GW1-2022-08376_Well Construction - GW1_20220519

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. fL
4146A fL i
NC Well Contractor Certification Number 15.INNER CASING OR TUBING �eothernral closed-loo
FRONT TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft.1 5 fJ 1 in.1 Sch.40 1 PVC
Company Name 16.OUTER CASING for multi-cased hells OR INER(ifapplicable
FRONT I TO I DIAMETER I THICKNESS I MATERIAL
2.Well Construction Permit#: N/A fL rt. in.
List all applicable well permits(i.e.County,State, variance,b jection,etc.)
ILI fL I in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM To I DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 a. 15 ft. 1j in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ElResidential Water Supply(single) ft. ft. in
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO It K ERIAL EMPLACEMENT METHOD&AMOUNT
❑Irri ation
fL fL
Non-Water Supply Well:
®Monitoring ❑Recovery rt. rL
Injection Well: fL ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if applicable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft. rt.
kfll
❑Experimental Technology ❑Subsidence Control 0 fL 1attaa rt. Natural Bac
20.DRILLING LOG ch additional sheets if necessary)
❑Geotliemial(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness.soil/rock tv a Brain size etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft rL
4.Date Well(s)Completed: 04/28/22 Well ID#: TMW-03 rL ft.
fL fL
5a.Well Location:
fL ft. f -Gi^.9 r.-- •_
NCDEQ-Bowden Grocery and Grill 0-017636
ft
Facility/Owner Name Facility ID#(if applicable) t MAY
fL
6879 US HWY 401 SOUTH,BUNNLEVEL,NC 28323
a. rL
Physical Address,City,and Zip
21.RE1%1ARKS -
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)
35.307234 N -78.781397 W 5/13/2022
SignatureofCertified Well Contractor Date
6.Is(are)the wcII(s): ❑Permanent or ®Temporary Bvsigning thisfornr,ihereby certtfi,that the it was(were)constructed in accordance with
ISA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standardv 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 stature of
the repair tinder#21 remarks section or on the back ofthisform. 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 saute 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 d�erent(example-3@200'and 2@1009 construction to the following:
10.Static water level below top of casing: 4•6 (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: 4.25 (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: Direct Push completion ofwell 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 Svpply&lniection 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
zzozzs SHEET 1 OF 1
PROJECT NO.: 220226 STATE: NC I COUNTY: HARNETT LOCATION: BUNNLEVEL
PROJECT: BOWDEN GROCERY AND GRILL LOGGED BY: T. PARKS WELL ID:
DRILLER: D.T. CHALMERS JR. TMW-03
NORTHING: 566816 1 EASTING: 2065218 CREW:
SYSTEM: NCSP NAD 83 USft BORING LOCATION: NE of LISTA T.O.C.ELEV.: 100.00
DRILL MACHINE: Power Probe METHOD: Direct Push 0 HOUR DTW: 4.6 TOTAL DEPTH: 16.0
START DATE: 4/28/22 END DATE: 4/28/22 124 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 ELEVATION DETAIL
0.0 LAND SURFACE 100.0 0.0
0.0 Q (GW)-Gray to orange,Sandy GRAVEL 0.0 =
1.0 99.0
(CL)-Gray to tan,Sandy CLAY
Direct TMW-03 0
a
Push NM (Z 3) D
0
t -
U -
VI
4.0
5.0
Direct N M M -
Push
8.0
oa
Direct N M M
Push
rn t
12.0 12.0 88.0
(SC)-Tan to orange,Clayey SAND
Direct NM Sat. �No -
Push
15.0 -
16.0 '�' 16.0 sa.o � 1s.o
BORING TERMINATED AT ELEVATION 84.0 ft in
Clayey SAND
Native Backfill