411598_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
Weil 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#(if applicable) NA
SITE WELL ID #(if applicable) MW-2
3. WELL USE (Check One Box) Monitoring id Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection ❑
Irrigationp Other 0 (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 CValley "Flat DRidge DOther
LATITUDE 34 ° 45 ' 8.4000 "DMS OR _ DD
LONGITUDE 77 26 56.2800 " DMS OR DD
Latitude/longitude source: MPS ['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.)
NA NA
Facility Name Facility ID# (if applicable)
540 Richlands Hiahwav
Street Address
.Iacksonville NC
City or Town State Zip Code
Joe Zuncich Applied Resource Mot PC
Contact Name
P O Box 882
Mailing Address
Hamnstead NC 28443
City or Town State Zip Code
( 9108 270-2919
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 10
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO LV
c. WATER LEVEL Below Top of Casing: 3 90 FT.
(Use "+" if Above Top of Casing)
411598
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 (gpm): 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)
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 1 Ft. 2" SCH4( PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0.3 _ Bottom 0.5
Top 0.1 Bottom 0.3
Top Bottom
Material
Ft. Bentonite
Ft. Neat Cement
Ft.
Method
9. SCREEN: Depth Diameter Slot Size Material
Top 1 Bottom 9 Ft. 2" in. 0.010in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 1 Bottom 10 Ft. Coarse Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG 1* ri +""'r '`,,f
Top Bottom ForrnarbCDesorlphon I,
II
/ See at44&ched&berinq Io
/ i': 0,rn' r `�93 l PI
12. REMARKS:
II
- CE JVFD
, information Processing Unit
OWO/Rfjfr
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
RECO EN PROVIDED
LL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
ISA NCAC
SIGN
r+ VELL OWNER. y
FFCCERTIFL N CTR ( DATE/72
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water (duality - Information`Processing,"
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1 b
Rev. 2/09

MW-2
BORING LOG
STANCIL PROPERTY
540 RICHLANDS HIGHWAY
JACKSONVILLE, NORTH CAROLINA
DRILLED BY: J. Zuncich
LOGGED BY:: E. Corneae
DATE: 11/29/12
Sample
Depth
Description
Water
Content
Blow Count
0'-8'
Brown -orange, sandy backfill. Slight
hydrocarbon (HC) odor.
Low to
Moderate
Not
Applicable
8'-10'
Gray to brown, very fine grained sand. Slight
HC odor.
High
Not
Applicable

Steel Manhole
Ground Surface
t
0,2' Bentonite
1
9' Sand
•
MW-2
Locking Well Cap
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Concrete/Grout Crown
•
1' Riser
A
8' Screen
. 9' Total Depth
Applied Rei out^ce
Management, l' C
Hampstead, NC28
TITLE: '
Type II Monitoring Well Asbuilt
JOB:
12098
SCALE:
Not to scale
DATE:
12/30/12
DRAWN BY:
EFC
WELL ID:
MW-2