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Home My WebLink AboutGW1--06926_Well Construction - GW1_20241119 . 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. i . 4366A rt. ft. 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 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,Stale, 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 rt. 10 ft. 21 !in. Slot.010 Sch.40 PVC ❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ft. ft. ; in. ❑IndustriaUCommercial 0 Residential Water Supply(shared) 18.GROUT FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT ❑Irrigation ft. It. Non-Water Supply Well: ®Monitoring ❑Recovery 1 ft. 4 it Bent.Pellets Surface Pour Injection Well: ft. ft. . . ❑Aquifer Recharge 0 Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable) - 0 Aquifer Storage and Recovery 0 Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test 0 Stomtwater Drainage 4 ft. 10 ft. #2 Medium Sand Surface Pour ft. rt. 1 0 Experimental Technology ❑Subsidence Control 20.DRILLING LOG(attach additional sheets i!necessary) ❑Geothermal(Closed Loop) 0 Tracer FROM TO DESCRIPTION(color.hardness,soil/rock woe.grain size.etc.) ❑Geothermal(Heating/Cooling Return) 0 Other(explain under#21 Remarks) rt. it. I ft 4.Date Well(s)Completed: 08/13/24 Well ID#: MW-02 ft. I footo ft. ft. S elp 5a.Well Location: pkG1 ft. NCDEQ NCDEQ-Liz Price Facility/Owner Name Facility!IN(if applicable) ft. �� ft. ._ "; 444 East Broad Ave,Rockingham,NC,Rockingham,NC 28379 tf - _ i..-.- ....,J.• �-• n. ft. ` :':� - ,' Physical Address,City,and Zip 21.REMARKS c➢NOV Y fl ()7,l L RICHMOND . uL County Parcel Identification No.(PIN) , s'-r , I i . 5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: i D. `,;c `-''i (if well field,one lat/long is sufficient) 22.Certification: 34.9325425 N -79.7673408333 wc 11/13/2024 Signature of Certified Well Contractor Date 6.Is(are)the well(S):-(Ifl Permanent or ❑Temporary By signing this form t hereby ce,rif•that the well(s)u•as(were)constructed in accordance with -- 15A NC4C 02C.0100 or/5.4 NCAC 02C.0200 Well Construction Standards and that a copy of 7.Is this a repair to an existing well: ❑Yes or C31 No this record has been provided to the well owner. !Phis is a repair fill out known well construction information and explain the nature of the repair under 1121 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 SUBMITTAL INSTRUCTIONS can submit one form. 9.Total well depth below land surface: 10.0 (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 rr l00) 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 casin tree 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 8.25 (in.) 24b.For Infection 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 constructK n to the following: (i.e.a:tger,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&Inflection Wells: Also submit one copy of this form within 30 days of completion of well 136.Disinfection type: Amount: construction to the county health department of the county where constructed. Adapted front Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resburces Revised 2-22-2016 I wE.LL LoGENVIRONMENTAL,CIVIL GEOTECHNICAL CATLIN W4ington,Raleigh,Washington, Charleston Engineers and Scientists 223125 SHEET 1 OF 1 PROJECT NO.: 223125 STATE: NC COUNTY: RICHMOND LOCATION: Rockingham PROJECT: LOGGED BY: Logan' Hamilton WELL ID: NCDEQ Richmond Rentals Inc 48872 DRILLER: Austin Fowler NORTHING: 131451 EASTING: 539503 CREW: i ' MW402 SYSTEM: NCSP NAD 83 (USft) DRILL MACHINE: CME 550 ATV T.O.C.ELEV.: 99.50 VERT.DATUM: NAVD88 (USft) METHOD: HSA 0 HOUR DTW: Dry TOTAL DEPTH: 10.0. START DATE: 8/12/24 END DATE: 8/13/24 24 HOUR DTW: NM WELL DEPTH: 10.0 DEPTH BLOW COUNT OVA LAB o L SOIL AND ROCK WELL 0.5ft 0.5ft 0.5ft 0.5ft (PPm) S G DEPTH DESCRIPTION 1 ELEVATION DETAIL 0.0 Land Surface 99.5 0.0 0.0 - ''::et (SM)-Brown to reddish brown Sandy SILT.' - 0.0 6 .. — .4 .?... .. 5 •d'vf 0 a r - •,•• 0 — "At — a i0 .i ° v 4 x••�;. - _ Via;.H av a •:r.r 5.0 .'•• 5.0 - i` - 6- 3 .. — — — 13 •`••`a4 ! 50 ^.L i !a.. - c.> N V— - e° - — °a t •3•• • .a t. - _7 • 10.0 - 50/ ,° 10.0 89.5 —10.0 a 10.0 I ' - it - I; 15.0 BORING TERMINATED AT ELEVATION 84.5 ft c z — — P a - - a - - z - I c — — C C — — z Fe c - - Q z - - - I '•Bentonite Pellets 0#2 Medium Sand