404370_Well Construction - GW1_20120501

DATE DRILLED ##
TIME COMPLETED
4. WELL LOCATION:
City: Wilmington
R ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2485
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1. WELL CONTRACTOR:
Sean Cropsey
Well contractor (Individual) Name
Skipper's Well Drilling & Pump Service, Inc.
Well Contractor Company Name
107 Oakland Avenue
Street Address
Leland
NC 28451
City or Town State
910 3712770
Area Code Phone Number
Zip Code
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WP0290486
SITE WELL ID# (if applicable)
3. WELL USE (Check Applicable Box): Residential well
AMIEPMEj
7417 Dunbar Road
County New Hanover
• g. WATER ZONES (depth): 1101?)70
. Top 140 Bottom 170 Top r Bottom
. Top __ Bottom _ Top Bottom
. Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight
Top +2 Bottom 95 Ft. 4
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 20 Ft.
Top 0 Bottom Ft.
Top Bottom Ft.
Material
PVC
Material Method
Bentonite pump
0 9. SCREEN:Depth Diameter Slot Size Material
Top 140 Bottom 170 Ft. 2 in. in. pvc
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
(Street Name, Numbers, Community, subdivision, Lot Nol, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
JSIope n Valley [FIat Ridge clOther
LATITUDE N34' 16. 567 '
LONGITUDE W077' 47 . 006 '
Latitude/longitude source: nGPS ETopographic map
(location of well must be shown on a USGS topo map and attached to
this form if not using GPS)
5. WELL OWNER
Marianne Wellman
Owner Name
502 tanbridge road
Street Address
Wilmington, NC 28405
City or Town State Zip Code
( 910 ) 796-1087
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 170
b. DOES WELL REPLACE EXISTING WELL? YES El NO ®
c. WATER LEVEL Below top of Casing: 20 FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 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): METHOD OF TEST
f. DISINFECTION: Type HTH Amount cup
Submit within 30 days of completion
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10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft. #2 Southern Products
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top / Bottom
0 / 30 clay, shells, sand
Formation Description
30 / 90 limestone
90 / 150 mud and shells
150 / 170 sandstone
1
1
12. Remarks:
ECEIVED
MAY 2
(-Olt
IDWQ/BQG
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OW R.
SIGNATURE OFCERTIFIED ELL TRACT R
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
oali Information ProcessingForm GW-1 a
Rev. 2/09