411597_Well Construction - GW1_20130205

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
State Zip Code
City or Town
(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-3
3. WELL USE (Check One Box) Monitoring Ld' Municipal/Public 0
Industrial/Commercial ❑ Agricultural 0 Recovery0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 1 1 /29/12
4. WELL LOCATION:
540 Richlands Highway
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
crn': Jacksonville couNTYOnslow
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope OValley jFlat ❑Ridge ❑Other
LATITUDE 34 ^ 45 •8.2800 "DMS OR DD
LONGITUDE 77 ° 28 ' 55.1000 " DMS OR DD
Latitude/longitude source: !PPS DTopographic 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.)
FaA ci ty Name FacilAity ID# (if applicable)
540 Richlands Hiahwav
Street Address
Jacksonville NC
City or Town State Zip Code
Joe Zuncich Aoolied Resource Mat PC
Contact Name
P O Box 882
Mailing Address
Hampstead NC 28443
City or Town State Zip Code
( 910b 270-2919
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 10
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Li
c. WATER LEVEL Below Top of Casing: 3 92 FT.
(Use "+" if Above Top of Casing)
411597
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 2 Ft. 2" SCH4( PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0.5 Bottom 1.0 Ft. Bentonite
Top 0.2 Bottom_ 0.5 Ft. Neat Cement
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 2 Bottom 10 Ft. 2" in. 0.010 in. 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
Top
Bottom Ft.
Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
n
/ See ttached-bo 011Odtv,' ,
/ 61e' Ir.... 't,1/ 11
/
, ip(
:: 4L li*t.8 1 1 2313
t s 2::.r
/
12. REMARKS:
ECFJlJim
FEB 0 5 71113
,Ft el Processing Unit
DWQ/BOG
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2 L CONSTRUCTION ST DARDS. AND THAT A COPY OF THIS
RECOR AS N PROVIDED ELL OWNER. e
SIGN RE OF CERT
LL CONY OR
PRI
TED 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 27899-161, Phone : [phone]i0
Form GW-1 b
Rev. 2/09

MW-3
BORING LOG
STANCIL PROPERTY
540 RICHLANDS HIGHWAY
JACKSONVILLE, NORTH CAROLINA
DRILLED BY: J. Zuncich
LOGGED BY: E. Comette
DATE: 11/29/12
Sample
Depth
Description
Water
Content
Blow Count
0'-3'
Brown -orange, sandy backfili. Slight
hydrocarbon (HC) odor.
Low to
Moderate
Not
Applicable
3'-5'
Gray to dark gray, fine to medium grained
sand. High HC odor.
Moderate
Not
Applicable
5'-8'
Light gray silty clay. Slight hydrocarbon HC
odor.
Low
Not
Applicable
8'-10'
Light gray to white, very fine grained sand. HC
odor.
High
Not
Applicable

w
MWW3
Steel Manhole
Ground Surface
i
0, 5' Bentonite
.l
9' Sand
•
Locking Well Cap
r.•.• .4 ••i.••
►❖•� ••••%•
►... .
►•••••4 • •••
Groundwater r.•••• •❖•••
Table r•••••4 i.•.❖
1•:.•4 ••••••
►... .❖••
►❖.4 •❖•!
►•.❖. • •❖
r_._.=. ••i.•
r_.=.=. .❖• .•
r❖.10
• .❖.•
..••
...
►i .• s•••••
!��•• ••••••
... ...
r❖.• .❖.•
r❖.• •••❖
I•�•• ••••••
... • • •
%• �•�•�•
• • •
Concrete/Grout Crown
2' Riser
•
A
8' Screen
♦ 10' Total Depth
Applied Keeaurce
Management, 17C F
Hampatead NC25443
TITLE:
Type I1 Monitoring Well
Asbuilt
JOB:
12098
SCALE:
Not to scale
DATE:
12/30/12
DRAWN BY:
EFC
WELL ID:
MW-3