GW1-2022-10838_Well Construction - GW1_20221209

WELL CONSTRUCTION RECORD For lntenal U.ONLY
I he fain can be used for single,r nwhiple weae
1.Well Contractor Information: — — - -
M WATER ZONES
D.T. CHALMERS,JR. MONI To DESCRIPnON
Well Contractor Name n. n.
4146A ft.1 a
NC Well Contractor Cemfieation Number IS.INNERC'ASINGORTURING eoLermile1oee6I
MAI TO D1:1A@TER n1 1—s) I VL{hRIAL
CATLIN Engineers and Scientists 0.5 n. 15 ftl 2 Sch.40 1 PVC
Company Name KOUTER CASING fa edtiened"lidOR LINER ifa motile
FROM To DIAMMYR n-0CI:pFSS I >IAMRLU
2.Well Construction Permit H: N/A
List all app6cuhle well permits f.e.Courey,Stine, Yardme,/tyecnon,ere)
n. n.
3.Well Use(check well me): IT SCREEN
Water Supply Wen: fnosl ro Dfas�TR sLOrslzE mlcr.�TSS NIATLmu
OAgricultmal ❑MlmicipaLPublic 15 n. 30 n. 2 SIot.010 Sch.40 PVC
OGeothemul(Hearing/Cooling Supply) ❑Residential Water Supply(single) n. n.
❑Industrial/Commercial ❑Residential Water Supply(shared) IL GR Irr in
FROM TD AIAIEmAL EsmLAIP\u\r\n°nloDa ��4e .,.
❑lni tron r Supply VWell: 0.5 n. 0.6 a Concrete Surface Pour
Noo-Wate
®Monitoring ❑Reomery 0.6 n 13 n Bent. Surface Pour
Injection Well: n. n.
OAgwfer Recharge O Gramdwater Remediabon 19.SAND/GRA\BLPACI( io isade
El Aquifer Storage and Recovery ❑Salinity Banner FWAi TO SrrD�,u F.ml nct+nv>�EmoD
❑Aquifer Test O Stormwater Drainage 13 n. 32 u. Torpedo Sand Surface Pour
❑Experimental Technology OSubsidence Control n. f,
20.DRILLING LOG tattwb ad&ttand Sheets ifiimessarr
❑Geothermal(Closed Loop) 0Tracer FROM To I DEX81rno> n—d—,..d—k!,p, e,.,.. .
❑Geothermal(Healing/Cooling Retain) ❑Other(explain under#21 Remarks) n rt.
4.Date Wen(s)Completed: 11115122 Wen IDN: MW-03
n a G
Sa.Well Location:
011600 n r
NCDEO-Former Texaco Food Mart No.2 0- �C
n `
Facility/Osmler Name Facdirp DO(if applicable)
1700 COTTON GROVE RD.,LEXINGTON,27292
n n
Phcsical Address Cit,'.and lip
.I.REMARKS
DAVIDSON N/A
County Parcel Identification No.(PIN) t-r•_
r •
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 1certification: f
(ifeell field,one lathing is sufficient)
35.77802 N -80.25931 W yG��L�% 11/23/2022
SignanueofCmifiel Well Contracts ' Gate
6.Is(are)the we0(s): ®Permanent or OTemporary
8r signing ibis/nit,/hereby renhvini t/ce we/1/sJ win/were/[wttlrmtttlm mrankxe wi/h
15A MAC 02C 0100 or 15A At A( Well Caurra n.Smrtdurds and thin a ,Fy of
7.Is this a repair to an existingwen: OVes or ®No tMr rccardhw hernprovidedrothe writ aa•rer.
/fl/as a a repair,Ill out kwien well comtrucrtim irfvnturirm and i r#mn the earure of
the repmr under=21 remorlr section or on the buck ofthis 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 ifnecessary.
Fro maltiple iryrcnan or rcm-wrter styrity wells ONLY with the•some consmucdon.You SUBMITTAL INSTRUCTIONS submit one form.
9.Total well depth below land surface: 30.0 (R-) 24a.For An A cUs: Submit this form within 30 days of completion of well
Far multiple wells list all depths in wfjerem fecample-3@200'and 2@100% construction to the following:
10.Static water level below top of casing: 23.62 (g•) Division of Water Resources,Information Processing Unit,
lfwsaer level is above coring,use •• 1617 Man Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8.25 1*0 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
11.Well construction method: HSA completion ofwell construction to the following:
(i.e.auger,mmry,cable,direct push,eta.) Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Man Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water SvnDly&Infection Wells:
Also submit one copy of this form within 30 days of completion of wen
13K 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

WELL LOG EN RONMENTAL CIVIL
CATLIN
cEOTECHNICAL
vvl� n,nseo w.�.N w
GiYtlai Engineersand Scientists
2211M SHEET 1 OF 1
PROJECT NO.: 221185 1 STATE: NC I COUNTY: DAVIDSON LOCATION: LEXINGTON
PROJECT: FORMER TEXACO FOODMART NO.2 LOGGED BY: C. BLACK WELL ID:
DRILLER: D.T. CHALMERS JR. MW-03
NORTHING: 7404651 EASTING: 1626482 1 CREw: C. STRATTON
SYSTEM: NCSP NAD 83 USft BORING LOCATION: -8 FT FROM LIGHT POLE IN FRONT IN GRASSY T.O.C.ELEV.: 99.50
DRILL MACHINE: Diedrich D-50 METHOD: HSA 1 0 HOUR DTw: 23.6 TOTAL DEPTH: 32.0
START DATE: 11/15/22 END DATE: 11/15/22 24 HOUR DTw: NM WELL DEPTH: 30.0
DEPTH BLOW COUNT OVA o a SOIL AND ROCK WELL
o.sn o.5n 0.sa 0.5ft (PPM) s G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 LAND SURFACE 100.0 00
0.0 s ' TOPSOIL -06 0.6
10 s 5 0.1 M (CL)-Brown to fed and Mack,Silly CLAY
5.0 2
3 s 0.0 M
B
S
5
N
10.0
2 2
3 0.3 D
s
13.0
15.0 15.0 85.0 +s.o
1 2 (ML)-Bran and red grading to ft.hoen r with black and
3 + 0.0 M gray.Clayey SILT
20.0
2 2
3 s 0.0 M
oy `
oa
sS i
V1�
�y
25.0
2 2
3 0.3 M
s
30.0 w.o
2 2
s 0.1 M
32.0 68.0 32.0
32.0
BORING TERMINATED AT ELEVATION 68.0 it in
Clayey SILT
ElPortland CementIM Bentonite Pellets 0#2 Medium Sand

. •
�I• N
o
Z MW-5
m
0
_FORMER
`--�, KEROSENE I� /
A..2 UST
4. T-z
AS , VE-
0 FORMER'
ve"3
E-0 KEROSENE ; FORMER , „ w>•
A5-t(:11 rOAs-4 DISPENSER i GASOLINE 1
Y11 DISPENSER
T-1 .VEF1
T l _ 1 1I�// MW-0
MW2 yE-5 f i
FORMER ' FORMER
01
GASOLINE MW- SUPREME
DISPENSER IVE
KSTS FORMER LEGEND
vE6 MW
7*46 -0 �.5 y ® Abandoned Monitoring
FORMER FORMER Well(Type ll)
REGULAR DIESEL Destroyed Monitoring
mw-3 / (D j 1002 USTS DISPENSER ® Well (Type II)
j 1 - Temporary Monitoring
R r Well (Type II)
M` t Destroyed Monitoring
Well (Deep)
Air Sparge
wo Vapor Extraction
MW6
{ ® Approximate Location
t of Former UST Systems
1
r � ,
Parcel Boundary
rf OneMap, NC Center ra is or 'lysis.;NC 911
g.
NOTE: Well and tank locations were obtained from previous 40 20 0 40 80
reports prepared by other consultants and are approximate. jjjj Feel
Mt Cr TITLE FIGURE
FORMER TEXACO
CATLIN FOTTON GROVE
SITE MAP
171X1 COTTON GROVE RD
LEXINGTON,NC
Engineers and Scientists
�'.uoExr xo xle xo. ATE a auwx ercxEcxEoer
22332 221185 DEC 2022 AS SHONM KMCBJA