405174_Well Construction - GW1_20120521

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JVON '' `{ SIDATTIAL 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)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation Other 0 (list use)
DATE DRILLED 04/25/12
4. WELL LOCATION:
345 Semmes Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTY New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat DRidge ❑Other
LATITUDE 34
LONGITUDE 77
011 '3.8300 "DMS OR
54 , 25.0800 "DMS OR
DD
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 State Zip Code
Molly Stanley
Contact Name
345 Semmes Dr
Mailing Address
Wilminaton NC 28412
City or Town State Zip Code
( 910 ) 392-1698
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 180'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO [�
c. WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
FT.
Submit within 30 days of completionto: Division o
1617 Mail Service Center, Raleigh; NC 27699-161:, Phone
q�t1'7
: 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 Alrlift
f. DISINFECTION: Type HTH Amount 3c 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 +1.5 Bottom 160' Ft. 4" sch40 PVC
: Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0' Bottom 26' Ft. Grout Tremmie
: Top 152' Bottom 156' Ft. Bent. chips Tremmie
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 160' Bottom 180' Ft. 4" in. .020 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 156' Bottom 180' Ft. Coarse Sand
Top Bottom Ft.
Top Bottom Ft.
.
▪ 11• . DRILLING LOG
: Top Bottom Formation Description
0 / 65' Sandy clay to clay
65' / 118' Limestone
118' / 155' Clay/mudrock
155' / 185' Sandstone
12. REMARKS:
iv* .� 1 2012
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUC ON ST DARDS, AND THAT A COPY OF THIS
• REC.' . HAS BEEN P'OVI "• : ++-• T LL OWNER.
' 04/25/12
ER IFI' R WELL CONTR CTOR DATE
S TURE OF
Donald H. Cummings
PRINTED NAME OF PERSON CONSTRUCTING THEi \WELD'_' j
r• ,
ater•Quality - lnformation Processing,
919) 807-6300
;�`1° 2012