406102_Well Construction - GW1_20120626

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2111-A
1. WELL CONTRACTOR:
Thomas Bill
Well Contractor (Individual) Name
Bill s Well Drilling Co., Inc.
Well Contractor Company Name
800 McArthur Rd
Street Address
Fayetteville NC 28311
City or Town State Zip Code
(910 ) 488-3740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WS0800910
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) Well #4
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural Lf Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 3-15-12
4. WELL LOCATION:
Warren Rd Faison. NC.. _.._ . .
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) •
CITY: Faison COUNTY Duplin
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
['Slope ❑ Valley E Flat D Ridge DOther
LATITUDE 35 ° 5 , 548.0000 DMS OR 3x.xxxxxxxxx DD
LONGITUDE78 ( ° 8 ' 803.0000 " DMS OR 7X.xxxxxxxxx DD
Latitude/longitude source: EGPS :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.)
Goodson & Wells Farms_ Ins
Facility Name Facility ID# (if applicable)
Street Address
City or Town State Zip Code
Bob McCloud
Contact Name
PO Box 7266
Mailing Address
Trenton NJ 08628
City or Town State Zip Code
( 910,E 260-0125
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 330
b. DOES WELL REPLACE EXISTING WELL? YES ❑
NO D'
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS +3 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): 1200 METHOD OF TEST Pumping
f. DISINFECTION: Type HTH Amount 1 0lbs
g. WATER ZONES (depth):
Top 248 Bottom 288 Top
: Top 300 Bottom 320 Top -
Top Bottom Top
7. CASING: Depth
Top 0
Top +3
Top 289
Bottom 40
Diameter
Ft. 24"
Bottom
Bottom
Bottom
Thickness/
Weight
.375
Material
Steel
Bottom 248 Ft. 12" .375 Steel
Bottom 300 Ft. 12" .375 Steel
8. GROUT: Depth Material Method
Top 0 Bottom 40 Ft. Cement Pumped
Top 230 Bottom 248 Ft. Bentonite Pumped
Top Bottom Ft.
▪ 9. SCREEN: Depth
- Top 248 Bottom 288
Top 300 Bottom 320
Top
Diameter Slot Size Material
Ft. 12" in. ._ _..30 -in.. _....S S.S.
Ft. 12 in. 30 in. SS
Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth
Top 200 Bottom
Size
330 Ft. No. 4
Top Bottom Ft.
: Top • Bottom Ft.
11. DRILLING LOG
Top Bottom
•
•
• RECEIVE
Material
Gravel
Formation Description
See Attached
/
/ information Processing Unit
JUN 2?U2 6-20,2
DWQ/BOG
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
: RECORB HAS BEEN PROVIDED Ts THE . L OWNER.
• ( % 1 r
!/
•
• SI
14!
CERTIFIED WELL CONTRACTOR
• Thomas Bill
3-15-12
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL;
Submit within 30 days of completion to: Division of Water Quality information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
JUL 0Frn?t'-1b
Rev. 2/09

BILL'S WELL DRILLING CO., INC.
Goodson & Wells Farms
Drilling Log Lithology
Well #4
From
To
Formation Description
0
1
Topsoil
1
10
Black Sandy clay
10
25
Brown Sand
25
32
Black Clay
32
54
Gray Sand w/Clay Streaks
54
80
Gray Clay
80
90
Gray Sand
90
94
Gray Clay
94
110
Sand Fine
110
116
Gray Clay
116
140
Gray Sand
140
142
Gray Clay
142
150
Gray Sand
150
156
Gray Clay
156
180
Gray Sand
180
195
Gray Clay
195
209
Fine Sand
209
250
Gray& White Clay
250
285
Loose Large Sand
285
304
Tight Clay
304
310
Loose Sand
310
314
Gray Clay
314
318
Loose Sand
318
330
Gray Clay
RECEIVED
JUN 2 6 2012
information Processing Unit
OWQ/BOG