GW1-2022-00246_Well Construction - GW1_20221216

WELL CONSTRUCTION RECORD Far Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
14.WATER ZONES
COREY D.FUTRAL FROM 1, TO DESCRIPTION
Well Contractor.Name FL ft. '
4330B
NC Well Contractor Certification Number 15.INNER CASING OR TUBING eothermal closed-loo
FROM.. TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists 0 ft. 2 ft-1 1 in.I Sch.40 PVC
Company Name 16.OUTER CASING far multi-cased wells OR LiNER if applicable)
FROM. .. TO DIAMETER I THICKNESS I MATERIAL -
2.Well Construction Permit#: N/A fL e, in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc)
ft R. in.
3.Well Use(check well use): 17.SCREEN
FROM I TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Water Supply Well: I
OAgricultural ❑Municipal/Public 2 ft. 12 ft1 in. Slot.010 SCh.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft: ft in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 19.GROUT
FROM TO MATERIAL EMPLACEMEM'METHOD&AMOUNT
❑Irri anon ft: ft.
Non-Water Supply Well:
f
❑Recoveft. tt
®Monitoring 4'
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK ifa licable
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier
fL ft.
O Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 0 fL 12 rt. Natural Backfill
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soiYTmk tNw,vain sire etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft rt.
ft
4.Date Well(s)Completed: 12/13/22 Well ID#: TMW-2 O
ft ft. p
5a.Well Location: rL rt. �G� e."-,p Ham`4'14 t'-
Murphy USA#8572 00-0-0000037088 ft.
applicable)
Facility/Owner Name Facility 1D#(if a C
ft.
1670 N Howe St.,SOUTHPORT 28461 ;i}C-
fL rt.
i cTv. 1 i�ft?C,.^ ni�,ry tn,p.
Physical Address,City,and Zip zl K3 iJ RENIAR
BRUNSWICK N/A
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if Nvell field,one lat/long is sufficient)
33.943824 N -78.029151 W `>• 1 211 3/2 0 2 2
Signature ofCertifed We Co tractor. Date
6.Is(are)the well(s): ❑Permanent or O Temporary Bysigning this form,l hereby certify drat the wells)it-as(were)constructed in accordance with
15A NCAC 02C.0100 or 1 5A NCAC 02C.0200 Well Consiniction Standards and 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.
Ifllus 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 ofthis 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 scone construction,you SUBMITTAL INSTRUCTIONS
can submit one forin.
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@I009 construction t0 the following:
10.Static water level below top of casing: (ft,) Division of Water Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
7fwater level is above casing,use too
11.Borehole diameter: 4.25 (in.) 246.For Infection Wells ONLY: In addition to sending the form to the
address in 24a above,also submit a copy ofthis form within 30 days of
12.Well construction method: DPT 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
24c.For Water Svvnly&Infection Wells:
13a.Yield(gpm) Method of test: Also submit one copy ofthis form within 30 days of completion of well
construction to the county health department of the county where constructed.
13b.Disinfection type: Amount:
Revised 2-22-2016
Adapted from Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources

i
ENVIRONMENTAL,CIVIL
GEOTECHNICAL CATLIN
Wilmugton,Ralegh Washington,
chf i Engineers and Scientists
WELL LOG 22z295 s5 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: 71986 FASTING: 2294491 CREW: EDDIE SWAIN TMW-2
SYSTEM: NCSP NAD 83 USft BORING LOCATION: NW corner of UST Basin T.O.C.ELEV.:
DRILL MACHINE: Power Probe METHOD: DPT w 0 HOUR DTW: NM TOTAL DEPTH: 12.0
START DATE: 12/13/22 END DATE: 12/13/22 24 HOUR DTW: FIAD WELL DEPTH: 12.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
o.5ft o.5ft o.5ft 0.5ft (PPM) s G DEPTH DESCRIPTION i DETAIL
3.0
0.0 LAND SURFACE o.o
0.0 0.5 (GW)-CONCRETE a
1.0 (SW)-Tan F.SAND with gravel
- U
(SP)-Black F.SAND to -
Hand NM D 2.0�
Auger -
4.0 -
Direct N
Push M M
oa -
00 -
8.0 8.0 (,SC)-Brown grading to It.gray,Clayey F.SAND
Direct NM Sat. R. 10.0 =
Push
(SW)-Lt.gray,F.SAND
I
I -
12.0
12.0-
20 ?; 12.0 12.0
BORING TERMINATED AT DEPTH 12.0 ft in F.SAND
i
Native Backfill
4