414898_Well Construction - GW1_20130726

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3497 A
1. WELL CONTRACTOR:
John Salmon
Well Contractor (Individual) Name
Coastal Geothermal
Well Contractor Company Name
102 Middle St.
Street Address
Jacksonville NC 28645
City or Town State Zip Code
(910 ) 353-0926
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0800201
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irigationo Other d(list use) Geothermal LOOD
DATE DRILLED Feb/Mar-2013
4. WELL LOCATION:
BEQ HP-485
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Camo Leieune COUNTY Onslow
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
oSlope ❑Valley elat ❑Ridge ❑Other
LATITUDE 36 ° "DMS OR 3X.x000xx00(x OD
LONGITUDE 75 "DMS OR 7X.)000X000cX DD
Latitude/longitude source: LPS ❑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.)
BFO
Facility Name
"Ie Street
Street Address
Camn I P.iP.iine
City or Town
Carl H Baker
Contact Name
Blda 1005 Michael Rd
Mailing Address
Camn Leienne
City or Town
( 910$ 451-2213
Area code Phone number
6. WELL DETAILS:
a TOTAL DEPTH: 255'
Facility ID# (if applicable)
NC 28547
State Zip Code
NC 28547
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES L7 NO rj
c. WATER LEVEL Below Top of Casing: n/a FT.
(Use "+• if Above Top of Casing)
139
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): n/a METHOD OF TEST
f. DISINFECTION: Type n/a
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
Amount
Top n/a Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 255 Ft. Bentonite Pump
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 Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 75
75 / 115
115 / 210
210 / 255
/
12. REMARKS:
Formation Description
Clay some Sand
Sandy Silt
Soft to Medium Limestone
Sandy Silt/Limestone
JUL 1 4 2111R
WATER QUA/ ITY sPCTIOM
INFORMATION PROCESSING UNIT
I'staliea 4U-LJU X 1 get) eflilal IuOlIS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
RECO9 HAS BEEN P:OVID - O THE,/ ELL OWNER.
'ATURE OF IED WELL
ohn Salmon
PRINTED NAME OF PERSOI4 CONSI2UC' r
ATE
1 " GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Proces$ipg, Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone c'[phone]