401007_Well Construction - GW1_20120117

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3470 A
1. WELL CONTRACTOR:
William Matthew Wiggins
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationV Other ❑ (list use)
DATE DRILLED 01 /02/2012
4. WELL LOCATION:
1008 Butler National Ln.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTY New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley filrFlat ❑ Ridge ❑Other
LATITUDE 34 ° 17 46.2400 DMS OR DD
LONGITUDE 77 45 ' 58.9900 " DMS OR DD
Latitude/longitude source: 33PS ❑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.)
Facility Name Facility ID# (if applicable)
Street Address
City or Town State Zip Code
Dennis Callanan
Contact Name
1008 Butler National Ln.
Mailing Address
Wi I minaton NC 28411
City or Town State Zip Code
(910 ) 681-1026
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 190
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: 21
(Use "+" if Above Top of Casing)
FT.
4 0 -
: d. TOP OF CASING IS 1.5 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 Airlift
▪ f. DISINFECTION: Type HTH Amount %c 10%
: 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' Bottom 170' Ft. 4" sch40 PVC
: Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0' Bottom 165' Ft. Bentonite Tremmie
: Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 170' Bottom 190' Ft. 2" in. 20 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
: Top 165' Bottom 190'
Top
Top
11. DRILLING LOG
: Top Bottom
•
0' / 10'
Bottom
Bottom
10' / 25'
25' / 130'
130' / 145'
145' / 190'
/
1• 2. REMARKS:
Size Material
Ft. Sand
Ft.
Ft.
Formation Description
Clayey sand
Dark grey clay
Limestone
Clay / mudrock
Sandstone
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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 BEEN ',.VIDgD T() THE WELL OWNER.
SIGNATOF CE
01/02/12
WELL CONTRACTOR DATE
William Matth Wiggins
PRINTED NAME OF PERSON CONSTRUC
ater
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Rev. 2/09

Wate rWo rks
I.O. Box 882
Hampstead, NC 28443
WATER ANALYSIS SHEET
for
1008 Butler National Lane
Name & Address Mr. Dennis Callanan
1008 Butler National Lane
Wilmington, NC 28411
Date: January 3, 2012
Phone: [phone]
Fax:
Inspection Information:
(Please Check)
1. Blue discoloration of fixtures. N/A 7. Soap will not lather well. N/A
2. Red or brown discoloration of fixtures. N/A 8. Glassware dries cloudy. N/A
3. Pipes are eaten away or corroded. N/A 9. Water becomes cloudy. N/A
4. Pipes are clogged or filled w/ deposits. N/A 10. Water filled with dirt or silt. NO
5. Rotten odor. N/A 11. Is water clear when drawn? YES
6. Bad odor. N/A 12. Other
Source of Water & Complimenting Information:
City
Well X Other
Pump Capacity: 1 HP 25 GPM Pressure Tank Size: 44 Gallon
Water Pressure: 40/60 Tank Type: Captive Air Bladder
Equipped w/ volume
control
SAMPLE RESULTS:
Total Hardness
pH 6.47
10 Iron 0.2 Hydrogen Sulfide N/A
A Division of Applied Resource Management P.C.
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