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Home My WebLink AboutGW1--05718_Well Construction - GW1_20240920 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 ft. ft. 4366A ft. ft. NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-loop) FROM TO DIAMETER I I III KNESS MATERIAL CATLIN Engineers and Scientists 0 ft. 25 rt. 2 io. Sch. 40 PVC Company Name 16.OUTER CASING(for muhi-cased wells)OR LINER(if applicable f Rt)M1 TO DLAMLIER THICKNESS MATERIAL 2.Well Construction Permit#: N/A ft. ft. in. List all applicable well permits(i.e.County,Gate, Variance,Injection,etc.) rt. it. in. 3.Well Use(check well use): 17.SCREEN Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public 25 rt. 45 ft. 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 1 FROM TO NIAII!RI:AL I AIPLACEVIENT METHOD&WO(]T 0 Irrigation ft. It. Non-Water Supply Well: - - - Oil Monitoring ❑Recovery OIt. 24 rt. Bent.Pellets Surface Pour Injection Well: ft. ft. ❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable) I ❑Aquifer Storage and Recovery ❑Salinity Barrier Rt,\1 ro NIA r1RIA1. EMPLACEMENT METHOD 24 rt. 45 rt. #2 Medium Sand Surface Pour 0 Aquifer Test 0 Stormwater Drainage - 0 Experimental Technology 0 Subsidence Control ft. ft. - 20.DRILLING LOG(attach additional sheets if necessary) ❑Geothermal(Closed Loop) 0 Tracer FROM TO DESCRIPTION(color,hardness.sorb rock nps.Stan size.etc) ❑Geothermal(Heating/Cooling Return 0 Other(explain under#21 Remarks) ft. ft. 4.Date Well(s)Completed: 08/15/24 Well ID#: MW-01 _ ft. ft. 4"ele• It. It. r/ VO 5a.Well Location: ft. fi. ogic N NCDEQ Facility/Owner Name Facility ID#(if applicable) ftP� ` --f►:' 323 Mason-Drewry Rd,Manson,Warren County,NC,Manson,NC . SF P c� 27553 0 �2¢ Physical Address,City,and Zip ft. tl.1- 21.REMARKS WARREN fr"w' vy County Parcel Identification No.(PIN) 5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: (if well field,one lat/long is sufficient) 36.429361 N -78.295223 w / �� 9/12/2024 Signature of Certified Well Contractor Date 6.Is(are)the ss ell(s): ®Permanent or OTemporary By signing this form.I hereby certify that the wellls)was(were)constructed in accordance with ISA MA('01('.0100 or 15A N(A('02('.0200 Well(instruction Standards and that a copy of 7.Is this a repair to an existing well: Oyes or No this record has been provided to the well owner. If this is a repair,lilt 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: 45.0 (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@100') construction to the following: 10.Static water level below top of casing: 34.5 (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 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,cic.i Division of Water Resources,Underground Injection Control Program, 1 FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 24c.For Water Supply&Injection Wells: 132.Yield(gpm) Method of test: Also submit one copy of this orm within 30 days of completion of well 131). 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 WEI. I. I_OG GEOTECHNICAL CATLIN Wilmington.Raleigh.Washirgton, Charleston Engineers and Scientists 223209.01 SHEET 1 OF 3 PROJECT NO.: 223209.01 STATE: NC COUNTY: WARREN LOCATION: Manson PROJECT: Boyd's BP LOGGED BY: Logan Hamilton WELL ID: DRILLER: Austin Fowler MW_O1 NORTHING: 2207361 EASTING: 975946 CREW: Andrew Dunivan SYSTEM: NCSP NAD 83 (ft) DRILL MACHINE: CME 55 TRACK T.O.C.ELEV.: VERT.DATUM: NAVD88 (USft) METHOD: HSA 0 HOUR DTW: 34.5 TOTAL DEPTH: 45.0 START DATE: 8/15/24 END DATE: 8/15/24 24 HOUR DTW: N/A WELL DEPTH: 45.0 DEPTH BLOW COUNT OVA LAB o o 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 7 (CL-ML)-Light to dark brown,Gravelly Silty CLAY 0.0 •'- .s 14 15 D ••• - 5 / ••• s M — .. is 3.0 - - .;• re z x 3 4 D — is 8 •- / :. l .• M 1_7.5 _ .;. (ML)-Light brown,Clayey SILT 8.0 — — : - .s 3 ..• - 4 s M - :. .• 7 :. :•: .• . > :.. .. _ v ;. 13.0 - U :;: .• P V .. .;• c 3_ 4 M _ :•*. : z 7 i4 • c 6• C 0 n .. v .• cc 18.0 — — :, n 4 ,;. 6 M :•: C - 9 ;, C — — MZ .• C .. ... Z - . F :Kt;�.�.�,Bentonite Pellets ri#2 Medium Sand ENVIRONMENTAL,CIVIL GEOTECHNICAL CATLIN WEI.I. I_OG 22320 ton.Raleigh.Washington. Charleston Engineers and Scientists 223209.01 SHEET 2 OF 3 PROJECT NO.: 223209.01 STATE: NC COUNTY: WARREN LOCATION: Manson PROJECT: Boyd's BP LOGGED BY: Logan Hamilton WELL ID: DRILLER: Austin Fowler MW_01 NORTHING: 2207361 EASTING: 975946 CREW: Andrew Dunivan SYSTEM: NCSP NAD 83 (ft) DRILL MACHINE: CME 55 TRACK T.O.C.ELEV.: VERT.DATUM: NAVD88 (USft) METHOD: HSA 0 HOUR DTW: 34.5 TOTAL DEPTH: 45.0 START DATE: 8/15/24 END DATE: 8/15/24 24 HOUR DTW: N/A WELL DEPTH: 45.0 DEPTH BLOW COUNT OVA LAB o L SOIL AND ROCK WELL o.stt 10.sn 10.5n I o.5tt (PPm) S G DEPTH DESCRIPTION DETAIL — (ML)-Light brown,Clayey SILT(continued) — 23.0 - - o: 2 5 M — is 24.0 11 26.0 .. is - 1- = 28.0 — — _ 3 a M - _ 6 s 33.0 - - — _ 8 - _ — 14 M = • 16 12 oa—: - - oa .:. � - _ IV 47 n _ F- C z 38.0 — — a - _ z 8- 6 11 W - C 12 a. - - v — — c — CC __ _ Q1 - - —_ C _ c Z 43.0 - - a _ — c 5 ix 7 W — —_ z — g - t2 - a i�i i i y� p.Bentonite Pellets n#2 Medium Sand ' WELL LOG ENVIRONMENTAL,CIVIL AnATLIN GEOTECHNICAL IL/ NAlmi Raleigh.Washington. Charleston Engineers and Scientists 223209.01 Engineers 3 OF 3 PROJECT NO.: 223209.01 STATE: NC COUNTY: WARREN LOCATION: Manson PROJECT: Boyd's BP LOGGED BY: Logan Hamilton WELL ID: DRILLER: Austin Fowler MW-01 NORTHING: 2207361 EASTING: 975946 CREW: Andrew Dunivan SYSTEM: NCSP NAD 83 (ft) DRILL MACHINE: CME 55 TRACK T.O.C.ELEV.: VERT.DATUM: NAVD88 (USft) METHOD: HSA 0 HOUR DTW: 34.5 TOTAL DEPTH: 45.0 START DATE: 8/15/24 END DATE: 8/15/24 24 HOUR DTW: N/A WELL DEPTH: 45.0 DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL 0.5ft 0.5ft 0.5ft 0.5ft (PPm) S G DEPTH DESCRIPTION DETAIL 45.0 45.0 45.0 J 45.0 BORING TERMINATED AT DEPTH 45.0 ft 2 a _ U 2 C C - C C C Z C 6 _ 2 a c:. tip;§Bentonite Pellets #2 Medium Sand