GW1-2022-08330_Well Construction - GW1_20220822

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
'74rWXTER'ZONESW,--4M Vw 3'�;.:
D.T. CHALMERS, JR. FROM TO DESCRIPTION
Well Contractor Name fL R
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4146A fL ft I
NC Well Contractor Certification Number '15:=INNER CASING!O111TIIBINCr eothermalT osedrloo
FROM TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists -31L 2 fL 1 in Sch.40 PVC
Company Name T6.Cil1TER CASIKG fo`r muI i"c"ased well W&Oanf e'lica6le
FROM I TO I DIAMETER THICKNESS MATERIAL -
2.Well Construction Permit#: N/A I
n. ft.1 in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
fL fL in:
3.Well Use(check well use): „a1,Tg`O EN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public
2 rt. 12 n. 1 in.1 Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL fL 1 in.
❑industrial/Commercial ❑Residential Water Supply(shared) 1s.GaouT #';[
FROM TO I MATERIAL EMPLACEMENT h'IPTHOD&AMOUNr
❑Irrigation
e. e.
Non-Water Supply Well:
®Monitoring ❑Recovery fL n.
Injection Well: fL ft.
❑Aquifer Recharge ❑Groundwater Remediation 6 91SAND/CR'dVEIIIPAGKt ira licable
FROM TO❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage ft. rL MATERIAL ENIPLACEMENC METHOD
❑Experimental Technology ID Subsidence Control 0 rL 12 rt. Natural Backfill
k10.113IRUMING11010G a� tsehhTaddiTidnal shf e`etstir•necessa '�i�`Ia::
❑Geothermal(Closed Loop) ❑Tracer FROM TO I DESCRIPTION color,hardness soil/rock twe.min site,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) fL ft.
4.Date Well(s)Completed: 08/09/22 Well ID#: TMW-03 rL ft.
fL rt. S� O
5a.Well Location: E/►
tL R. P r c '<�
NCDEQ-NCDOT Rockhill Rd. NA �'-'
Facility/Owner Name Facility ID (it applicable) fL
fL
-3500 Rock Hill Rd,CASTLE HAYNE,NC
Physical Address,City,and Zip I'L ft.1 InfiHmaugn Pri-nawng Urd
-zi:fiEEMalilt's '
NEW HANOVER 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)
34.307107 N -77.922076 W 8/10/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): O Permanent or O Temporary Br signing this form,/hereby certi/i,that the well(s)was(were)constructed in accordance with
13A NCiC 02C.0100 or W NCI C 02C.0200 Well Cousin iction Standards and that a copy of
7.Is this a repair to an existing well: OYes or ®No this record has been provided to the well owner.
1f 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 conslrucdon,you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 12.0 (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@100) construction to the following
10.Static water level below top of casing: NM (ft,) Division of Water!Resources,Information Processing Unit,
1f water level is above casing,use"+^ 1617 Mail Se ii,
ice Center,Raleigh,NC 27699-1617
11.Borehole diameter: 2.25 (in.) 24b.For Infection Wells ONLY: In addition to sending the fore]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 SvuDly&fIniiection 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 Fonn GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016
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CATLIN
Engineers and Scientists
WELL LOG z�2°'4 SHEET 1 OF 1
PROJECT NO.: 220274 STATE: NC COUNTY: NEW HANOVER LOCATION: CASTLE HAYNE
PROJECT: Corner of Rockhill Rd. an d Castle Hayne LOGGED BY: c.I FUTRAL WELL ID:
Rd. DRILLER: D.T. CHALMERS JR. TMV11-03
NORTHING: 204530 1 EASTING: 2325533 CREW:
SYSTEM: NCSP NAD 83 USft BORING LOCATION: Corner of Rockhill Rd.an d Castle Hayne Rd. T.O.C.ELEV.:
DRILL MACHINE: Power Probe METHOD: DPT 0 HOUR DTw: NM TOTAL DEPTH: 12.0
START DATE: 8/9/22 END DATE: 819/22 24 HOUR DTW: FIAD WELL DEPTH: 12.0
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
3.0
i
0.0 LAND SURFACE, 0.0
0.0 0,5 (GW)-Asphalt and Gravel mixture 0.0a -
(SP)-Gray with tan grading to It.gray with orange
t
mottling,F.SAND
Direct N NI M
Push "
4.0 -
oa
Direct N M W o o� -
Push -
U L
8.0
Direct WATER:
Push NM TMW-03. Sat.
i
12.0 :{ 12.0 - 12.0 12.0
BORING TERMINATED AT DEPTH 12.0 ft in F.SAND
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Native Backfill 1
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