413539_Well Construction - GW1_20130528

.WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2485
.waLeuN 1 RACTOR:
Sean Cropsey
Well contractor (Individual) Name
Skipper's Well Drilling & Pump Service, Inc.
Well Contractor Company Name
107 Oakland Avenue
Street Address
Leland
NC 28451
City or Town State Zip Code
910 3712770
I 1
. g. WATER ZONES (depth):
Top 90 Bottom __150 Top
Top Bottom Top
___ ......_.
Top Bottom Top
Bottom
Bottom
Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +1.5 Bottom 90 Ft. 4 sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
Area Code Phone Number
8. GROUT: Depth
2. WELL INFORMATION: Top 0 Bottom 20 Ft.
WELL CONSTRUCTION PERMIT# Top Bottom Ft.
SITE WELL ID# (if applicable) Top Bottom Ft.
3. WELL USE (Check Applicable Box): Residential well
DATE DRILLED 01/04/2003
TIME COMPLETED 12:00am AM
4. WELL LOCATION:
City: Wilmington
County
PM ED
New Hanover
(Street Name, Numbers, Community, subdivision, Lot Nol, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
E]slope rivaney niFlatriRidge jOther
LATITUDE N34° 16 . 109 '
LONGITUDEWOrr 50 . 402 '
Latitude/longitude source: EIGPS Topographic map
(location of well must be shown on a USGS topo map and attached to
this form if not using GPS)
5. WELL OWNER
Lewis Strawberry Farm
Owner Name
6525 Gordon Road
Street Address
Wilmington, NC 28405
City or Town
910 )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 150
b. DOES WELL REPLACE EXISTING WELL? YES D NOD.
State Zip Code
c. WATER LEVEL Below top of Casing: FT
(Use "+" if Above Top of Casing) 15
d. TOP OF CASING IS 1.5 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): 25 METHOD OF TEST pump
f. DISINFECTION: Type HTH Amount
Submit withi
LAY
cup
9. SCREEN:Depth
Top Bottom
Top Bottom
Top Bottom
Material
portland
Method
pump
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top Bottom Ft.
Top Bottom Ft.
Top
Bottom Ft.
11. DRILLING LOG
Top / Bottom
0 / 10 overburden, sand
10 / 30 sand and clay
30 / 50 sand and clay
50! 80 limestone
Size
Material
Formation Description
80 / 90 clay
90 / 120 clay
120 / 150 sandstone
/
12. Remarks:
.L 4 2013
,! E
t.
▪ I DO HEREBY CERTIFY T :Ilk THIS WELL WAS CON :,r- UCTED IN
ACCORDANCE WITH 15A NM ZG,i/YELLCONSIRUCTION
▪ STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
• SIGNATU E OF CERTIFIED WELL CONTRACTQR e[ATE
•
PRINTED NAME OF PER
7.4(
CONSTRUCTING THE
WELL
srmation
Form GW-la
Rev. 2/09
AnilificAr Mil:VW/A ni 0, M.: