GW1--05608_Well Construction - GW1_20240916

•
WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells l
1.Well Contractor Information: '
14.WATER ZONES
Austin Fowler FROM TO DESCRIPTION •
Well Contractor Name ft. ft. 1
•
. 4366A ft. .ft. '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. ' 5.9 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.) .
ft. ft. in. . _
3.Well Use(check well use): • 17.SCREEN _
Water Supply Well: • 'FROM TO : • ' DIAMETER SLOT SIZE.• THICKNESS MATERIAL. .
OAgricultural ❑Municipal/Public 5.9 ft. 35.9 ft. '3 . in. Slot.010 Sch.40 . PVC
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) . R. -. ft. in. . _
❑Industrial/Commercial 0 Residential Water Supply(shared) 18.GROUT
FROM TO - _ . .MATERIAL EMPLACEMENT METHOD&AMOUNT
Irrigation
Non-Water Supply Well: . . rt. ft.
®Monitoring ❑Recovery 0 ft. 2.5 ft. Bent.Pellets Surface Pour
Injection Well: ft. ft.
• ❑Aquifer Recharge • ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
O Aquifer Storage and Recovery . 0 Salinity Barrier FROM TO MATERIALEMPLACEMENTMETxoD
•
❑Aquifer Test ❑StormwaterDrainage 2.5f. . 35.9rt. #2 Medium Sand Surface Pour
❑Experimental Technology IDSubsidence Control
ft. ft.t ,
20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed:Loop) 0 Tracer • FROM TO DESCRIPTION(color,hardness.soil/rock type.Frain size,etc.)
• 0 Geothermal(Heating/Cooling Returii) . 0 Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed: 08/27/24 Well ID#:.HF2 MW-02 ft.
ft. ft. , tisi)
5a.Well Location: pkGI
rt. R.
• USDA Forest Service • . oc .
ft.
Facility/Owner Name .Facility ID#(if applicable)
ft. •
12305 Hampton Rd,Rouqemont, NC 27572,Rouqemont,NC 27572 -
ft. ft.
Physical Address,City,and Zip
21.REMARKS
DURHAM - _ • . .. •
County Parcel Identification No.(PIN) ' .
5b.Latitude and Longitude in degrees/minutes/seconds Or decimal degrees: `"t*-_'•e.E�-_• �,,22.Certification:
(if well field,one lat/long is sufficient) ,
' 36.2173663839 N -78.865719712 . w • 1 6 2024 9/612024.
. Signature of Certified Well Contractor . Date
l ps.,-7...,l ., ,•err.*:fa"'r,1 t �:
6.Is(are)the well(s): ®Permanent or 0 Temporary r w••(s)` '
By signing this form,1 hereby certify that the we!!(s)uvs Jwere)�pnssuctec%in accordance with
15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well tonstniction 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 mtiltiple 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: . 35.9 (ft.) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths indifferent(example-3@200'and 2@100) construction to the following:
10.Statie water level below top of casing: 31.7 (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: 4.25 (in.) 24b.For Injection Wells ONLY: In additioh 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 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 subniit one copy of this form within 30 days of completion of well
• construction to the county health department of the county where constructed.
13b.Disinfection type: Amount: • - • _ -
Adapted from Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

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ENVIRONMENTAL,CIVIL
WELL LOG GEOTECHNICAL CATLIN
Wilmington,Raleigh,Washington,
CharlestonEngineers and Scientists
224088 SHEET 1 OF 2
PROJECT NO.: 224088 STATE: NC COUNTY: DURHAM I L'OCATION: Rougemont
PROJECT: LOGGED BY: Cameron Stratton WELL ID:
USDA Durham County
DRILLER: Austin Fowler HF2 MW-02
NORTHING: . 898572 EASTING: 2040426 CREW: Rayce Harrelson
SYSTEM: NCSP NAD 83 (m) DRILL MACHINE: CME 55 TRACK T.O.C.ELEV.: 589.00
VERT.DATUM: NAVD88 (USft) METHOD: HSA 0 HOUR DTW: 31.7 TOTAL DEPTH: 40.0
START DATE: 8/22/24 END DATE: 8/27/24 24 HOUR DTW: N/A WELL DEPTH: 35.9
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
4.1
0.0 Land Surface 584.9 0.0
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ENVIRONMENTAL,CIVIL
GEOTECHNICAL CATLIN
INEI_ 1_ LOG 'Wilmington,Raleigh,Washington,
Charleston Engineers and Scientists
224088 SHEET 2 OF 2
PROJECT NO.: 224088 STATE: NC COUNTY: DURHAM 1 LOCATION: Rougemont
PROJECT: LOGGED BY: Cameron Stratton WELL ID:
USDA Durham County DRILLER: Austin Fowler
t NORTHING: 898572 EASTING: 2040426 CREW: Rayce 'Harrelson HF2 MW-02
SYSTEM: NCSP NAD 83 (m) DRILL MACHINE: CME 55 TRACK T.O.C.ELEV.: 589.00
VERT.DATUM: NAVD88 (USft) METHOD: HSA O HOUR DTW: 31.7 TOTAL DEPTH: 40.0
START DATE: 8/22/24 END DATE: 8/27/24 24 HOUR DTW: N/A WELL DEPTH: 35.9
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (ppm) S G DEPTH DESCRIPTION ELEVATION DETAIL
— (ML)-Red to brown,Clayey SILT(continued) — _
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35.9 549.0 35.9 35.9
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Ei 40.0 BORING TERMINATED BY AUGER REFUSAL AT —
= - ELEVATION 544.9 ft IN:SANDY SILT -
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