410452_Well Construction - GW1_20130211

R ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2485
1. WELL CONTRACTOR:
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
910 371-27. 0
Area Code Phone Number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WP0290400
SITE WELL ID# (if applicable)
3. WELL USE (Check Applicable Box): Residential well
DATE DRILLED 8/24/12
TIME COMPLETED AM(R,PM::
4. WELL LOCATION:
City: Castle Hayne
County New Hanover
(Street Name, Numbers, Community, subdivision, Lot Nol, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
]Slope JJVaIIey JFiFlatri Ridge Other
a
LATITUDE N34"
LONGITUDE W077 -
Latitude/longitude source: rJGPS Topographic ma
(location of well must be shown on a USGS topo map and attached to
this form if not using GPS)
5. WELL OWNER
Scott Gerow / Maritime West Development
Owner Name
P.O. Box 15970
Street Address
Wilmington, NC 28408
City or Town State Zip Code
( 910 ) 279-1582
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 75
b. DOES WELL REPLACE EXISTING WELL? YES
c. WATER LEVEL Below top of Casing: 20
(Use "+" if Above Top of Casing)
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): METHOD OF TEST
f. DISINFECTION: Type HTH Amount cup
NOD.
FT
. g. WATER ZONES (depth):
. Top 55 Bottom 75 Top
. Top Bottom Top
. Top Bottom Top
. 7. CASING: Depth
Top +2 Bottom
Top Bottom
▪ Top i Bottom
Bottom
Bottom
Bottom
Thickness/
Diameter Weight Material
55 Ft. _ PVC
Ft.
Ft.
• 8. GROUT: Depth Material
Top
Top
Top
0 Bottom 3 Ft. cement
3 Bottom_ Ft. Bentonite
Bottom Ft.
9. SCREEN: Depth Diameter Slot Siz
e
. Top 55 Bottom 75 Ft. 4 in.
Top
▪ Top
Bottom
Bottom
Method
Material
in. PVC
Ft. in. in.
Ft. in. in.
. 10. SAND/GRAVEL PACK:
Depth
. Top 50 Bottom 75 Ft.
. Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top / Bottom
0/ 10
10 / 20
20 / 45
45 / 75
Size Material
#2 Southern Product
Formation Description
clay
sand
clay and sand layers
Limestone and sand layers
� UEC 0 2012
12. Remarks:
•
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 HAS BEEN
PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
rrp 2i111/
ubmit within 30 da s : i _. _ . _ _ _ -
ofcomletPRINTED NAME OF PERSON CONSTRUCTING HE WELL
y p _ . on to� ....:Division of Water Quality ; ;`
Information Processing �� �-
FomGW
'1617 Mail Service Center, Raleigh, gh, SIC 27699='161 Phone 19 9 r _1 a
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