GW1-2022-05839_Well Construction - GW1_20220615

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 TO DESCRIPTION
Well Contractor Name ft ft
4146A ft ft
NC Well Contractor Certification Number 15.INNER CASING OR TUBING eothermal closed-loo
FROM TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft.1 12 ft.1 1 in. SS I SS
Company Name 16.OUTER CASING for multi-cased wells OR LINER if applicable
FROM TO DIAMETER I THICKNESS I MATERIAL
2.Well Construction Permit#: N/A
ft ft in.
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
El Agricultural ❑Municipal/Public 12 ft 16 ft 1 in Slot.010 SS SS
❑Geothermal(Fleating/Cooling Supply) ❑Residential Water Supply(single) ft ft is
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
ft ft
Non-Water Supply Well:
®Monitoring ❑Recovery ft ft
Injection Well: ft ft
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
ft ft
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 20.D 0 ft 1 ft Natural Bac ssa
RII,LING LOG(attach additional sheets if uecessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hmdness soil/rock type,pyain size etc.
❑Geothermal(Fleating/Cooling Return) ❑Other(explain under#21 Remarks) ft ft
4.Date Well(s)Completed: 06/14/22 Well ID#: TMW-02 ft ft -
ft ft �O
5a.Well Location: R07900-003-009-000,R07900-003-010-000,
R07900-003-010-001,R07900-003-010-002, ft ft
CRIBB POLLY GREENE and R07900-003-01 1-000
F0
Facility/Owner Name Facility ID#(if applicable)
ft
6221,6223,6229 CAROLINA BEACH RD,WILMINGTON, NC 28412
ft ft
Physical Address,City,and Zip
21.REl\f ARKS
NEW HANOVER 3133-33-4659
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)
34.112036 N -77.897825 W 6/15/2022
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
15A NCAC 02C.0100 or 15A 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 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: 16.0 (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@I00) construction to the following:
10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit,
Ifwater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 3.25 (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: DPT 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 Svnnly&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

CATLIN
WELL LOG Engineers and Scientists
222113 SHEET 1 OF 1
PROJECT NO.: 222113 STATE: NC COUNTY: NEW HANOVER LOCATION: WILMINGTON
PROJECT: CRIBBS HOBBY LOGGED BY: C. FUTRAL WELL ID:
DRILLER: D.T. CHALMERS JR. TMW-02
NORTHING: 133620 EASTING: 2333645 CREW: E. SWAIN
SYSTEM: NCSP NAD 83 USft BORING LOCATION: SE OF MW-1 T.O.C.ELEV.: NM
DRILL MACHINE:CATLIN GeoProbe METHOD: DPT 0 HOUR DTW: NM TOTAL DEPTH: 16.0
START DATE: 6/14/22 END DATE: 6/14/22 24 HOUR DTW: FIAD WELL DEPTH: 16.0
DEPTH BLOW COUNT OVA LAB 0 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
0.0 0.0
Direct NM D _
Push
4.0
Direct
Push NM M
8.0 (SP)-Various browns and tans, F.SAND
Direct NM W
Push
12.0 12.0
0
oU
Directco
Push N M TMW-02 Sat.
16.0 16.0 16.0 16.0
cc BORING TERMINATED AT DEPTH 16.0 ft in F.SAND
cc
1"Stainless Steel well set to 16'BLS
cc
cc Took grab water sample and abandoned well
cc
Native Backfill

N
GW-3
z
GW-2
SB.0 MW-2
-
',
SB-01
ICA
TMW-03 TMW-02 r-_.. .
l 4L f ' .. LEGEND
Soil Boring
Former r
$ Groundwater Sample
Monitoring Well
(Type II)
1 Temporary Monitoring .
Well (Type II)
Former Monitoring
j i ® Well (Type II)
Parcel Boundary
F ` E=GniG he GI r C
100 50 0 100 200
Feet
PROJECT TITLE FIGURE
CRIBBS HOBBY
ATLINA221, 6223, & 6229 SITE MAP
CAROLINA BEACH RD
Engineers and Scientists WILMINGTON, NC
SITE ID JOB N0. DATE SCALE DRAWN BYICHECKED BY
NONCD0001564 222113 JUNE 2022 AS SHOWN KMC/BJA