404633_Well Construction - GW1_20120423

1. WELL CONTRACTOR:
Ronald E Stewart
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3094-A
Well Contractor (Individual) Name
Mid -Atlantic Drilling, Inc.
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach
City or Town
(910 ) 458-5020
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-A2
3. WELL USE (Check One Box) Monitoring C1 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 3/13/2012
State
4:04633
d. TOP OF CASING IS 0.5 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): NA METHOD OF TEST NA
f. DISINFECTION: Type NA Amount NA
g. WATER ZONES (depth):
NC 28428 : Top Bottom Top Bottom
: Top Bottom Top Bottom
: Top Bottom Top Bottom
Zip Code
4. WELL LOCATION:
Proposed Wilminaton River Front Marina
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Han
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope (Valley ❑ Flat t6 Ridge ❑ Other
KKI$TCD 34 IAAAA&AAAAAAAA! CL R OR '34"2L456,2cc
KNMF I$TCD 77 i^^^^&^^^^^^^^! CL R OR 7/71511O844A^ cc
Latitude/longitude source: 3PS ❑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.)
River Front Marina
Facility Name
Nutt St
Facility ID# (if applicable)
Street Address
Witminaton NC 28401
City or Town State Zip Code
Adam Lisk
Contact Name
720 North Third Street Ste, 202
Mailing Address
Wilmington NC
City or Town State
( 910n 251-6160
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 51"
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
c. WATER LEVEL Below Top of Casing: —3.5 FT.
(Use "+" if Above Top of Casing)
28401
Zip Code
• 7. CASING: Depth Diameter
Top +0.5 Bottom -0.5 Ft. 2"
: Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom -0.25 Ft.
Top Bottom Ft.
Top Bottom Ft.
Thickness/
Weight Material
S 40 PVC
9. SCREEN: Depth Diameter
Top -0.5 Bottom -4.25 Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top -0.25 Bottom -4.25 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
Slot Size Material
in.
in.
in.
jIllaterial
APR 2 1?
Formation Description
n \i
if
0 / -6.5 Disturbed Sediment and Debris
/
/
12. REMARKS:
APR 9 2012
Information Processing Unit
DW0180G
• 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 BEE PROVIDED TO THE WELL OWNER.
3/26/201
IGNATURE OF CERTIFIED WELL CONTRACTOR DATE
,r
: Ronald E Stewart
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
•
Submit within 30 days of completion to: Divisiono ater Quail
1617 Mail Service Center, Raleigh, NC 27699-161, Phone [phone]
Information Processing,
Form GW-1 b
Rev. 1/08