411387_Well Construction - GW1_20130211

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North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACT
1. WELL CONTRACTOR:
VINCE FEDERLE
CE
TWEICAT!ON # 3552
Well Contractor (Individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
Street Address
STATESVILLE NC 28625
City or Town State Zip Code
( 704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID Of applicable) MW-2
3. WELL USE (Check One Box) Monitoring El Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 01/22/13
4. WELL LOCATION:
100 WEST SALISBURY STREET 28480
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WRIGHTSVILLE BEACH COUNTY NEW HANOVER
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope [Walley FiFlat 0 Ridge ❑Other
LATITUDE 34 ° 13 .4.5200 " DMS OR
LONGITUDE 77 ° 47 ' 46.1500 „ DMS OR
Latitude/longitude source: VGPS :Topographic 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.)
DD
DD
WRIGHTSVILLE BEACH FOOD MART N/A
Facility Name Facility ID# (if applicable)
100 WEST SALISBURY STREET
Street Address
WRIGHTSVILLE BEACH
City or Town
SPRINGER EUBANKS
NC 28480
State Zip Code
Contact Name
123 SHIPYARD BLVD
Mailing Address
WILMINGTON NC 28412
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 12.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ef
c. WATER LEVEL Below Top of Casing: 5.0
(Use "+" if Above Top of Casing)
h� 7l�T•'. n.t:'
W ,
FT.
d. TOP OF CASING IS 0.0 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): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
: Top Bottom Top Bottom
: Top Bottom Top Bottom
: Thickness!
: 7. CASING: Depth Diameter Weight Material
Top 0.0 Bottom 2.0 Ft. 2 INCH SCH 40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0.0 Bottom 1.0 Ft. PORTLANDBENTONITE SLURRY
Top Bottom Ft.
: Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 2.0 Bottom 12.0 Ft. 2.0 in. .010 in. PVC
: Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
: Top 1.5 Bottom 12.0 Ft. 20-40 FINE SILICA SAND
: Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Formation Description
: 0.0 / 1.0 ASPHALT/GRAVEL
: 1.0 / 12.0 DARK GRAY SANDY SILT
/
/
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12. REMARKS:
: BENTONITE SEAL FROM 1.0 TO t5 FEET
ct_Vi - 2.0
.fin `'
P rOCe
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 HA EEN PROVIDED TO HE WEL OWNER.
• ,1 _ . 4 1j . • /,01 /25/ 13
SIGNAT RE OF CERTIFIED WELL ~• fw 1 " ' :,_ i DATE
: VINCE FEDERLE ^.t: {t.. -4,,_,,,, .;bR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
�, FEB2O13
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formation Processin'
Form GW-1
Rev. 2/09