404367_Well Construction - GW1_20120501

R ESIDENTIA1WELL 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
910 3712770
Area Code Phone Number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W08-199
SITE WELL ID# (if applicable)
Zip Code
3. WELL USE (Check Applicable Box): Residential well
DATE DRILLED . 03/27/12
TIME COMPLETED AMEPME
4. WELL LOCATION:
City: Castle Hayne County New Hanover
5579 Sycamore Drive, Castle Hayne Colony Lot 4R
(Street Name, Numbers, Community, subdivision, Lot Nol, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
JSIope JValley []FIatRidge nOther
LATITUDE N34° 21. 118 '
LONGITUDE 77 54. 379 '
Latitude/longitude source: E1GPS 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
Legend builders
Owner Name
400 Carl Street
Street Address
Wilmington, NC 28403
(
City or Town
910 ) 790-9031
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 33
b. DOES WELL REPLACE EXISTING WELL? YES NOD.
c. WATER LEVEL Below top of Casing: 8 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
State Zip Code
g. WATER ZONES (depth):
Top 23 Bottom 33 Top
. Top Bottom Top
. Top Bottom Top
•
•
.
mit within 30 days of campletion'o" Division of Water:
ail Service Center, Raleigh, NC 27699-161, Phone: (9
.
Bottom
Bottom
Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 23 Ft. 2 pvc
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom
Top ` Bottom
Top Bottom
20 Ft.
Ft.
Ft.
Material Method
Bentonite pump
9. SCREEN:Depth Diameter Slot Size
Top 23 Bottom 33 Ft. 2 in.
Top
Top
Bottom Ft.
Bottom Ft.
10. SAND/GRAVEL PACK:
Depth
Top Bottom
Material
in. pvc
in. in.
in. in.
Size Material
Ft. #2 Southern Products
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top / Bottom Formation Description
01 10 Clay
10 l 15 Sand and clay
/ 51 33 Limestone and sand layers
1
1
/
/
12. Remarks:
RECEIVFJrJ
MAY x 2W2
rmation �iDV Processing Una
OG
I 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 E
WELL O R.
SIGNATURE O CERTIFIED WELL RACT