407689_Well Construction - GW1_20120831

R ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2485
1. WELL CONTRACTOR:
Sean Cropsey
Well contractor (Individual) Name
Skipper's Well Drilling & Pump Service, Inc.
Well Contractor Company Name
107 Oakland Avenue
Street Address
Leland
NC 28451
City or Town State Zip Code
910 3712770
Area Code Phone Number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WP0290717
SITE WELL ID# (if applicable)
3. WELL USE (Check Applicable Box): Residential well
DATE DRILLED 508/02/12
TIME COMPLETED AMEIPME
4. WELL LOCATION:
City: Wilmington
7778 Alexander road
County New hanover
(Street Name, Numbers, Community, subdivision, Lot Nol, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
Slope Valley nFlatERidge Ej Other
LATITUDE N34' 17 . 274
LONGITUDEVVIT-7777' 48 393
Latitude/longitude source: ri GPS ETopographic map
(location of well must be shown on a USGS topo map and attached to
this form if not using GPS)
5. WELL OWNER
Mary Outlaw
Owner Name
7778 Alexander Road
Street Address
Wilmington NC 28411
City or Town State Zip Code
( 910 ) 686-9880
Area code Phone number
g. WATER ZONES (depth):
Top 91 Bottom 141 Top
• Top Bottom Top
▪ Top Bottom Top
Bottom
Bottom
Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2
Top
▪ Top
Bottom 160 Ft.
Bottom Ft.
Bottom Ft.
4
steel
8. GROUT: Depth Material Method
• Top
Top
Top
0 Bottom 20 Ft.
• 0 Bottom Ft.
Bottom Ft.
9. SCREEN:Depth Diameter Siot Size
Top 91 Bottom 141 Ft. 4 in.
Top Bottom Ft. in.
Top Bottom Ft.
10. SAND/GRAVEL PACK:
Top
Top
• Top
6. WELL DETAILS:
a. TOTAL DEPTH: 160
b. DOES WELL REPLACE EXISTING WELL? YES NOE1
c. WATER LEVEL Below top of Casing: 51 FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 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 HTH Amount cup
Depth
Bottom
Bottom
Material
in.
in.
in. in.
Size Material
Ft. #2 Southern Produc
Ft.
. Bottom Ft.
11. DRILLING LOG
Top / Bottom Formation Description
0 / 10 clay
10 / 30 sand
30 1 40 shells, and sand
40 90 limestone
90 / 140 clay, mud, rock
140 I 160 sandstone
160 / open hole
AUG 3 2012
12. Remarks:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
▪ SIGNATURE OF CERTIFIED W
TRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to" Division of Water Quality 'I formation ,Processing Form GW-1 a
1617 Mail Service -Center, Raleigh, NC 27699-161, Phone: [phone] - _ Rev. 2/09