405833_Well Construction - GW1_20120625

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 4163
1. WELL CONTRACTOR:
MARK IRELAND
Well Contractor (Individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
Street Address
STATESVILLE NC 28625
City or Town State Zip Code
( 704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WV0800060
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-1
3. WELL USE (Check One Box) Monitoring Cl Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 05/08/12
4. WELL LOCATION:
100 WEST SALISBURY STREET 28480
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WRIGHTSVILLE BEACH COUNTY NEW HANOVER
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
['Slope [Walley 'Flat ❑Ridge ❑Other
LATITUDE 34 ° 13 4.8600 " DMS OR
LONGITUDE 77 ° 47 ' 46.2600 " DMS OR
Latitude/longitude source: VGPS ❑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.)
DD
DD
FMR SCOTCHMAN - 36 N/A
Facility Name Facility ID# (if applicable)
100 WEST SALISBURY STREET
Street Address
WRIGHTSVILLE BEACH
City or Town
SPRINGER EUBANK
NC 28480
State Zip Code
Contact Name
123 SHIPYARD BLVD
Mailing Address
WILMINGTON NC 28412
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 12.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO L>r
c. WATER LEVEL Below Top of Casing: 5.0
(Use "+" if Above Top of Casing)
7: Ma:il Sel vice Center rRaleit
FT.
i•�:a St�:�.r�.':Y.', � J .-... r ...t. .ram
Top 0.0 Bottom 0.5
405833
d. TOP OF CASING IS 0.0 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): NIA METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
: Top Bottom Top Bottom
• Thickness/
: 7. CASING: Depth Diameter Weight Material
Top 0.0 Bottom 2.0 Ft. 2 INCH SCH 40 PVC
Top Bottom Ft.
: Top Bottom Ft.
8. GROUT: Depth Material
Ft. PORTLAND BENTONITE
: Top Bottom Ft.
: Top Bottom Ft.
Method
SLURRY
9. SCREEN: Depth Diameter Slot Size Material
Top 2.0 Bottom 12.0 Ft. 2.0 in. .010 in. PVC
: Top
: Top
Bottom Ft. in. in.
Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 1.0 Bottom 12.0 Ft. 20-40 FINE SILICA SAND
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
• Top Bottom
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
0.0 / 12.0
/
/
/
/
Formation Description
SAND
12. REMARKS:
: BENTONITE SEAL FROM 0.5 TO 1.0 FEET
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C WELL CONSTRUCTION T ._ 1 • RDS, f D THAT PY OF THIS
• RECO' c`. BEEN PI' VIDED T 0 :1' R.
SIGNATURE OF CERTIFIED WELL CONTRAC
: MARK IRELAND
05/ 16/ 12
OR _ _ DATE
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
oomatior
RE C.
JUN.:
I
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Information process'
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