GW1-2022-07229_Well Construction - GW1_20220805

i
WELL CONSTRUCTION RECORD For Internal Use ONLY.
This form can be used for single or multiple wells
1.Well Contractor Information:
14.WATER ZONES
Austin Fowler FROM TO DESCRIPTION
Well Contractor Name ft. ft.
4366A M ft
NC Well Contractor Certification Number 15.INNER CASING OR TUBING eothermal closed-loo
FROM TO DIAMETER 7tIICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft 5 a. 1 Sch.40 1 PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER ifn licable
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: N/A ft. ft. in.
List all applicable well permits(i.e.C.oun(y,State, Variance,Injection,etc.)
ft. R, in.
3.Well Use(check well use):
17.SCREEN
Water Supply Well: FROM TO i DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 ft. 15 ft. j1 ! in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUKI'
❑Irrigation
rt. rt.
Non-Water Supply Well:
®Monitoring ❑Recovery 2 rt. 3.5 ft.
Injection Well: ft. e.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTMETHOD
❑Aquifer Test ❑Stomrwater Drainage 3.5 ft-120*1 Medium Sand Torpedo Sa d;urface Pour
❑Experimental Technology ❑Subsidence Control ft I ft
20.DRILLING LOG attach additional sheets if necessary
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soittrock tvpe,twain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed: 04/26/22 Well ID#: 1601-C-TW03 ft' ��-
fr. n. S �O
5a.Well Location:
ft ft.MEADOWS NA ft I
Facility/Owner Name Facility ID#(if applicable)
rt.
,CAMP LEGEUNE,NC -
Physical Address,City,and Zip ft. rt.
21.REMARKS . ^
ONSLOW NA
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)
34.66654 N -77.338967 W 7/22/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): O Permanent or ❑Temporary Br signing this form,I hereby cent ,that the wells)iras(were)constructed in accordance with
IAA NCAC 02C.0100 or ISA NCIC 02C.0200 Well Construction Statdords and that a copy of
7.Is this a repair to an existing well: ❑Yes or ONO this record has been provided to the well owner.
Ifthis 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: I construction details. You may also attach additional pages if necessary.
For tnuhiple 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: 15.0 (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: (ft.) Division of Water Resources,Information Processing Unit,
Ifwaler level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 2.25 (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: DPT completion of well construction to the following:
(i.e.auger,totaty,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
I.
13a.Yield(gpm) Method of test: 24c.For Water Sypply&Iniection 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 Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

i
i
I
CATLIN
Engineers and Scientists
WELL LOG 8027.02 SHEET 1 OF 1
PROJECT NO.: 218027.02 STATE: NC COUNTY: ONSLOW LOCATION: CAMP LEJEUNE
PROJECT: POL LEAGACY SITE BB71 and 1601 LOGGED BY: i T. Moore WELL ID:
DRILLER: Austin Fowler 1601-C-TW03
NORTHING: 33775.11 EASTING: 2499430 CREW: CATLIN
SYSTEM: NCSP NAD 83 USft BORING LOCATION: T.O.C.ELEV.:
DRILL MACHINE: GeoProbe METHOD: DPT 0 HOUR DTW: NM TOTAL DEPTH: 20.0
START DATE: 4/26/22 END DATE: 4/26/22 124 HOUR DTW: NM WELL DEPTH: 15.0
DEPTH BLOW COUNT OVA LAB M L SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (ppm) s G DEPTH DESCRIPTION DETAIL
I
0.0 LAND SURFACE 0.0
0.0 (SW)-Black Sandy Topsoil 0.0
(SW)-Tan to black,SAND
Direct NM D a
Push
0
3.5
4.0 4.0
4 (SC)-Tan to brown,Clayey SAND
(CL)-Gray,Sandy CLAY ! 5.0
Slight HCO from 8.0-8.9'BLS
Direct N
Push M D
8.0
8.9
(OH)-Gray,CLAY with slight HCO o
>
i/
Direct NM M /; o
Push c
U)
12.0
Direct
Push NM Sat.
15.0
15.4
(SC)-Tan and gray,Clayey SAND
16.0 Slight HCO
Direct Push NM Sat.
18.0
18.5
Direct Push N M Sat. (CL)-Gray,Sandy CLAY
Slight HCO
I
20.0 20.0 _ 20.0
BORING TERMINATED AT DEPTH 2Q.0 ft in Sandy
CLAY
II
Bentonite Pellets El92 Medium Sand
I