411573_Well Construction - GW1_20130211

ArliSTAlt
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3314A
1. WELL CONTRACTOR:
Ellen Cornette
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#(if applicable) NA
SITE WELL ID #(if applicable) AMW-1
3. WELL USE (Check One Box) Monitoring 11 Municipal/Public 0
Industrial/Commercial ❑ Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 12/17/12
4. WELL LOCATION:
Tract 2 Brown's Island Zip Name, Numbers, Community, Subdivision, Lot No., Parcel, Z p Code)
CITY: Harkers Island COUNTY Carteret
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
LATITUDE 36 ' "DMS OR 34.70962N DD
LONGITUDE 75 ° " DMS OR-76.53811 W DD
Latitude/longitude source: 3GPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
NA NA
Facility Name Facility ID# (if applicable)
Tract 2 Brown's Island
Street Address
Marshallbura NC 28553
City or Town State Zip Code
James Cornette. Applied Resource Mat. PC
Contact Name
P . O _ Box 882
Mailing Address
Hampstead
City or Town
( 910,E 270-2919
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 8
b. DOES WELL REPLACE EXISTING WELL? YES 0
NC 28443
State Zip Code
NO qI
c. WATER LEVEL Below Top of Casing: 4.0 FT.
(Use "+" if Above Top of Casing)
411573
d. TOP OF CASING IS +2 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
4. g. WATER ZONES (depth):
: Top 4' Bottom 8' Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
: 7. CASING: Depth Diameter Weight Material
Top +2 Bottom 3 Ft. 2" SCH4( PVC
: Top Bottom Ft.
: Top Bottom Ft
8. GROUT: Depth
Material Method
: Top 0.5 Bottom 2.5 Ft Bentonite
Top Bottom Ft.
Top Bottom Ft
9. SCREEN: Depth Diameter Slot Size Material
: Top 3 Bottom 8 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 2.5 Bottom 8 Ft. Coarse Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
: Top Bottom
:•
/
/
.
12. REMARKS:
Formation Description
See attached boring Togs.
FES .1,- h
2013
i' 4 5_!1.! ' aHHer process]
1 OG
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
: 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H S BE PROV} EDO THE W 0 NER.
: SIGNATURE CERTIFIED WELL CONTRACTOR
PRINTED NAME OF PERSON CONS)r-K7c-t-le
RUCTING THE WELL
/ /3
D TE
Submitdays within 30 da s of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone [phone]
Form GW-lb
Rev. 2/09

AMW-1
BORING LOG
BROWN'S ISLAND
NC COASTAL LAND TRUST
CARTERET COUNTY, NORTH CAROLINA
DRILLED BY: ARM
LOGGED BY: E. Cornette
DATE: 12/17/12
Sample
p
Depth
Description
p
Water
Content
Blow Count
0-5'
Tan, fine grained sand.
Low to
Moderate
Not
Applicable
5 '-7'
Dark gray,sandyclay.
Y
High
Not
Applicable
7'-8'
Dark gray, very fine grained sand.
High
Not
Applicable
>8'
Gray, sandy clay. cla .
High
Not
Applicable
2013