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 3 ft. 20;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 rmc,grain size,etc.
❑Geothermnal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. it
4.Date Well(s)Completed: 04/11/22 Well ID#: MW-01 ft. ft. -
ft. ft.
5a.Well Location:
ft ft
NCDEQ-Tackett Residence NA
ft.
Facility/Owner Name Facility ID#(if applicable)
ft.
13117 N. ROXBORO ST,ROUGEMONT,NC 27572
ft. IT
Physical Address,City,and Zip
21.REMARKS
WAKE NA
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(ifwell field,one lat/longis sufficient)
36.221241 N -78.927716 W C /� 4125/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or ❑Temporary By signing this form,I hereby certify that the well(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 ifnecessary.
For multiple injection or non-water supply wells ONLYwith 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: 5.12 (ft.) Division of Water Resources,Information Processing Unit,
Ifwater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 2 7 699-1 61 7
11.Borehole diameter: 8•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,rotanv,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 Svuuly&Injection Wells:
Also submit one copy of this form within 30 days of completion of well
13b.Disinfection type: Amount: construction to the comity 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

CATLIN
WELL LOG Engineers and Scientists
zzlosz SHEET 1 OF 1
PROJECT NO.: 221052 STATE: NC COUNTY: WAKE LOCATION: ROUGEMONT
PROJECT: TACKETT RESIDENCE LOGGED BY: OLIVIA DAYNES WELL ID:
DRILLER: D.T. CHALMERS, JR. MW-01
NORTHING: 2021323 EASTING: 899447 CREW: TREVOR MIZELLE
SYSTEM: NCSP NAD 83 USft BORING LOCATION: North of former UST basin T.O.C.ELEV.: 99.04
DRILL MACHINE: CME 45B TRACK METHOD: HSA 0 HOUR DTW: 18.6 TOTAL DEPTH: 20.0
START DATE: 4/11/22 END DATE: 4/11/22 24 HOUR DTW: 5.1 WELL DEPTH: 20.0
DEPTH BLOW COUNT OVA LAB o a SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (ppm) s G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 99.0 0.0
0.0 (FILL)-Silty FILL 0.0 - 0.5
4 4 0.9 M 1.0 98.0
s (MH)-Orange,highly elastic SILT
Slight HCO from 5-7'BLS
Lt.brown from 10-11'BLS a
3.0
N
5.0 5.0
z 4 4 167.3 M6 a j1 M
10.0
1
z 4 35.8 W 11.0 88.0
5 (ML)-Lt.brown,slight to mod.elastic SILT
o>
oa
LL
LL
o�
�L
V N
15.0 15.0 84.0
_ (WR)-Brown,Silty WEATHERED ROCK
9
LL 38 50i 25.7 D
.2 =
LL
20.0 _ 20.0 79.o zo.o zo.o
BORING TERMINATED AT ELEVATION 79.0 ft in Silty
WEATHERD ROCK
EjPortland Cement EM Bentonite Pellets El#2 Medium Sand

G
s N
V'
f r �O
O
'PO
- - - MW-01
y
MW-02
MW-03
WSW-6
P
LEGEND
® Monitoring Well
(Type II) `
y s
O Active Potable it
Water Supply Well
Approximate Location
of Former UST Basin P
U Parcel Boundary
Source: Esri,Maxar, GeoEye, Earthstar Geographies, ONES/AirbL4 DS,
USDA, USGS,AeroGRID, IGN,and the GiS User Community
NOTE:Well and tank locations were obtained from previous
reports prepared by other consultants and are approximate. 30 15 0 30 60
Feet
PROJECT TITLE
FIGURE
TACKETT RESIDENCE
ATLIN 13117 US HWY 501 SITE MAP
CROUGEMONT, NC
Engineers and Scientists
INCIDENT NO. JOB N0. DATE SCALE DRAWN BY/CHECKED BY
13145 221052 MAY 2022 AS SHOWN KMC/SJO