GW1-2022-08403_Well Construction - GW1_20220513

WELL CONSTRUCTION RECORD For Internal U ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
14. s m4mz Tia
D.T. CHALMERS, JR. FROM TO I DESCRIPTION
Well Contractor Name fL R
4146A fL f.
NC Well Contractor Certification Number =i5'nSNER'GnSfN6J6WTUHING 'eofne-;nal closed'loo
'FROM TO DIAMETER. THICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft. 5 rL ;1 Sch.40 PVC
Company Name
161011TER1GASI9G-.-foPniu`Ifi-csred wells':O'R1'LINER''1f'a`lica6le
FROM I TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: NSA IL a in.
List all applicable well permits(i.e.(ounty,State, Variance,Injection,etc.)
fL fL in.
3.Well Use(check well use): RE _
.r;17;SGEN';a�..s:v.:' r:,.;1F..a «..'
Water Supply Well: FROM TO .DIAMETER SLOTSUE ��THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 rL 15 R. 1 in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) O Residential Water Supply(single) rc rL
❑Industrial/Commercial D Residential Water Supply(shared)
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation
Non-Water Supply Well:
®Monitoring ❑Recovery fL fL
Injection Well: fL rL
❑Aquifer Recharge ❑Groundwater Remediation iOS:vsiu/Ganvi[ArnCiZ rf a"ficitil"e
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I To I MATERIAL I EMPLACEMENT NEI-HOD
❑Aquifer Test ❑Stomtwater Drainage fL fL
❑Experimental Technology ❑Subsidence Control 0 ft-1 16 rL Natural Baekfill
20:DRILLING+L'OG`5'tt3ck-.a'dditional"sheefs,if.necessa'" -31
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soillrock in size etc.
❑Geothermal(Heating/Cooling Return) OOther(explain under#21 Remarks) fl fL
4.Date Well(s)Completed: 04/28/22 Well ID#: TMW-01 rL rL
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5a.Well Location: r.N
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NCDEQ-Twins Too 0-034441
a
Facility/Owner Name Facility ID#(if applicable)
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RECRv
1741 Hwy 58 S,Snow Hill 28580
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Physical Address,City,and Zip
21.REMA72ICS.1-...-..'::.'
s
GREENE NA
County Parcel Identification No.(P"
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one latAong is sufficient)
35.426382 N -77.637262 W 5/13/2022
Signature of Certified Well Contractor Date
6.Is(are)the well(s): OPermanent or ®Temporary
Rr signing This jonn,!hereby certij•that the well(v)>7•as(s•ere)constructed in accordance with
I9A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Constriction Standards and that a copy of
7.Is this a repair to an existing well: O Yes or ®No this record has been provided to the well owner.
Ijthis is a repair,fill out known well construction information and explain the name 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 construcdon,you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 15.0 (g.) 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: 6.2 (B) Division of Water Resources,Information Processing Unit,
ljwater Icvel is above casing,use"+" 1617 Mail Se`cep Center,Raleigh,NC 27699-1617
11.Borehole diameter: 4.25 (in.) 24b.For Infection 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: completion of well construction.to the following:
I
(i.e.auger,rotary,cable,direct push etc.) Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Servi 1 ce Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water SvaDly&Infection Wells:
Also submit one copy of this form within 30 days of completion of well
13b.Disinfection type: Amount: construction to the county hea'Ith 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

CATLIN
WELL LOG i Engineers and Scientists
z?ozn SHEET 1 OF 1
PROJECT NO.: 220277 STATE: NC I COUNTY: GREENE LOCATION: WILMINGTON
PROJECT: LOGGED BY: T. PARKS WELL ID:
Twins Too DRILLER: D.T. CHALMERS JR. TMW-01
NORTHING: 24059511 EASTING: 612895 CREW:
SYSTEM: NCSP NAD 83 USft BORING LOCATION: East of UST Basin T.O.C.ELEV.: 101.10
DRILL MACHINE: Power Probe METHOD: 0 HOUR DTW: 6.2 TOTAL DEPTH: 16.0
START DATE: 4/28/22 END DATE: 4/28/22 124 HOURIDTW: NM WELL DEPTH: 15.0
BLOW COUNT OVA o L SOIL AND ROCK WELL
DEPTH 0.5ft 0.5ft O'5ft 0.5ft (PPM) LAB. s c DEPTH DESCRIPTION ELEVATION DETAIL
fI
0.0 LAND SURFACE, 101.1 0.0
(SW)-Brown,Gravelly SAND 0.0 _
r 1.0 100.1
(CL)-Gray to tan,Sandy CLAY
Direct NM o
Push
0
4.0
5.0
Direct NM TMW-01 6.0 95.1
Push (4-5) (SC)-Tan to brown with orange mottling,Clayey F.to -
CSE.SAND
8.0
pU
oa
Direct NM
Push
rn t
n
12.0
2.
Direct NM _
Push
15.0
16.0 16.0 85.1 16.0
BORING TERMINATED AT ELEVATION 85.1 ft in
Clayey F.to CSE.SAND
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Native Backfill ! I
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