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Home My WebLink About412460_Well Construction - GW1_20130430WELL CONSTRYJCTION RECORD This form can be used for single or multiple wells 1. Well Contractor Information: Harry M. Sage Well Contractor Name 2531 NC Well Contractor CertificationNumber Applied Resource Management, PC Company Name 2. Well Construction Permit #: NA List all applicable well construction permits (i.e. County, State, Variance, etc.) 3. Well Use (check well use): Water Supply Wen: ❑Agricultural ❑Geothermal (Heating/Cooling Supply) ❑ lndustriaVCommeroial ❑ In-igation Non -Water Supply Well: °Monitoring Injection Well: °Aquifer Recharge °Aquifer Storage and Recovery ❑Aquifer Test OExpperimental Technology ❑Geothermal (Closed Loop) OGeothermal (Heating/Cooling Return) 4. Date Well(s) Completed: 2/1 1 /13 5a. Well Location: Hampstead Town Center °Municipal/Public °Residential Water Supply (single) °Residential Water Supply (shared) °Recovery ❑Groundwater Remediation ❑Salinity Barrier ❑Stormwater Drainage OSubsidenoe Control ❑Tracer °Other (explain under #21 Remarks) Well MW-4 Facility/Owner Name Facility ID# (if applicable) 17270 Highway 17 N, Hampstead NC 28443 Physical Address, City, and Zip Pender 3293-86-8315-0000 County Parcel IdentificationNo. (PIN) 5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: (if well field, one lat/long is sufficient) 24 deg. 23' 23.65" N 77 deg. 40' 31.33" W 6. Is (are) the well(s): °Permanent or ❑Temporary 7. Is this a repair to an existing well: OYes or ID No If this Le a repair, fill out !mown well construction information and explain the name of Use repair under 021 remarks section or on the back of this form 8. Number ofwells constructed: 4 For multiple injection or non -water supply wells ONLY with the same construction, you can submit one form. 9. Total well depth below land surface: 16 For multiple wells list all depths if different (example- 3@200'and 2@100') 10. Static water level below top of casino: 5.49 (ft) Ifnater level is above casing, use "+" 11. Borehole diameter: 8 (in.) 12. Well construction method: Auger (ft.) (i.e. auger, rotary, cable, directpush, etc.) FOR WATER SUPPLY WELLS ONLY: 13a. Yield (gpm) 13b. Disinfection type: Method of test: Amount: ForintemalUse ONLY: . 1 c it �, l l kJ14. WATER ZONES FROM TO DESCRIPTION 5 ft 16 Surficial ft ft 15. OUTER CASING (for multi -cased wells) OR LINER (if applicable) FROM TO DIAMETER THICKNESS MATERIAL +3 ft 1 ft 2 in' SCH-40 PVC 16. INNER CASING OR TUBING (geothermal closed -loop) FROM TO DIAMETER THICKNESS MATERIAL ft ft in. ft ft in. 17. SCREEN FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL 1 $ 16 ft 2 ht 0.010 SCH-40 PVC ft ft in. 1& GROUT FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT 0 ft 0.5 It Bentonite Poured ft ft ft. ft - 19. SAND/GRAVEL PACK( Of applicable) FROM TO MATERIAL EMPLACEMENT METHOD 0.5 ft 16 ft Coarse Sand Poured ft ft. 20. DRILLING LOG (atta h additional sheets if necessary) FROM TO DESCRIPTION (color, hardness, soil/rock tree, grain aim, etc.) ft. ft See attahced. ft ft ft ft ft ft ft n. MAR ..2 5 ii113 ft ft ft ft. wFiiNK'y3CINb!iY vCCiION RfoRmAtinh! PROCESSING UNIT zl. REMARKS 22. Certification: /11 Signature of Certifip9 Well Contractor� Date By signing this fonn, I hereby certjy that the well(s) was (were) constructed in accordance with ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a copy of this record has been provided to the well corner. 23. Site diagram or additional well details: You may use the back of this page to provide additional well site details or well construction details. You may also attaoh additional pages if necessary. SUBMITTAL INSTUCT1ONS 24a. For All Wells: Submit this fo construction to the following: Division of Water Quality, 1617 Mail Service Cent mtru+ SQ, daroo y.,,j'i 'd'.' `)_ well rmuY% tiPegsipp}x��ptelt, leigh, NC�227699,1Yte 246. For Infection Wen�ts: In addition till • e form to the add `- `. in 24a above, also submit a copy of this form within 30 days o t of' well construction to the following: Division of Water Quality, Underground Injection Control Program, 1636 Mail Service Center, Raleigh, NC 27699-1636 24c. For Water Sunoly & Injection Wells: In addition to sending the form to the address(es) above, also submit one Dopy of this form within 30 days of completion of well construction to the county health department of the county where constructed, HAMPSTEAD TOWN CENTER 17270 HIGHWAY 17 HAMPSTEAD, NORTH CAROLINA MW-1 Drilled by: M. Sage Logged by: J. Zuncich Date:02/11/13 Depth (ft.) Description Water Content Blow Count 2 - 4 Brown -orange to tan, very fine grained sand with root matter. No odors. Low Grab 5 - 7 Tan to light brown mottled orange, silty to very fine grained sand with minor wood fragments. No odor. Moderate HP 10 - 12 Tan to light brown mottled orange, silty to very fine grained sand with minor wood fragments. No odor. High HP 15 - 17 Greenish -gray, slightly clayey, silty fine grained sand. No odor. High HP HP - Hydraulic Push HAMPSTEAD TOWN CENTER 17270 HIGHWAY 17 HAMPSTEAD, NORTH CAROLINA MW-2 Drilled by: M. Sage Logged by: J. Zuncich Date: 02/11/13 Depth (ft.) Description Water Content Blow Count 2 - 4 Tan -brown mottled orange, silty to very fine grained sand with organic material and root matter. No odors. Low Grab 5 - 7 Medium gray, slightly clayey sand, grading to a brown- orange, silty, very fine grained sand. No odor. Low to Moderate HP 10 - 12 Tan -orange, very fine grained sand with thin lenses at 10.2' - 10.3'. No odor. High HP 15 - 17 Tan -orange very fine grained sand with thin lenses at 10.2' - 10.3' changing to greenish -gray, slightly clayey sand. No odor. High HP - i-iyorauilc rus HAMPSTEAD TOWN CENTER 17270 HIGHWAY 17 HAMPSTEAD, NORTH CAROLINA MW-3 Drilled by : M. Sage Logged by: J. Zuncich Date:02/12/13 Depth (ft.) Description Water Content Blow Count 2 - 4 Brown -orange, silty to fine grained sand with abundant root matter changing to a light tan -gray mottled orange, very fine grained sand. No odors. Low to Moderate Grab 5 - 7 Gray -brown, very fine grained sand with wood fragments. No odor. High HP 10 - 12 Tan to light brow, slightly clayey sand with wood fragments. No odor. High HP 14 - 16 Tan to light brown, slightly clayey sand with wood fragments changing to greenish -gray, silty clay at 15.5'. No odor. High HP HP = Hydraulic Push -4 HAMPSTEAD TOWN CENTER 17270 HIGHWAY 17 HAMPSTEAD, NORTH CAROLINA MW-4 Drilled by : M. Sage Logged by: J. Zuncich Date: 02/11/13 Depth (ft) Description Water Content Blow Count 2 - 4 Gray -brown, very fine to fine grained sand with orange mottles, root matter and organic material. No odors. Low to Moderate Grab 5 - 7 Tan -light brown, very fine grained sand with minor wood fragments. No odor. High HP 10 - 12 Light gray -tan, silty to very fine grained sand with wood fragments. No odor. High HP 14 - 16 Light gray -tan, silty to very fine grained sand changing to greenish -gray, clayey sand/sandy clay mixture. No odor. High HP HP = Hydraulic Push