410448_Well Construction - GW1_20130211

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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
WeII Contractor (Individual) Name
Coastal Geothermal
Well Contractor Company Name
102 Middle St
City or Town
( 910) 353-0926
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0800311
Street Address
Jacksonville NC 28546
State 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 CI
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: (check appropriate box)
DSlope ❑ Valley dFlat ❑Ridge ❑Other
LATITUDE 36
LONGITUDE 75
"DMS OR 3X.)00000000X DD
" DMS OR 7X.XX000000( DD
Latitude/longitude source: ❑GPS ['Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
Dawn & Mark Carter
Owner Name
3308 Alleaanv Dr
Street Address
Raleiah
City or Town
(919 ) 873-0662
Area code Phone number
•
•
•
•
g. WATER ZONES (depth):
Top n/a Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top n/a Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 255' Ft. Bentonite pump/tremie
Top Bottom Ft.
Top Bottom Ft.
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
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
000' / 035'
035' /060'
060' / 100'
100' / 120'
120' / 255'
/
/
/
NC 27609- I
State Zip Code /
/
6. WELL DETAILS:
a. TOTAL DEPTH: 255'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: n/a 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.
ea YIELD (gpm): n/a METHOD OF TEST n/a
f. DISINFECTION: Type n/a Amount n/a
•
•
•
Ft.
Ft.
Ft.
Formation Description
Sand with Shell Layers
Clay
Silt
Limestone
Sandy Silt
uct
ZOVL
12. REMARKS:
Drilled 6-255' bore holes sett' geothermal loop in each
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTR CTION .
STANDARDS, AND THAT A COPY OF THIS-RECORP HASTBEEF
PROVIDE ' O THE WELL O ER.
SI N TUR
Sa ford Sweeting
F CERTIFIED WELL CONTRACTOR
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality -
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Information Processing,
Form GW-la
Rev. 2/09