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Home My WebLink AboutGW1--06188_Well Construction - GW1_20230922 ; WELL CONSTRUCTION RECORD For Internal Use ONLY This form can be used for single or multiple wells 1.Well Contractor Information: 14.WATER ZONES Austin Fowler FROM TO DESCRIPTION Well Contractor Name ft. ft 4366A ft. ft NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-loop) FROM TO DIAMETER THICKNESS MATERIAL CATLIN Engineers and Scientists 0 ft. 3 ft. '4 in. .010 PVC Company Name 16.OUTER CASING(for multi-cased wells)OR LINER(if applicable) FROM TO DIAMETER THICKNESS MATERIAL 2.Well Construction Permit#: N/A ft ft in. List all applicable well permits(i.e.County,State, Variance,Injection,etc.) ft. rt. in. 3.Well Use(check well use): 17.SCREEN Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public 3 rt. 13 ft. 4 i in. Slot.010 .010 PVC ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in. ❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT ❑irrigation 0.5 ft. 1 ft. Portland Cement Surface Pour Non-Water Supply Well: . ❑Monitoring ®Recovery 1 ft. 2 rt. Bent.Pellets Surface Pour Injection Well: ft. ft. ❑Aquifer Recharge 0 Groundwater Reniediation 19.SAND/GRAVEL PACK(if applicable) ❑Aquifer Storage and Recovery ElSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test 0 Stomnvater Drainage 2 ft.• 15 rt. #2 Medium Sand Surface Pour ❑Experimental Technology 0 Subsidence Control ft ft. 20.DRILLING LOG(attach additional sheets if necessary) ❑Geothermal(Closed Loop) 0 Tracer FROM TO DESCRIPTION(color,hardness.soil/rock type,min size,etc.) 0 Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) rt. ft. , tole 4.Date Well(s)Completed: 07/28/23 Well ID#: RW-2 ft. ft. �O ft. ft. p,,,,�� 5a.Well Location: ft. ft. NCDEQ Lumberton Mobile ft. r. t--; c L_f `.- �, , Facility/Owner Name Facility[Di(if applicable) �� ft. P V".-I•. .,a e.i V .U 5105 Fayetteville Road,Lumberton,NC 28360 Physical Address,City,and Zip R. fe S E P 9 . 2023 21.REMARKS ROBESON r✓.r �_ LR _ CountyParcel Identification No.(PIN) '� r* +`n.� 5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: % - (if well field,one lat/long is sufficient) 34.6720288499 N -79.0079539752 W 9/14/2023 Signature of Certified Well Contractor Date 6.Is(are)the well(s): ®Permanent or CI Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with 15A NCAC 02(7.0100 or/5.4 NCAC 02C.0200 Well Construction Standards and that a copy of 7.Is this a repair to an existing well: ❑Yes or 0 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 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 ur non-water supply wells ONLY with the same construction,you S can submit one form. UBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 13.0 (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 a 100) construction to the following:1 10.Static water level below top of casing: 5.44 (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: 10.25 (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: HS A - completion of well construction`,to the following: (i.e.anger,rotary,cable,direct push,etc.)• + l 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&Injection Wells: Also submit one copy of this ifotm 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 Resoulrces Revised 2-22-2016 I . 6 ENVIRONMENTAL,CIVIL WELL LOG GEOTECHNICAL CATLIN 2202 gton,Raleigh,Waslimgton, Charle�ton Engineers and Scientists_ °ngto n,NC SHEET 1 OF 1 PROJECT NO.: 220237 STATE: NC COUNTY: ROBESON LOCATION: Lumberton PROJECT: Lumberton Mobile LOGGED BY: M. Aupperle WELL ID: DRILLER: Austin;Fowler RW-2 NORTHING: 335570 EASTING: 1997608 CREW: R. Gonzalez SYSTEM: NCSP NAD 83 (USft) DRILL MACHINE: CME 550 ATV T.O.C.ELEV.: 98.81 VERT.DATUM: EST. METHOD: HSA 0 HOUR DTW: N/A TOTAL DEPTH: 15.0 START DATE: 07/27/23 END DATE: 07/28/23 24 HOUR DTW: 5.4 WELL DEPTH: 13.0 BLOW COUNT OVA o L SOIL AND ROCK WELL DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPm) LAB. S G DEPTH DESCRIPTION ELEVATION DETAIL 0.0 Land Surface(Concrete) 98.8 0.0 0.0 - - > .- to ,: — •• 2.0 v • 3.0 _ —. :.. 5.0 - 5.0 , 93.8 _ (SC)-Brownish gray,Clayey SAND i Iii H 2 2 2 105.3 Sat. r . ' TO111 91.8 _ 0 a �o — y . — I. • 10.0— 10.0 88.8 — - 111 Y ' (SC)-Brownish gray,Clayey,fine SANDI _ n - 12 15 50.7 j� _ 18 i — 111 f 12.0 86.8 — " 13.0 - 13.0 85.8 _ 13.0 _ (SP)-Very dark gray,fine SAND 5 4 — 11 _ 5 _ 15.0 15.0 83.8 : 15.0 - BORING TERMINATED AT ELEVATION ION 83.8 ft _ — f - Ej Portland Cement :�•�Bentonite Pellets Li#2 Medium Sand LA9 • • Aror----r-----w--- t T N ISNI4 B-3 FORMER ,•;:• ® ,�, USTrBASI 3 ) RWO2 t. MW102 11 .. D 3 t RW-01ilk A ,. „, , . `� , . -"\\ N , ,, S W NIS 1\ .-0.1 • GASOLINI= LEGEND a DISPENSERS ibl . BMW-01 Q Recovery Well i �• ® Monitoring Well ,,,,,,,,, (Type II) ® Abandoned Monitoring - Well (Type II) ,. \ j Piezometer ., 1 0 Parcel Boundary 0 Approximate Location . of UST System ► sr, — *. l Maxari,Earthstar G-0grap sTnar]tfnra M4 NOTE: Well and tank locations were obtained from previous reports prepared by other consultants and are approximate. 30 15 0 30 60 iimi imonme Feet PROJECT TITLE FIGURE LUMBERTON MOBILE ATLIN 51 05 N FAYETTEVILLE RD SITE MAP LUMBERTON, NC Engineers and Scientists - INCIDENT NO JOB NO DATE SCALE DRAWN BY CHECKED BY 20262 220237 SEP 2023 AS SHOWN KMC/SJO