411572_Well Construction - GW1_20130211

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3314A
1. WELL CONTRACTOR:
Ellen Cornette
Well Contractor (Individual) Name
Applied Resource Management, PC
Well Contractor Company Name
257 Transfer Station Road
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# NA
OTHER ASSOCIATED PERMIT#(if applicable) NA
SITE WELL ID #(if applicable) AMW-2
3. WELL USE (Check One Box) Monitoring G/ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 12/17/12
4. WELL LOCATION:
Tract 2 Brown's Island
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Harkers Island couNTY Carteret
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope [Valley VFlat ❑ Ridge ❑ Other
LATITUDE 36 "DMS OR 34.70962N
DD
LONGITUDE 75 " DMS OR-76.53811 W DD
Latitude/longitude source: VGPS ❑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.)
NA NA
Facility Name Facility ID# (if applicable)
Tract 2 Brown's Island
Street Address
Marshallbura NC 28553
City or Town State Zip Code
James Cornette. Applied Resource Mat. PC
Contact Name
P.O. Box 882
Mailing Address
Hampstead
City or Town
NC 28443
State Zip Code
t 910j9 270-2919
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 9.5
b. DOES WELL REPLACE EXISTING WELL? YES ❑
NO q/
c. WATER LEVEL Below Top of Casing: 3.2 FT.
(Use "+" if Above Top of Casing)
411572
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): NA METHOD OF TEST NA
f. DISINFECTION: Type NA Amount NA
: g. WATER ZONES (depth):
: Top 4' Bottom 8' Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
: 7. CASING: Depth Diameter Weight Material
Top +2 Bottom 3 Ft. 2" SCH4( PVC
Top Bottom Ft.
: Top Bottom Ft.
8. GROUT: Depth Material
: Top 0.5 Bottom 2.5 Ft. Bentonite
Method
: Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 3 Bottom 9.5 Ft. 2" in. 0.010 in. PVC
: Top Bottom Ft in. in.
: Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
.
Top 2.5 Bottom 9.5 Ft. Coarse Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
: Top Bottom Formation Description
/ See attached boring logs.
/
•
. /
/.
•
. /
12. REMARKS:
• I DO HEREBY CERTIFY THAT THIS WELL WAS C ON`STRCT IN ACCORDANCE WITH
: 15A NCAC 2C, WELL CONSTRUCTION STANDAR1S ;'SAND THAT A COPY OF THIS
RECO.0=•ENPR? DE OTHE WE OWjJ R.
▪ divAier
SIGNATURE OF CERTIFIED WELL CONTRACTOR D
�-'ll.
ilt
r
PER 10 .5 2013
,';formation Pr
oCe�Rf�c
14,
en ii.1"5
Pnit,
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, `NC 27699-161, Phone [phone]
Form GW-lb
Rev. 2/09

AMW-2
BORING LOG
BROWN'S ISLAND
NC COASTAL LAND TRUST
CARTERET COUNTY, NORTH CAROLINA
DRILLED BY: ARM
LOGGED BY: E. Cornette
DATE: 12/17/12
Sample
Depth
Description
Water
Content
Blow Count
0-2'
Dark gray, loamy sand.
Low
Not
Applicable
2'->1 O'
Tan, fine to medium grained sand.
High
Not
Applicable