GW1-2022-07895_Well Construction - GW1_20220825

220 Old Dairy Road
CATLIN Wilmington, NC 28405
45
[phone]-5861
Engineers and Scientists
www.CatlinUSA.com
August 25, 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 — Bass Country Store
8440 NC 27 E.
Coats, North Carolina 27521
Incident Number: 6361
CATLIN Project No.: 221267
To Whom it May Concern,
CATLIN Engineers and Scientists (CATLIN) recently constructed one (1) monitoring well
at the above referenced site. Attached to this letter is the completed North Carolina
Well Construction Record with associated Attachments for the site in Coats, 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 Record, Well Log, 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 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 3 ft.1 2 in. Sch. 40 1 PVC
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 3 ft 18 ft 2 in Slot.olo Sch. 40 PVC
❑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
El Irrigation 0 ft 0.5 it. Concrete Surface Pour
Non-Water Supply Well:
®Monitoring ❑Recovery 0.5 it. 2 it. Bent. Pellets Surface Pour
Injection Well: ft ft
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL EMPLACEMENT METHOD
2 ft 18 ft.#2 Medium Sand Surface Pour
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control a' a
20.DRII,LING LOG attach additional sheets if necessary)
❑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: 08/18/22 Well ID#: MW-01 ft ft -
ft ft �O
5a.Well Location:
NCDEQ-BASS COUNTRY STORE NA ft P
ft
Facility/Owner Name Facility ID#(if applicable) ft
8440 NC 27 EAST, COATS, 27521
Physical Address,City,and Zip ft ft
21.REVI ARKS
HARNETT 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)
35m399057 N -78.601229 W 8/19/2022
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: 18•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: 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 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
221267 SHEET 1 OF 1
PROJECT NO.: 221267 STATE: NC COUNTY: HARNETT LOCATION: COATS
PROJECT: LOGGED BY: M. APPUERLE WELL ID:
BASS COUNTRY STORE DRILLER: D.T. CHALMERS JR.
NORTHING: 600402 EASTING: 2118835 CREW: T. PARK MW-U1
SYSTEM: NCSP NAD 83 USft BORING LOCATION: NW portion of building T.O.C.ELEV.: NM
DRILL MACHINE: Diedrich D-50 METHOD: HSA 0 HOUR DTW: NM TOTAL DEPTH: 18.0
START DATE: 8/18/22 END DATE: 8/18/22 24 HOUR DTW: NM WELL DEPTH: 18.0
DEPTH BLOW COUNT OVA LAB o 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 % _
:' 0.5 Brown,TOPSOIL 0.0 0.5
3 5 NM D (SP)-Brown and white, F.SAND a
s
6
2.0
(V
3.0 3.0
(SC)-Brown to gray,Clayey SAND
Increase in clay content at depth
5.0
1
z NM M
6
5
8.0
(CH)-Red with orange and tan, Highly plastic CLAY
10.0 9
3 60
5 :'.
7 N
s M M
N�
12.0 _________________ ______
(CL)-Red to brown,Cse.Sandy slightly plastic CLAY
15.0
1
z 2 N M Sat.
z
cc
18.0 18.0 18.0 18.0
BORING TERMINATED AT DEPTH 18.0 ft in Cse.
Sandy CLAY
cc
ElPortland Cement Em Bentonite Pellets El#2 Medium Sand

tiCy� N
' 2�F
4
® MW-7 MW-3
*.I
rs
WSW-1
MW-1 RW-1• —r _
MW-01 •
MW-9
MW-8
®�MW-5
LEGEND
0 Recovery Well
Monitoring Well �l
® (Type II) / V�
® Abandoned Potable
Water Supply Well cz)
❑ Approximate Location
of Former UST System O
❑ Parcel Boundary
(Incident#6361)
❑ Parcel Boundary
(Incident#3357) Source: Esri, Maxar,GeoEye, Earthstar Geographics,G ES/A b DS,
TIN USDA, USGS,AeroGRID, IGN,and the GIS User Com
NOTE: Well and tank locations were obtained from previous 50 25 0 50 100
reports preapred by other consultants and are approximate.
Feet
PROJECT TITLE
FIGURE
PON
ATLIN BASS COUNTRY STORE
8440 NC 27 EAST SITE MAP
CCOATS, NC
Engineers and Scientists
INCIDENT NO I JOB N0. DATE SCALE DRAWN BY/CHECKED BY
6361 221267 AUG 2022 AS SHOWN GDH/CDF