413976_Well Construction - GW1_20130610

WELL CONSTRUCTION RECORD
This 1 rm can be used for single or multiple wells
For Internal Use ONLY:
4- 13 9 7 6'
Kv
1. Well Contractor Information:
Joe Zuncich
Well Contractor Name
3324-A
NC Well Contractor Certification Number
Applied Resource Management, PC
Company Name
2. Well Construction Permit #: NA
List all applicable well construction permits (i.e. County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
:Agricultural
DGeothennal (Heating/Cooling Supply)
DlndustrialJComrn ercial
❑Irrigation
❑Municipal/Publie
DResidential Water Supply (single)
DResidential Water Supply (shared)
Non -Water Supply Well:
DMonitoiing
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
:Aquifer Test
DExperimental Technology
❑Geothermal (Closed Loop)
DGeothennal (Heating/Cooling Return)
4. Date Well(s) Completed: 5I2,'13
5a. Well Location:
Eastbrook, LLC
❑Recovey
D Cnoundwater Remediation
❑ Salinity Barrier
D Stoimwater Drainage
D Subsidence Control
DTracer
❑Other (explain under #21 Rernaiks)
Well IB# M WAO C-5
Facility/Owner Nance Facility ID#t (if applicable)
P.O. Box 157 Leland, NC 28451
Physical Address, City, and Zip
Brunswick
219903008431
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.270307 N-78.0339671
6. Is (are) the well(s): OPermanent or DTerporary
7. Is this a repair to an existing well: ❑Yes or No
If this is a repair, fill out known well construction ilrformation and explain the nature of the
repair under 421 remarks section or on the back of this form.
8. Number of wells constructed:
For multiple injection or non -water supply wells 011E1' with the sane construction, you can
submit one form.
9. Total well depth below land surface: 13
For multiple wells list all depths ifdifferent (example- 3@200' and 2@.100')
10. Static water level below top of casing: 0'42
If water level is above casing, use "+
11. Borehole diameter:8
(in.)
12. Well construction method: rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop) • .
FROM
TO
DIAMETER
THICKNESS
MATERIAL
-2 ft-
3 ft.
2 'ri
SCH40
PVC
ft.
ft.
in
17. SCREEN .
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
3 ft.
13 ft.
2 in
0.010
_
SCH40
PVC
ft.
ft.
in
18.. GROUT `
FROM
TO
_ MATERIAL
EMPLACEMENT METHOD 8 AMOUNT
0 ft*
0.5 ft•
Neat Cement
Poured
0.5 ft-
1.5 ft•
Bentonite
Poured
• ft.
ft.
-. 19. SAND/GRAVEL PACK (if applicable)
FROM
T O
MATERIAL
EMPLACEMENT METHOD
1.5 ft.
13 ft.
#2 Sand
_
Poured
ft.
ft.
• 20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soll/rock type, grain size, etc.)
ft.
ft.
See Attached
ft.
ft.
ft.
ft.
ft.
ft
t.s iUN . 6-.1 Ltili
ft..
ft.
WATER QUALITY SECTIO ,t
ft.
it.
INFORMATION PROCESSINC:, UNIT
• 21. REMARKS
r
22. Ce a'on:
Signa e of Ceti ed Well C .. 1•
Date
By .igning this form, 1 hereby certify that the well(s) was (were) constrzceded in accordance
w h 1 A NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide
construction details. You mad• also attach addi1 pages if necessary.
SUBMITTAL INSTUCTIONS
JUN 1 0 2013
24a. For All Wells: Submit this form tin 0 days of completion of w
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above; also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c: For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this foim within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GZ0'-1
North Carolina Department of Environment and Natural Resources - Division. of Water Quality Revised Jan. 2013

BORING LOG
EG DALE 91.37 ACRE TRACT (FORMERLY CAROLINA CREOSOTE)
ADJACENT TO SEABOARD COAST LINE RAILROAD
EASTBROOK, LLC
LELAND, NORTH CAROLINA
MWAOC-5
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 05/02/13
0-0.5'
Leaf litter with organics.
Low
Grab
2-4'
Tan orange, very fine to fine grained sand changing to medium
gray, silty to fine grained sand. No hydrocarbon odor.
Low To
Moderate
Grab
5-7'
Medium gray, fine grained clayey sand. No hydrocarbon odor.
High
Grab
10 - 13'
Lime green, silty clayey sand. No hydrocarbon odor.
High
Grab

g550urce
Management, ! C.
Harnpstead, NC 03443.

Approximate Monitoring Well
Adapted from USGS Topographic "Leland, N.C.," 1984, Contour Interval = 2 Meters
TITLE: Approximate MW-1 And
Applied Peoource _:. _ � vMWAOC-5 Well Location Map
Matiagemerrt,
Ham oteaM NC 25443 k Q325 ��" = 5a0 5128� 3 EFC