404632_Well Construction - GW1_20120423

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
City or Town
(910 ) 458-5020
NC 28428
State Zip Code
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-B2
3. WELL USE (Check One Box) Monitoring C1 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 3/14/2012
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 [Walley ❑Flat Ridge ❑Other
KKISTCD 34 i^AAA&AAAAAAAA! CL R OR 34' 246624 7 cc
KNMF I$TCD 77 iAAAAVAAAAAA^! CL R OR 71512044"^ cc
Latitude/longitude source: WhPS ❑ropographic 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_
Facility ID# (if applicable)
Street Address
Wilminaton NC 28401
City or Town State Zip Code
Adam Lisk
Contact Name
720 North Third Street Ste_ 202
Mailing Address
Wilminaton NC 28401
City or Town State Zip Code
( 910j6 251-6160
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 44"
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO G
c. WATER LEVEL Below Top of Casing: 3.5 FT.
(Use "+" if Above Top of Casing)
NONRESIDENTIAL WELL CONSTRUCTION RECORD
11 -5 3 2
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
Top -0.5 Bottom -3.75 Ft. in. in.
Top Bottom Ft. in. in.
Material
. Top Bottom Ft. in. r 7-- r .
in LI \ I
. 10. SAND/GRAVEL PACK: G € 1
Top -0.25 Bottom
Depth Size -3.75 Ft. z'1 EMater'
F R 2 3 2012
pE !(
: Top Bottom Ft.
: Top Bottom Ft.
: ▪ 11. DRILLING LOG
Top Bottom
0 /-4
/
/
/
/
/
•
12. REMARKS:
info .
• t ssi ti
• I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
: RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Formation Description
Disturbed Sediment and Debris
r
AIR I" ,.
2012
20197erieLf.S7a,":4�� 3/26/201
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
: Ronald E Stewart
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
•
ubmit.wdaysofcompletinto:Diiion o ater Quail
o
17 Mart Service Center, Raleigh, NC 27699-161,•
Phone (919) 8Q7-63Q
Form GW-1 b
Rev. 1/08