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Home My WebLink AboutGW1--06959_Well Construction - GW1_20231027 WELL CONSTRUCTION RECORD For Internal Use ONLY This form can be used for single or multiple wells 1.Well Contractor Information: �., 14.WATER ZONES �/�/ - - _ ------ T.Jason bite FROM( TO , DESCRIPTION -- ----- --- Well Contractor Name ft. ft. 3323A ft. ft. NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-loop) FROM TO DI:1\IL7ER 'THICKNESS Ni• CATLIN Engineers and Scientists 0 ft. 20 it. 20 in. Sch.40 PVC Company Name 16.OUTER CASING(for multi-cased wells)OR LINER(if applicable) I-1tt AI TO DIAMETER THICKNESS MATERIAL 2.Well Construction Permit#: N/A It. n. in. List all applicable well permits(i.e.County,Stale, Variance,Injection,etc) ft. ft. in. 3.Well Use(check well use): 17.SCREEN Water Supply Well: FRO\I - To - III 1\1C112 SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public 20 rt. 35 rt. 2 in.. Slot.010 Sch.40 PVC ❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ft. ft. in. ❑industrial/Commercial 0 Residential Water Supply(shared) 18.GROUT FROM TO MATERIAL EN(PLACEMENT V11.1IIOD R:1AIOl'NT ❑Irrigation 0.5 ft. 16 rt. Concrete Surface Pour Non-Water Supply Well: - ®Monitoring ❑Recovery 16 it. 18 rt. Bent.Pellets Surface Pour Injection Well: ft. ft. - 0 Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable) ❑Aquifer Storage and Recovery 0 Salinity Barrier FROM I TO \I:11ER(AL ENIPLACF\IF\T METHOD ❑Aquifer Test ❑StomwaterDrainage 18 ft. 35 rt. #2 Medium Sand Surface Pour ❑Experimental Technology 0 Subsidence Control ft. - ft. 20.DRILLING LOG(attach additional sheets if necessary) 0 Geothermal(Closed Loop) 0 Tracer FRI)\l TO DESCRIPTION(color 1,.,,,Irl,;;;,,I t:,<r tc IN,gram stze.etc) 0 Geothermal(Heating/Cooling Return) 0 Other(explain under#21 Remarks ft. ft. -_ I 4.Date Well(s)Completed: 07/14/23 Well ID#: MW-12R ° ° � �O ft. IT G� 5a.Well Location: ft. . oe pk. NCDEQ-Oxford Commons - n. ` P� Facility/Owner Name Facility iD#(if applicable) It. 3500 N.Roxboro st,Durham,NC Physical Address,City,and Zip ft. It. - 21.REMARKS - ---- -. - -.,_ . . DURHAM County Parcel Identification No.(PIN) hj,:,: - -5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: (if well field,one lat/long is sufficient) -78.892238 N 36.035065 w %Zolet.4.0417 " 1 : 10/24/2023 Signature of Certified Well Ct Date 6.Is(a r e)the 11 c l l(s): ®Permanent or 0 Temporary By signing this form./hereby certifi'that the wed(s)was(were)constructed in accordance with 15A MAC 02('.0100 or 15.4 NCAC 02C.0200 Well Construction Standards and that a copy of 7.Is this a re pa it to an existing well: O 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 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 bells constructed: 1 construction details. You may also attach additional pages if necessary. For multiple injection or ram-water supply wells ONLY with the same construction,you can submit one form. SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 35.0 (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 00'and 2@l00) construction to the following: 10.Static water level below top of casing: 29.19 (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: 8.25 (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: H.S.AUGERS 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 Svaaly&injection 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 ENVIRONMENTAL,CIVIL GEOTECHNICALIMIrringlo CATLIN WEI.. I. I_OG 221073. Raleigh,Washington Charleston Engineers and Scientists z2tp7a0t SHEET 1 OF 1 VNlmngton,NC PROJECT NO.: 221073.01 STATE: NC COUNTY: DURHAM LOCATION: Durham PROJECT: NCDEQ Oxford Commons LOGGED BY: T. Park WELL ID: DRILLER: T. Jason White MW-12R NORTHING: EASTING: CREW: S. Pugh SYSTEM: DRILL MACHINE: CAT1314 CME-45B 86.7%04/05/2023 T.O.C.ELEV.: VERT.DATUM: METHOD: H.S. AUGERS 0 HOUR DTW: N/A TOTAL DEPTH: 35.0 START DATE: 07/14/23 END DATE: 07/14/23 24 HOUR DTW: 29.2 WELL DEPTH: 35.0 DEPTH BLOW COUNT OVA LAB o L SOIL AND ROCK WELL 0.5ft 0.5ft 0.5ft 0.5ft (ppm) s G DEPTH DESCRIPTION DETAIL 0.0 Land Surface o.o 0.0 _ (ML)-Orange tan,Sandy SILT w/tr.clay. Dry No HCO - 0.0 —- G — - R - A - - B - 5.0 - - E= - 6.0 - - - G (ML)-Gray,SILT w/low elasticity. Dry. Slight HCO _ C_ R _ A _ - — B o _ > - - - a - _ - o - 10.0 — - - - o - N —- G — - R - A - B - E- 15.0 - _ — 16.0 G 17.0 R A (MH)-Dark gray,SILT w/high elasticity. Moist. High - B HCO - 18.0 N - 20.0 — L.20.0 j:: a z _ - - G — R d - - 25.0 - _ _ Oo U—,•.c: O - R o0 C B N L t _ _t( X 30.0 — - o — G R —(2 z A o B - n • 35.0 35.0 35.0 �.'.''' 35.0 c: - BORING TERMINATED AT DEPTH 35.0 ft - c — — a - z - - E - c — cc — z - - F- _ a - c- Portland Cement •iii,Bentonite Pellets 7#2 Medium Sand s NIk p • ` i,k: BMW-11p tIc �V t 4 .y ,r , T. l ' J dh,M W-8 F . .� Mir IV •...A I 1 il „1.1. ,i. -.4._ t : : , ED MW-3 , _ p MW-7 illi MW-4k4)1 i�~ 1r tea.._... a• 6 . a Y 7. l • r .. Ilico,..„...., ',,k0.4‘•%\ -•'' t , R s B lik MW-2 \t t NI OROST � APP■ROXIMATE LOCATIION �`-, . lilk/ 1 ...". -. tk., `' OF FORMER 1,000-GAL.. ; } " ," �HEATING'OIL UST �� MW-5 '�,MW10* ::IIii - LEGEND APPROXIMATE LOCATION _ 4 IP FORMER BASIN Monitoring Well �� MW;,1 �Lr - ® (Type II) �', APP,ROrXI�MATE LOCATION OF • MW-9� FORMER'DISPENSER ISLAND ® Abandoned Monitoring - Well (Type II) v 4N..... MW'12 S Destroyed Monitoring MW-12R** FO�O ,' ® Well (Type II) M p OX L Abandoned Monitoring If• �`L O f el7 ''' O Well (Deep) �r/ ;� MW-6 ElApproximate Location r err I ' ' 4" .r 1 of Former UST System 04 , 0 Parcel Boundary A • k. . , ..+ •.er /SA, _ p.•j,,• Source: Esri. Maxar, Earthstar Geograp ics.'-and triCOR 1J93-? ommunity N TE • 1 Well and tank locations were obtained from previous reports prepared by other consultants and are approximate. 120 60 0 120 240 2 The location of the former AST system is unknown. 3 '=Well abandoned by CATLIN on 03/25/2022. I Feet 4 "=Well installed by CATLIN on 09/21/2023. PROJECT TITLE FIGURE OXFORD COMMONS ATLINSHOPPING CENTER SITE MAP 3500 N ROXBORO ST DURHAM, NC Engineers and Scientists INCIDENT NO. JOB NO. DATE SCALE DRAWN BY CHECKED BY 5665 221073 OCT 2023 AS SHOWN KMC/SJO