411078_Well Construction - GW1_20130204

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2412 A
1. WELL CONTRACTOR:
Donald H. Cummings
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) MW-1
3. WELL USE (Check One Box) Monitoring 1 Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation° Other 0 (list use)
DATE DRILLED 12/12/12
4. WELL LOCATION:
Off of Hwv 50 North
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Holly Ridge cowry Pender
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
DSlope °Valley 'Flat °Ridge ❑Other
LATITUDE 34 ° 34. • 4.7400 "DMS OR DD
LONGITUDE 77 ° 35 ' 22.2700 " DMS OR DD
Latitude/longitude source: IWPS (]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.)
Surf City WWTP
Facility Name
Off of Hwv 50 North
Street Address
Holly Ridne
City or Town
I M Mc.I amh and Son Inc
Contact Name
R00 Mcl amh Rd
Mailing Address
Calabash
City or Town
(910 ) 443-7082
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 12'
Facility ID# (if applicable)
NC 2R44.
State Zip Code
NC 28467
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ° NO
c. WATER LEVEL Below Top of Casing: 5' FT.
(Use "+' if Above Top of Casing)
411078
d. TOP OF CASING IS 2 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
f. DISINFECTION: Type Amount
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 2' Ft. 2" sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0' Bottom 0.5
Top 0.5 Bottom 1'
Top Bottom
9. SCREEN: Depth
Top 2' Bottom 12'
Top Bottom
Top Bottom
10. SAND/GRAVEL PACK:
Material
Ft. Grout
Method
Poured
Ft. Bentonite Poured
Ft.
Diameter Slot Size Material
FL 2" in. .020 in. PVC
Ft. in. in.
Ft. in. in.
Depth Size Material
Top 1' Bottom 12' Ft. #2 Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
/ See attached
12. REMARKS:
ens
"0A
�t u
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
R - D HAS BEEN PR • VIDEO TO T, WELL OWNER.,
12/17/12
OF CERTIFIED ELL CONTR '(TOR DATE
Donald H Cummings
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]
RECEIVED
JAN882013
Form G W-1 b
Rev. 2/09

Juniper Swamp
Surf City Waste Water Treatment Rant
Holly Ridge, NC
MW-10
Drilled By: Donald Cummings
Logged By: Joseph Zuncich
Date: 12/12/12
Depth
(ft.)
Description
Water
Content
0 - 2'
Medium brown, silty to very fine sand, slightly clayey with
Low
root matter.
5' - 7'
Brown orange, very fine grained clayey sands.
High
8' - 10'
Tan gray, sandy clay / clayey sand mixture.
High
10' - 12'
Tan light gray, sandy clay.
High