411599_Well Construction - GW1_20130211

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3324A
1. WELL CONTRACTOR:
Joe Zuncich
Well Contractor (Individual) Name
Applied Resource Management. PC
Well Contractor Company Name
257 Transfer Station Road
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# NA
OTHER ASSOCIATED PERMIT#(d applicable) NA
SITE WELL ID #(if applicable) M W-1
3. WELL USE (Check One Box) Monitoring 11 Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
IrrigationD Other ❑ (list use)
DATE DRILLED 1 1 /29/12
4. WELL LOCATION:
540 Richlands Hiahwav
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Jacksonville COUNTY Onslow
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
['Slope ❑Valley atlat ❑Ridge ❑Other
LATITUDE 34 -45 .84400 "DMS OR
LONGITUDE 77 . 26 • 55.7400 " DMS OR
Latitude/longitude source: 3,PS Dropographic 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.)
NA NA
Facility Name
540 Richlands Hiahwav
Street Address
Jacksonville
City or Town State Zip Code
Jne 7uncich Anolied Resource Mat PC
Contact Name
P O Box 882
Mailing Address
Hampstead
City or Town
( 9101 270-2919
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 10
DD
DD
Facility ID# (if applicable)
NC
NC 28443
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO qt
c. WATER LEVEL Below Top of Casing: 3 92 FT.
(Use "+" if Above Top of Casing)
411519
d. TOP OF CASING IS 0 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 (gam)* NA METHOD OF TEST NA
f. DISINFECTION: Type NA Amount NA
g. WATER ZONES (depth):
Top 4' Bottom 10' Top Bottom
Top Bottom _ Top Bottom
Top Bottom Top Bottom
Thickness/
Weight Material
7. CASING: Depth Diameter
Top 0 Bottom 2 Ft. 2" SCH4( PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0.5 Bottom 1
Top 0.3 Bottom 0.5
Top Bottom
9. SCREEN: Depth
Top 2 Bottom 10
Top Bottom
Top Bottom
10. SAND/GRAVEL PACK:
Depth
Top 1 Bottom 10
Top Bottom
Material
Ft. Bentonite
Ft. Neat Cement
Ft.
Diameter Slot Size
Ft. 2" in.
Ft. in.
Ft. in.
Method
0.010 in.
in.
in.
Material
PVC
Size Material
Ft. Coarse Sand
Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Formation Description
/ See attached boring Togs.
FEB a 9 20 E�1s�ED
Ks li
12. REMARKS:
Information oroc ing Unit
,C/SArnnZOC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15ANCAC , WELL CONSTRUCTION STANDARDS, AND TT)i &A COPY OF THIS
RECO -. - BEEN PROVID -i THE WELL OWNER. t
SIGN
ACTOR `"DAB" a
P INTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - I
1617 Mail Service Center, Raleigh, NC 27699-161, Phone': [phone]
formationProcessing,;'
Form GW-lb
Rev. 2/09

MW-1
BORING LOG
STANCIL PROPERTY
540 RICHLANDS HIGHWAY
JACKSONVILLE, NORTH CAROLINA
DRILLED BY: J. Zuncich
LOGGED BY: E. Cornelia
DATE: 11/29/12
Sample
Depth
Description
Water
Content
Blow Count
0'-8'
Tan -orange to dark brown, fine sandy backfill.
No hydrocarbon (HC) odor.
Low to
Moderate
Not
Applicable
8'-10'
Tan -brown to gray, fine to very fine grained
sand. Slight HC odor.
High
Not
Applicable

MW1
9' Sand !•'.'.
Steel Manhole
Ground Surface
Locking Well Cap
0.5' Bentonite
l
Groundwater
Table
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r•••••�
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1 . . . ••••••
1 . • • •
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•••
1•.•.•. •••••.I
1••••• 1• ••••
1••••• L•• ••
I• •• ••• ••
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1 •
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1••••• • ••••
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•
00••• .••❖
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"••
Concrete/Grout Crown
2' Riser
•
8' Screen
10' Total Depth
Applied Re ource
Planagernent, f? C,
Nempztea4 NC25443
TITLE:
Type II Monitoring Well
Asbuilt
JOB:
12,098
SCALE:
Not to scale
DATE:
12/30/12
DRAWN BY:
EFC
WELL ID:
MW-1