GW1--05708_Well Construction - GW1_20240920

l-
WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells I
1.Well Contractor Information: ,
14.WATER ZONES
Austin Fowler FROM - .TO. DESCRIPTION .
Well Contractor Name ft. ft. I 1
4366A ft. . rt. - I.
NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
CATLIN Engineers and Scientists 0 rt. 5 ft. 2 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
❑Agricultural ❑Municipal/Public 5 ft. 15 ft. 2' in. Slot.010 Sch.40 PVC
0 Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. . .. ft. in.
0 Industrial/Commercial 0 Residential Water Supply(shared) 18.GROUT ,
FROM TO .MATERIAL EMPLACEMENT METHOD&AMOUNT '
0 Irrigation
Non-Water Supply Well: ft. ft.
®Monitoring ❑Recovery 1 it. 4rt. Bent.Pellets Surface Pour
Injection Well: rt. ft.
❑Aquifer Recharge 0 Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
r FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test 0 Stomtwater Drainage 4 rt. 15 ft. #2 Medium Sand Surface Pour
ft. ft.
❑Experimental Technology 0 Subsidence Control •20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) 0 Tracer ; FROM , TO DESCRIPTION(color.hardness.soil/rock type.cram size.etc.)
0 Geothermal(Heating/Cooling Return) 0 Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed: 08/14/24 Well ID#: MW-1CR ft. rt. ,
ft. fit. solO
5a.Well Location: PIP
H
ft. ft.
NCDEQ • o- ,m�,-•„s.„ -
Facility/Owner Name Facility ID#(if applicable) rt. ph:c y ;, z
ft. ll ca ti....z.,d t;..�1 e )t.-.
6606 Leesville Road,Durham,Durham County,NC,Durham,NC - 0 0 M
Physical Address,City,and Zip R. ft. SEP P 2, -r 4
21.REMARKS J L fL U -
DURHAM County Ir. ,--..;;•. r:, ?rr.,,,,,,,,,,I I .#t
County Parcel Identification No.(PIN) CONC:ta'300 - ._
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,One lat/long is sufficient) _,., •
35.9339041421 N -78.774640951 _W �� 9/12/2024
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or OTemporary By signing thisfrn•m.I hereby certify that the well(s)was(were)constructed in accordance with
15A NCAC 02C.0/00"or 15A NCAC 02C.0200 Well Construction Siandards 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 hack 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:_ 15.0 (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 ct i00) construction to the following: j;
10.Static water level below top of casing: 5.4 (ft.) Division of Water Resources,Information Processing Unit,
If wetter 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 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 fprrn 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
i

I.
ENVIRONMENTAL,CIVIL
GEOTECHNICAL CATLIN
WIrnington.Raleigh,Washington,
WELL LOG Charleston E ngineers and Scientist's
221I14I SHEET 1 OF 1
PROJECT NO.: 221140.04 STATE: NC COUNTY: DURHAM County LOCATION: Durham
PROJECT: Former Lil Country Store LOGGED BY: 1 1 Logan WELL ID:
DRILLER: Austin Fowler MW-ICR
NORTHING: 794914 EASTING: 2066716 CREW: Andrew Dunivan
SYSTEM: NCSP NAD 83 (m) DRILL MACHINE: CME 55 TRACK T.O.C.ELEV.: 99.40
VERT.DATUM: NAVD88 (USft) , METHOD: HSA 0 HOUR DTW: 5.4 TOTAL DEPTH: 15.0
START DATE: 8/14/24 END DATE: 8/14/24 24 HOUR DTW: N/A WELL DEPTH: 15.0
DEPTH BLOW COUNT OVA LAB o L SOIL AND ROCK ' WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPm) S G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 Land Surface 99.4 0.0
0.0 (ML)-Dark brown,fine Sandy SILT o.o
-
3
- 3 M -
4 6 .•.
> 4•
a #.
.4.
— — st ♦•
U .:
(V
..
_ — 4.0
5.0 i,.•;
- 3 ,
3 M I- __
3 4 1.;,.,...,:..:..i...::.,,,::;....,..,:.
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oa=ii'
N Nco1
a 4 4 ::
1- — 3 3 M t — =t :
z
13.0 -
W —
cr - - _
— � —
soi M _
> z 1
a15.0 15.0 84.4 15.0 = 15.0
a BORING TERMINATED AT ELEVATION 84.4 ft
U.
a
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4" It
v
0 —
0
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C - -
z
a
rc
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;;�Bentonite Pellets El#2 Medium Sand
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w TMW-03
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V T M W-0 1
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1<<FR , TMW-04 o s,
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APPROXIMATE LOCATION
OF FORMER 1,000-GAL. UST
I,'
MW-4R P.� ® APPROXIMATE LOCATION
DW-1 A OF FORMER 550-GAL. UST
,
- , MW-1 C
`., ®'8 MW:1 CR MW-6A
.
Tr--.
LEGEND � •,. •O
41> Abandoned Temporary i
.. Monitoring Well (Type I)
i
iG IF (Type Icing Well I) ;Ali; MW-3R MW-5R
® Destroyed Monitoring . ,
Well (Type II)
® Abandoned Monitoring IIP
. 411 .. .
_ . .
Well (Type II)
0 Abandoned Monitoring
Well (Type III)
EiApproximate Location
of Former USTs • Y MW-7=:
,--. Approximate Location 4 "
`- of Excavation Limits
El Parcel Boundary MW-8 _
— �•� i° M.xar, Earthstar Geographies, and the GIS Use
NOTE: Well and tank locations were obtained from previous
reports prepared by other consultants and are approximate. 20 10 0 20 40
�� Feet
PROJECT T'T,_E
FORMER LIL FIGURE
CATLIN COUNTRY STORE SITE MAP
6606 LEESVILLE RD
DURHAM, NC
Engineers and Scientists
INCIDENT NO. JOB NO. DATE SCALE DRAWN BY,CHECKED BY
9990 221140 SEPT 2024 AS SHOWN KMC/SJO