GW1-2022-10834_Well Construction - GW1_20221209

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 I DESCRIPTION
Well Contractor Name rt ft
4146A ft ft
NC Well Contractor Certification Number 15.INNER CASING OR TUBING geothermal closed-loc
FROM TO DIAMETER. _ THICKNESS I MATERIAL'
CATLIN Engineers and Scientists 0 ft.I 0fJ j 1 Sch.40 1 PVC
Company Name 16.OUTER CASING for multi-cased wdis OR LINER if a licable
FROM TO I DIAMETER I THICKNESS 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 SLOTS12E •THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 0 ft 15 it. 1 in. Slot.010 SCh.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft. j in.
❑Industrial/Commercial ❑Residential Water Supply(shared) :18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMO_
❑Irrigation
ftNon-Water Supply Well: R.
®Monitoring ❑Recovery ft ft
Injection Well:, ft ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SANDIGRAVEL PACK if applicable)
FROM TO
❑Aquifer Storage and Recovery ❑Salinity Barrier MATERIAL EhIPLACEMENT METHOD
' m tt
11 Aquifer Test ❑Stormwater Drainage
❑Experimental Technology 0 Subsidence Control 0 ft 15 ft Natural Backfill ,
20.DRILLING LOG attach additional sheets if necessary
❑Geothermal(Closed Loop) ❑Tracer FROM TO I DESCRIPTION color,hardness soillrock tyve.wain size etc.
i
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 921 Remarks) ft ft
ft ft
4.Date Well(s)Completed: 11/22/22 Well ID#: TMW-03 ft aAle,
Sa.Well Location:
0-033130 ft ft
NCDEQ-FORMER LIL COUNTRY STORE P
ft
Facility/Owner Name Facility ID#(if applicable)
6606 LEESVILLE RD.,DURHAM,27703
Physical Address,City,and Zip It. rt
21.REMARKS
DURHAM. N/A
County Parcel Identification No.(PIN) IrlSt:irr,^rim o_.
5b.Latitude and Longitude,in degrees/minutes/seconds or decimal degrees: ,r�1:;r I:3 .7 URa
(if well field,one lat/long is sufficient) 22.Certification: un^,
35.9340853 N -78.7746515 W 12/1/2022.
Signature of Certified Well Contractor Date
6.Is(are)the well(s):'❑Permanent., or ETemporary By signing thisform,I hereby certifi,that,the well(s)was llu:ere)co-nsinicted in accordance with
15A NCAC 02C.0100 or 15A NC4C 02C.0200 Well Construction Standards mid 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.
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 constiuction details. You may also attach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same construction,you SUBMITTAL INSTRUCTIONS
can submit and form
9.Total well depth below land surface: 15.0 (B,) 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,
If water 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- HSA completion of well construction to the following:
(i.e.auger,roteny,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 Svnaly k1njection 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

II
ENVIRONMENTAL,CIVIL
GEOTECHNICAL CATLIN
• •�WELL-LOG - IMlmington,Raleigh,Washington,.:
''
cF adeston Engineers and Scientists
2211,40 SHEET 1 OF .1
PROJECT NO.: 221140 . . STATE: NC COUNTY: DURHAM ... WCATION: DURHAM
PROJECT: LOGGED BY: Lc. BLACK :WELL ID:
FORMER LIL COUNTRY STORE. DRILLER: D.T. CHALMERS JR.
NORTHING: 7049801 FEASTING: 2066712 CREW: EJ DONT.ON TMW-03
SYSTEM: NCSP NAD 83 USft BORING LOCATION: North.side of Leesville Rd:across fromtel hone ole .T.O.C.ELEV.: NM
DRILL MACHINE: Diedrich D-25 METHOD: HSA . 0 HOUR DTW: NM. ..T.OTAL DEPTH: 15.0.
START DATE: 11/22/22 " END DATE: 11/22/22 124 HOUR DTk NM WELL DEPTH: 15.0
BLOW COUNT OVA o L SOIL AND ROCK ! WELL
DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPM) LAB• s G DEPTH DESCRIPTION DETAIL
I
0.0 -. LAND SURFACE! . 0.0
0.0 (SP)-Brown,F.to Med.SAND : 0.0 _
21 1.0 _
y 1.3 D q ASPHALT
'
2.0 a _
(CL)-Lt.brown and gray,Silty CLAY- -
5 0. 6.0
3. 3 0.1 M
q
8.0
(ML)-Brown and white,Sandy SILT _
o U -
10.0 se -
�t -
z
3 0.3 M -
5 5 _
12.5
13.0 k (SM)-Dark brown,Silty F.SAND
3. _
3 z 0.4 M +
3
15.0 15:0: _ .. 16.0 = 16.0
BORING TERMINATED AT DEPTH 15.0 ft in Silty
SAND
i •
i
SalveB Nat• ac�ll
i