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HomeMy WebLinkAbout407373_Well Construction - GW1_20120827N.NRESIDENTIAL WELL CONSTRUCTION TR N RLC®R North Carolina Department of Environment and Natural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATION # 2412-A 1. WELL CONTRACTOR: Donald H. Cummings Well Contractor (Individual) Name Applied Resource Management, RC. Well Contractor Company Name 257 Transfer Station Rd. Street Address Hampstead NC 28443 City or Town State Zip Code (910 ) 270-2919 Area code Phone number 2. WELL INFORMATION: : 7. CASING: Depth WELL CONSTRUCTION PERMIT# : Top +1.5' Bottom 130' Ft. 4" OTHER ASSOCIATED PERMIT#(if applicable) SITE WELL ID #(if applicable) 3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ Irrigationlj Other ❑ (list use) DATE DRILLED 07/18/12 4. WELL LOCATION: 200 Snua Harbour Dr. (Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) CITY: Wilmington COUNTY New Han. TOPOGRAPHIC / LAND SETTING: (check appropriate box) ❑ Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other LATITUDE 34 "DMS OR DD LONGITUDE 77 " DMS OR DD Latitude/longitude source: VGPS ❑Topographic map (location of well must be shown on a USGS topo map andattached to this form if not using GPS) 5. FACILITY (Name of the business where the well is located.) Facility Name Facility ID# (if applicable) Street Address City or Town Kevin O'Brien Contact Name 200 Snua Harbour.Dr Mailing Address Wilminaton City or Town ( 910 ) 262-1961 Area code Phone number 6. WELL DETAILS: a. TOTAL DEPTH: 145' b. DOES WELL REPLACE EXISTING WELL? c. WATER LEVEL Below Top of Casing: 25' (Use "+" if Above Top of Casing) State Zip Code NC 28405 State Zip Code YES ❑ NO Ei/ FT. d. TOP OF CASING 1S 1 .5' FT. Above Land Surface* *Top of casing terminated at/or below land surface may require • a variance in accordance with 15A NCAC 2C .0118. e. YIELD (gpm): 60 METHOD OF TEST Airlift f. DISINFECTION: Type HTH Amount 3q 1 0 fQ g. WATER ZONES (depth): Top Bottom Top Bottom : Top Bottom Top Bottom Top Bottom Top Bottom Thickness/ Diameter Weight Material sch40 PVC : Top Bottom Ft. Top Bottom Ft. 8. GROUT: Depth Top 0' Bottom 22' Material Ft. Grout Top Bottom Ft. Top Bottom Ft. 9. SCREEN: Depth. Method Tremmie Diameter Slot Size Material Top 130' Bottom 145' Ft. 4" in. .020 in. PVC Top Bottom Top Bottom Ft. in. in. Ft. in. in. : 10. SAND/GRAVEL PACK: Depth Top 125' Bottom 145' Top : Top Bottom Bottom : 11. DRILLING LOG Top Bottom Size Ft. #2 Ft. Ft. Material Sand Formation Description 0' / 52' Clay / sand : 52' / 90' Limestone 90' / 130' Clay 130' / 145' Sandstone (Cave 150') • rrA 12. REMARKS: t I DO HEREBY CERTIFY THAT THIS WELL WAS CONC,TEDTACCOR CE WITH • 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS ECORD HAS BEEN PIROVID D T THE WELL OWNER. A F ---� 07/18/12 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE • LJ Donald H a Cummings PRINTED NAME OF PERSON CONSTRUCTING THE WELL • Submit within 30 days of completion tog Division of Water uality 1617 Mail Service Center, Raleigh, NC 2Th99 16/, Phone (919) 807-6300 nfor atton. Processing, Form GW-lb Rev. 2/09