GW1-2022-00245_Well Construction - GW1_20221216

WELL CONSTRUCTION RECORD For internal Use ONLY: ;
This form can be used for:single or multiple wells
i
1.Well Contractor Information:
14.WATER ZONES
COREY D. FUTRAL FROM TO DESCRIPTION
Well Contractor Name R. ft.
4330B ft. fL
NC Well Contractor Certification Number - 15.INNER CASING OR TUBING eothermal dosed-loo
DIAMETER . THICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft. 2 R 1 in.1 Sch.40 1 PVC
Company Name 16.OUTER CASING for multi-cased wells OR LINER ifa licable
FROM. .. TO DIAMETER . THICKNESS MATERIAL-
ft.Well Construction Permit#: N/A ft. ft. in.
List all applicable well permits(i.e.County,State, Variance,Injection,eta)
t't.
3.Well Use(check well use):
17.SCREEN
Water Supply Well: FROM To DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 2ft. 12 It. in. Slot.olo Sch.40 PVC
[]Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft in.
❑Industrial/Commercial 17Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation ft.- R.
Non-Water Supply Well:
®Monitoring ❑Recovery ft. R.
Injection Well: ft. ft.
[I Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barria FROM I._TO MATERIAL EMPLACEMENTMETHOD
. •
0 Aquifer Test ❑Stormvater Drainage. ft. R
❑Experimental Technology ❑Subsidence Control 0 ft 12 ft Natural Backfill
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO -DESCRIPTION color,hardness wil/rock e,grain size etc.
❑Geothermal(Heating/CoolingReturn) ❑Other(explain under-#21 Remarks) R.. ft.
4.Date Well(s)Completed: 12/13/22 Well ID#: TMW-1 ft IL =
5a.Well Location: �N
00-0-0000037088
Murphy USA#8572 ft. ft
Facility/Owner Name FacilityIIJ#(ifapplicable), ftV 4 e �.y 1,
R. P. rr n
1670 N Howe St.,SOUTHPORT,28461 rt. rt. L� IZ
Physical Address,City,and Zip
21.REMARKS
BRUNSWICK N/A in;uc+�= "MI,I+hh:t:a }i V
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)
31943717 rl -78.02905 W. _ `/�, 12/13/2022
Signature ofCertifiedW Co tractor Date
6.Is(are)the well(s): ❑Permanent or . ®Temporary By'signing this form,I hereby certify that the m•ell(s)nag(were)constructed in accordance with'
ISA NCAC 02C.0100 or ISA NCAC 02C.0200 lVell Construction Standards and that a copy of
7.Is this a repair to an existing well: '0 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 nature of
the repair under#21 remarks section or on the back 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 if necessary.
Forr multiple injection or non-water supply wells ONLY with the sane constructon,you
can submit one farm. SUBMITTAL INSTRUCTIONS
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@1009 construction to the following:
10;Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit,
!f water level is above casing,use"+" 1617 Mail Service Centeri 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: APT 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 Svpplv-&Iniection 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.

.i
r
ENVIRONMENTAL,CIVIL
GEOTECHNICAL CATLIN
' Wlminglon,Raleigh,Wash-uglon,
crwleston Engineers and Scientists
WELL , LOG 222295. SHEET 1 OF 1
PROJECT NO.: 222295 STATE: NC I COUNTY: BRUNSWICK LOCATION: SOUTHPORT
PROJECT: LOGGED BY AARON WILLIAMSON WELL ID:
GES-DPT GROUNDWATER SAMPLING. DRILLER: COREY!FUTRAL
NORTHING: 71948 EASTING: 2294522 CREW: EDDIE SWAIN TMW-1
SYSTEM: NCSP NAD 83 USft ' BORING LOCATION: SW corner of UST Basin T.O.C.ELEV.:
DRILL MACHINE: Power Probe METHOD: DPT 0 HOUR DTW: NM TOTAL DEPTH: 12.0
START DATE: 12/13/22 END DATE: 12/13/22 124 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 i DETAIL
I
3.0
0.0 LAND SURFACE 0.0
0.0 "o fir. 0.5 (GW)-CONCRETE >
a
(SW)-Black F.SAND with Pea Gravel
)
Hand NM D 2.0 2.0� -
Auger (SP)-Black F.SAND with strong HCO from 2.0-4.0' -
BLS
4.0
Direct NM M
Push
ov
�U
�(n
8.0 8.0
(SN)-Brown,Silty F.SAND _
r 9.0 -
,�;� (SW)-Lt.Gray,F.SAND
Direct Push NM Sat.
11.0
(SC)-Lt.gray Clayey F.SAND -
12.0 12.0 I 12:0 12.0
BORING TERMINATED AT DEPTH 12.0 ft in Clayey
SAND
I,
j
i
i.
I
- If �
�NativeBackrill
f i