406589_Well Construction - GW1_20120723

P N IDENTIALWELL CONSTRUCTION
RECORD
North Carolina Department of Environment and Natural Resources- Division of Water ua ' Q l�ty
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)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial ❑ Agricultural 0 Recovery 0 Injection 0
Irrigation j Other 0 (list use)
DATE DRILLED 06/26/12
4. WELL LOCATION:
301 Marsh Oaks Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY. New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑ ValleyWrFlat ❑Ridge ❑Other
LATITUDE 34 ° 17 29.4800 DMS OR
DD
LONGITUDE 77 47 30.2400 DMS OR DD
Latitude/longitude source: (%BPS ❑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
Melissa Blair
State Zip Code
Contact Name
301 Marsh Oaks Dr
Mailing Address
Wilminaton NC 28411
City or Town State. Zip Code
(910 ) 617-6323
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 165'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO q/
c. WATER LEVEL Below Top of Casing: 28'
(Use "+" if Above Top of Casing)
FT.
Submit wi.thui .30 days of CoMpletio.n ofWater
1617 Mail Service Center;. Raleigh:, NC 27699-161, Phone [phone]
7. CASING: Depth
• Top 1.5'
Top 0'
Top Bottom Ft.
8. GROUT:
Top 0'
: Top 137'
Top Bottom Ft.
9. SCREEN: Depth
Top 145'
Top
Top
5 ni
: 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): 60 A 80'METHOD OF TEST Airlift
: f. DISINFECTION: Type HTH Amount 3q(r� 1 O%
g. WATER ZONES (depth):
: Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
Diameter Weight Material
Bottom 145' Ft. 4" sch40 PVC
Bottom 40' Ft. 6" sch40 PVC
Depth Material Method
Bottom 22' Ft. Grout Tremmie
Bottom 141' Ft. Bentonite Tremmie
Diameter Slot Size Material
Bottom 165' Ft. 2" in. .020 in. PVC
Bottom Ft. in. in.
Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
: Top 141'
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
: Top Bottom
0 /28'
28' / 85'
85' / 135'
135' / 165'
/
12. REMARKS:
Size Material
Bottom 165' Ft. #2 Sand
Formation Description
Sandy clays
Limestone
Clay / mud rock
Sandstone
JUL. 23 2012
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RRD HAS BEEN PROVIDED TO THE WELL OWNER.
06/26/12
SIGNATURE i F CERTIFIED WELL CO �`�'►�'` OR
3 DATE
PRINTED NAME OF PERSON CONS 1.�r
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