GW1--05606_Well Construction - GW1_20240916

•
•
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 R. ft. I i
4366A ... .• ft. ft. f 1
NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-loop)
FROM' TO DIAMETER. THICKNESS "MATERIAL
CATLIN,Engineers and Scientists 0 ft. . -1.2 ft. ' 3 in. . Sch.40 . 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)
R... ft. in. •
3.Well Use(check well use): 17.SCREEN
Water Supply Well: -- 'FROM TO • DIAMETER SLOT SIZE .THICKNESS MATERIAL - •
❑Agricultural 0 Municipal/Public -.1.2 ftc. 3.8 ft. 3. in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) , fi.: , , ft. in. .
0 Industrial/Commercial 0 Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
0 Irrigation • R. ft.
Non-Water Supply Well:
R. ft.
®Monitoring 0 Recovery
Injection Well: ft. ft.
❑Aquifer Recharge 0 Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
ElAquifer,Storage and Recovery 0 Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD-
❑AquiferTest ❑StormwaterDrainage 0 ft. 3.8 ft. #2 Medium Sand Surface Pour
ft. ft.
0 Experimental Technology ❑Subsidence Control 20.DRILLING LOG(attach additional sheets if necessary)
O Geothermal(Closed Loop) • 0 Tracer FROM TO . - DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
0 Geothermal(Heating/Cooling Return) . . 0 Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed: 08/22/24 Well ID#: HF1 MW-03 ft. ' ft. ee- .
R. ft. OO
5a.Well Location: ft. ft. �USDA Forest Service ri 1pig,
'
Facility/Owner Name Facility ID#(if applicable)
• ft.
• 12305 Hampton Rd,Rougemont, NC 27572, Rougemont,NC 27572 - - ft. it •
-
Physical Address,City,and Zip
• 21.REMARKS
DURHAM -
T'
County Parcel Identification No.(PIN) 5 `k;,;l- 't-` f ,Fq
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: S' P I.1i 1----
L.,.
(if well,field,one lat/long is sufficient) 1 b 2024
36.218042686 N -78.8637592588 w ,, 9/6/2024
Signature of Certified Well Contractor D2 ;:., ' '�1'+s'r�J,2a� H
6.Is(are)the well(s): ®Permanent or ['Temporary By signing thisfonn,I hereby certify that the well(s)was(were)constructed.in accordance with
15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: I]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 oradditional 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 ivells ONLY with the same construction,you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: • 3.8 (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@1002 construction to the following:
10.Static water level below top of casing: 3.3 (ft.) Division ofWater Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: .4.25 ' (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: HSA completion of well constriction 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 forth within 30 days of completion of well
construction to the county health department of the county where constricted. •
13b.Disinfection type:. Amount:
.. . I
Adapted from.Form GW-1. North Carolina Department of Environment and Natural Resources-Division of Water Resources ' Revised 2-22-2016

EEan,
WELL LOG CATLIN
cnlarleston • Engineers and Scientists
zz1 SHEET 1 OF 1
PROJECT NO.: 224088 STATE: NC ' COUNTY: DURHAM LOCATION: Rougemont
PROJECT: LOGGED BY: Cameron Stratton WELL ID:
USDA Durham County
DRILLER: Austin Fowler - HF1 MW-03
NORTHING: 898182 EASTING: 2039871 CREW: Rayce Harrelson
SYSTEM: NCSP NAD 83 (m) DRILL MACHINE: CME 55 TRACK T.O.C.ELEV.: 552.70
VERT.DATUM: NAVD88 (USft) METHOD: HSA 0 HOUR DTW: 3.4 TOTAL DEPTH: 3.8
START DATE: 8/22/24 END DATE: 8/22/24 24 HOUR DTW: 3.3 WELL DEPTH: 3.8
DEPTH BLOW COUNT OVA LAB o L SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (ppm) s G DEPTH . DESCRIPTION ELEVATION DETAIL
-1.2 =
0.0 Land Surface ' 552.7 = 0.0
o"l (GW)-Light brown,fine to coarse Sandy GRAVEL o.o
o>—.•::
mC:— :
)O DD 25 550.2 —
/�`: (SC)-Beige,Sandy CLAY
• 0: 3.8 548.9 3.8 — 3.8
3'8 — BORING TERMINATED BY AUGER REFUSAL AT -
- ELEVATION 548.9 ft IN:SANDY CLAY -
.
(7 -
—
•
m
m _
0
v ,
c -
Z .
c,
c -
s
Z - -
1I
FT#2 Medium Sand
i