414349_Well Construction - GW1_20130722

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1, Well Contractor Information:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
RECEIVEDIDENRJOWQ
JUL 15 2013
Aquifer Protection Section
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State. Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
°Geothermal (Heating/Cooling Supply)
❑ In d u st ri a l/C o m m erc i a l
❑Irrigation
Non -Water Supply Well:
@Monitoring
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
@Recovery
Injection Well:
❑Aquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatin /Cooling Return)
4. Date Well(s) Completed: 9/18/20
5a. Well Location:
NC Army National Guard
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
12Well IDH MW-1
Facility/Owner Name Facility ID# (if applicable)
2412 Infantry Road Wilmington NC
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
N W
6. Is (are) the well(s): ❑Permanent or @Temporary
7. Is this a repair to an existing well: DYes or ONo
if tiis is a repair, fill out known well construction information and explain the nature of the
repair under s21 remarks .section or on the hack of this form.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you con
submit one form.
1
9. Total well depth below land surface: 16 (ft.)
For multiple wells ltsiall depths ifdifferent (example- 3@200'and 2@I00')
10. Static water level below top of casing:
If water level is above casing, use "+"
11. Borehole dianietcr: 2 (in.)
direct push
12. Well construction method:
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a.'i'ield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
11, J4t.:
x
\N\ P)-ti
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap livable)
FROM
TO
DIAMETER
THICKNESS MATERIAI.
fl,
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
6 ft.
1 in.
sch 40
pvc
ft,
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
6 ft.
16 ft'
1 in.
0.01
sch 40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
2 ft,
4 ft•
bentonite
pour
0 ft.
2 ft.
concrete
pour
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
4 ft.
16 ft•
#2 torpedo sand
pour
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
see attached
ft.
ft.
ft.
ft.
—
ft.
ft.
ft.
rt.
ft,
ft.
ft.
ft.
21. REMARKS
Flush -mounted protective cover
22. Certification:
Ji n of enifed Well Contractor
r
10/10/2012
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC.' 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Bail Service Center. Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the addresses) above. also submit on: copy of this form within 30 days of
completion of well construction to the cowl
where constructed.
0
h'
Form GW- 1
North Carolina Department of Environment and Natural Resources — Division of Water Quality
JUL 2 L. 26 Jised
BY:
artt2013

PROJECT NAME: Wilmington Armory FMS#17 WELL NUMBER: MW-1
LOCATION: Wilmington, NC INSTALLATION DATE: September 19, 2012
CLIENT: NC Army National Guard FIELD REP: Bill Mabie
SUBCONTRACTOR: Mid -Atlantic Driling PROJECT NO.: 6260-12-0023
DRILLER: Jeff Smart
GROUND
SURFACE
WELL LOCATION: 2412 Infantry Road, Wilmington, NC
RtCEIVEU►UENRIDWQ
JUL 15 2013
CONCRETE PAD (+
(SLOPED TO DRAIN) ' uifer Protection Se
CEMENT/BENTONITE GROUT
2% BENTONITE BY WEIGHT
1" SCHEDULE 40, FLUSH
THREADED P.V.C.
WELL CASING
HYDRATED BENTONITE
SILICA SAND PACK
1" SCHEDULE 40, PVC
SLOTTED WELL
SCREEN W/.010 SIZE OPENINGS
FLUSH -THREADED PLUS
WELL DIAMETER (in.)
FLUSH -MOUNTED
PROTECTIVE COVER
(8" DIA. BOLT -DOWN)
TOP OF CASING
DEPTH
0
0.4'
-m— TOP OF ANNULAR SEALANT 3'
- TOP OF SAND PACK
TOP OF WELL SCREEN
mac-- BOTTOM OF WELL SCREEN
4'
6'
16'
BOTTOM OF WELL 16'
BOTTOM OF BORING
16'
PREPARED BY:
7347 West Friendly Ave,
Suite E
Greensboro, NC 27410
[phone]
TYPE II MONITORING WELL
CONSTRUCTION SCHEMATIC