GW1--07492_Well Construction - GW1_20231120

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 White FROM TO DESCRIPTION
Well Contractor Name ft. ft.
3323A ft. ft.
NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-loop)
PROM TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists o ft. 78 it 2 in. Sch.40 PVC
Company Name 16.OUTER CASING(for multi-ca.ed wells)OR LINER(if applicable)
FROM TO DI.AAI. lilt ILII(1KNI S MATERIAL.
2.Well Construction Permit#: NSA 0 n. 76.9 It. 4 in. Sch.40 PVC
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
-
ft. It. in.
3.Well Use(check well use): -
17.SCREEN
Water Supply Well: FROM TO DIA\IETFR SLOT SIZE DIICK\ESS MATERIAL
❑Agricultural ❑Municipal/Public 78 ft. 82.5 ft. 2 in. Slot.010 Sch. 40 PVC
0 Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial 0 Residential Water Supply(shared) IS.GROUT
FROM TO VI.AIIRIAI I-Nil'I.:A(P.AII AfAII II IUDs:AA101 VI
❑Irrigation 0.5 rt. 70.9 it. Portland Cement Tremie
Non-Water Supply Well: - -
®Monitoring ❑Recovery 70.9 Ii. 73.3 it. 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 TO MATERIAL EMPLACEMENT MI' IUD
❑Aquifer Test 0 Stormwater Drainage 73.3 n. 83.5 ft. #2 Medium Sand Surface Pour
❑Experimental Technology 0 Subsidence Control ft. ft.
20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FRn\t TO DESCRIP lON(color,hardness,soil/rock type,ssr,un svc eic I
❑Geothermal(Heating/Cooling Return) 0 Other(explain under#21 Remarks) n. ti. -_
4.Date Well(s)Completed: 06/27/23 Well ID#: TMW-04
Itl`. ft. ��
. It. el°
5a.Well Location: grkk
NCDEQ r p
n.
Facility/Owner Name Facility ID#(if applicable) - Ix '
It.
1700 Cotton Grove Road, Lexington. NC 27292
Physical Address,City,and Zip ft. u. n�/ ? ()
21.REMARKS -
DAVIDSON _
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one Iat/long is sufficient)
35.77808 N -80.25938 w
or 11/16/2023
Signature of Certified Well Co Date
6.Is(are)the well(s): ®Permanent or 0 Temporary By signing this form,I hereby certify that the wells)was(were)constricted in accordance with
ISA N(A('02('.0100 or 1 5A N(A('02('.0200 Well Construction Standards and that a copy of
7.Is this a repair 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 wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same construction,you can submit one form. SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 83.0 (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 a200'and 2@I00) construction to the following:
10.Static water level below top of casing: (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 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: MUD ROTARY 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 Supply&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-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

-i
ENVIRONMENTAL.CIVIL
WELL LOG GEOTECHNICALWIrrong CATLIN
22118ton.Rakgh.Washington.
5
Charleston Engineers and Scientists
wIm' n.NC SHEET 1 OF 1
PROJECT NO.: 221185 STATE: NC COUNTY: DAVIDSON LOCATION: Lexington
PROJECT: Former Texaco Food Mart #2 ID 22332 LOGGED BY: T. Park WELL ID:
DRILLER: T. Jason White TMW-04
NORTHING: EASTING: CREW: CATLIN
SYSTEM: DRILL MACHINE: CAT2002 MOBILE B-57 92.3% 12/23/22 T.O.C.ELEV.:
VERT.DATUM: METHOD: MUD ROTARY 0 HOUR DTW: N/A TOTAL DEPTH: 83.6
START DATE: 09/25/23 1 END DATE: 09/25/23 24 HOUR DTW: N/A ,WELL DEPTH: 83.0
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
0.7 6 2 NM 3 0 0.7 \ASPHALT / 0.0
3.6 1 1 4 0 (ML)-BROWN TO REDDISH BROWN,SILTY WITH
2
1 TRACE SAND. NO HCO
8.5 ' 2 2 0
3 -
13.5 3 3 5 0
5
18.5 3 6 8 0 =
9
23.5 1 1 1 0
2 27.0 -
28.5 WOH 1 (ML)-LIGHT REDDISH BROWN WITH GRAY -
2 0 MOTTLING,SILT. SLIGHT HCO
2 _
33.5 6 4 6 0
9 37.0 > � _a
38.5 17 43 (ML)-GRAY TAN WITH BROWN MOTTLING,SILT. Q.
40 0 SLIGHT HCO. 0 = n
• 28 SAPROLITE
43.5 4 5
• 13 0
14 47.0 -
., 48.5 27 25 (ML)-GRAY TAN WITH BROWN MOTTLING,SILT.
29 0 NO HCO.
• a6 SAPROLITE
50/ -
53.5 0.4 0
58.5 8 8 13 0
18 -
: 63.5 t7 25 =
31 0
• 36
68.5 45 55/ 0
0 -- 70.9
i•J50 -
• 73.5 0.1 3.2 •
- 733
.. 76.5 -
78.5 5 i 4 g (ML)-DARK GRAY BROWN,SILT WITH RELIC 78.00> -76.9
FABRIC. -a
• WEATHERED ROCK °`
.: 83.6 �oi \ 6.7 a3.s 113:r N 83.5
BORING TERMINATED AT DEPTH 83.6 ft
-
:•:tiff
Portland Cement ;titi•,Bentonite Pellets n#2 Medium Sand

N
talit-6.' •
0
11
K M W-06
m e � `
m
C MW-04 �� r
r 't TMW-04 ®�
' TMW-10 ® ;, Mir' :s.
ti:
ak MyW-01
MW-02 n"' ii! ;5i -. '.� r-
TMW-02 ® •
ILl--------
O
�� MW 03 MW-05. /'-TMW-03_. „i► ss.'�+-� '---�' A ,, ,, :
�
•
it,;)44, IS ''4.::: ''' f -Ak, ' .14‘ -- -,' —
LEGEND
k i Monitoring Well
•
OMonitoring Well ' r-,
(Type III) rib at f ' it it. f
— Water Lines '
— Sewer Lines ilitiN i`
- Unknown Lines li'"d+ `• reef/polo/Mall/Air
--- Electric Lines 1
•
Approximate Location • F,;fForru:TSYstems
0 ary
iliNip OneMa,p, C*ter for Geographic Inbrmatuon ) Its A19
+ "'Board
•
1 Tank locations were obtained from previous reports 50 25 0 50 100
prepared by other consultants and are approximate.
2.Well locations were obtained during field activities Feet
conducted by CATLIN and are approximate.
3.Utility locations were obtained from ESP and are approximate
PROJECT TITLE
FORMER TEXACO FIGURE
CATLIN FOODMART#2 SITE MAP
1700 COTTON GROVE RD
LEXINGTON, NC 1
Engineers and Scientists
INCIDENT NO. JOB NO. DATE SCALE DRAWN BY/CHECKED BY
22332 221185 NOV 2023 AS SHOWN KMC/SJO