404634_Well Construction - GW1_20120423

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3094-A
1. WELL CONTRACTOR:
Ronald E Stewart
Well Contractor (Individual) Name
Mid -Atlantic Drilling, Inc.
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach NC 28428
City or Town State Zip Code
[phone]
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-C 1
3. WELL USE (Check One Box) Monitoring Cl Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 3/13/2012
4. WELL LOCATION:
Proposed Wilminaton River Front Marina
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Han
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley ❑ Flat 1A6 Ridge ❑Other
KigISTCD 34 innnnVnnnnnnnl CL R OR 3440472 cc
KNMF ISTCD 77 innnngtnnnnnnnnt CL R OR 77!951 3?T5`^ CC
Latitude/longitude source: 3PS :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.)
River Front Marina
Facility Name
Nutt St.
Street Address
Wilminaton
City or Town
Adam Lisk
Facility ID# (if applicable)
Contact Name
720 North Third Street Ste. 202
NC
State
404934
d. TOP OF CASING IS 0.5 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): NA METHOD OF TEST NA
f. DISINFECTION: Type NA
Amount NA
g. WATER ZONES (depth):
Top Bottom Top
: Top Bottom Top
Top Bottom Top
Bottom
Bottom
Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +0.5 Bottom -0.5 Ft. 2" S 40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom -0.25 Ft.
Top Bottom Ft.
Top Bottom Ft.
Method
9. SCREEN: Depth Diameter Slot Size Material
Top -0.5 Bottom -3.75 Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth
Bottom
= Top -0.25
-3.75 Ft.
Top Bottom Ft.
111. (7,-) r^.-� i i -•; r
L
1•S
Size !MatertiipR 2
2012
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
28401•
Zip Code :
Mailing Address
Wilminaton NC 28401
City or Town State Zip Code
( 9106 251-6160
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 44"
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: NA FT.
(Use "+" if Above Top of Casing)
•
.
Formation Description
0 / -4 Disturbed Sediment and Debris
/
/
/
/
/
/
12. REMARKS:
e
APR 1 9 2012
wio nation Processing
• I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR CCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
: RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ge-07,4za 3/26/201
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
: Ronald E Stewart
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
ubmit within 30 days of completion to: Division: of Water Quill
1:61.7. Mail Service Center} Raleigh, NG 27699-161,, Phone (91:9) 807-6300
Form GW-lb
Rev. 1/08