415162_Well Construction - GW1_20130812

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2082
1. WELL CONTRACTOR:
Sanford Sweetina
Well Contractor (Individual) Name
Coastal Geothermal
Well Contractor Company Name
102 Middle St
Street Address
Jacksonville NC
City or Town State
( 910) 353-0926
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W1080031 1
28546
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable) n/a
SITE WELL ID #(if applicable) n/a
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 12-06-2012
TIME COMPLETED 2:00 AM ❑ PM 1
4. WELL LOCATION:
CITY:. Atlantic Beach COUNTY Carteret
1001 Ocean Ridae Dr
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley giFlat ❑ Ridge
LATITUDE 36
LONGITUDE 75
O
Latitude/longitude source: ❑PPS
(location of well must be shown on a
this form if not using GPS)
5. WELL OWNER
Dawn & Mark Carter
.
•
•
•
•
(check appropriate box)
❑ Other •
" DMS OR 3X.XXXXXXXXX DD •
" DMS OR 7X.XXXXXXXXX DD
❑Topographic map
USGS topo map andattached to•
Owner Name /
3308 Alleaanv Dr /
Street Address /
R?leiah NC 2760S /
City or Town State Zip Code /
(919 ) 873-0662 /
Area code Phone number
415162
g. WATER ZONES (depth): •
Top n/a Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
Top n/a Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
Thickness/
Weight Material
8. GROUT: Depth Material
Top 0 Bottom 255' Ft. Bentonite
Top Bottom Ft.
Top Bottom Ft.
Method
pump/tremie
9. SCREEN: Depth Diameter Slot Size Material
Top n/a Bottom Ft. in. in.
Top Bottom Ft in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top n/a Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top
000'
Bottom Formation Description
/ 035' Sand with Shell Layers
035' / 060'
060' / 100'
100' / 120'
120' / 255'
/
/
6. WELL DETAILS:
a. TOTAL DEPTH: 255'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO gr
g
c. WATER LEVEL Below Top of Casing:: nia FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS n/a 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): nia METHOD OF TEST nia
f. DISINFECTION: Type n/a Amount n/a
•
•
•
.
Clay
Silt
Limestone
Sandy Silt
SECTION
S�C�I 'rP",r-r•E..1 `4 N; r \ �?4. "bf',..:4.,t 9.r .�'"ti� U 4
12. REMARKS:
Drilled 6-255' bore holes set 1" geothermal h;,rermyc al loop in each„
K t
I DO HEREBY CERTIFY THAT I h#1S fx Isz AUK) TED IN
ACCORDANCE WITH 15A NC4 C, " co
STANDARDS, AND THAT A COt'y OF THIS RECORD HAS [EN
PRO • E a T JO TH ELL OWN,R.
1 t t^r, 4
(0-6 d
I UR • F CERTIFIED WELL CONTRACTOR DATE
San ord Sweeting
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2/09