412021_Well Construction - GW1_20130304

Wo
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3314-A
1. WELL CONTRACTOR:
Ellen Cornette
Well Contractor (Individual) Name
Applied Resource Management, PC
. Well Contractor Company Name
257 Transfer Station Road
11 1 2 0 2 1
d. TOP OF CASING IS 0 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 Amount
Street Address : g. WATER ZONES (depth):
Hampstead NC 28443 : Top 14' Bottom 14' Top Bottom
City or Town State Zip Code
Top Bottom Top Bottom
(910 ) 270-2919 : Top Bottom Top Bottom
Area code Phone number
Thickness/
2. WELL INFORMATION: i 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# N/A : Top 0 Bottom 3 Ft. 2" SCH4( PVC
'OTHER ASSOCIATED PERMIT#(if applicable) N/A
Top Bottom Ft.
SITE WELL ID #(if applicable) N/A : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring C1 Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection ❑ : Top 0.5 Bottom 1 Ft. Neat Cement
Irrigation❑ Other 0 (list use) : Top 1 Bottom 2 Ft. Bentonite
DATE DRILLED 1 /16/13 ; Top Bottom Ft.
4. WELL LOCATION: ; 9. SCREEN: Depth Diameter Slot Size Material
Market St. Citao. 6980 Market Street : Top 3 Bottom 13.2 Ft. 2 in. 0.010 in. PVC
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
: Top Bottom Ft. in. in.
CITY: Wilmington NC COUNTY New Hanove : Top Bottom Ft. in. in.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope [Walley (Flat ❑ Ridge ❑ Other .
LATITUDE 36 "DMS OR 34.265026 DD
LONGITUDE 77 " DMS OR -77.825939 DD
Latitude/longitude source: ly PS ❑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.)
Pon ShoDoe #124 •
: 10. SAND/GRAVEL PACK:
Depth Size Material
Top 2 Bottom 14 Ft. Coarse Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
: Top Bottom Formation Description
Facility Name Facility ID# (if applicable) : /
6980 Market Street•/
Street Address
Wilminaton
City or Town
Joe Zuncich. ARM. PC
NC 28411 /
State Zip Code • /
Contact Name
P.O. Box 882
Mailing Address
Hampstead
City or Town
( 910,E 270-2919
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 14
/
/
NC 28443•
•
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 10.05 FT.
(Use "+" if Above Top of Casing)
12. REMARKS:
See Attahced Boring Log
0
4�.
• 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 H §,BEEN P TOT LL OWNER.
1/30/13
ATURE 0 CERTIFIED WELL CONTRACTOR DATE
L(Ie7
ft j(w•►
• 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-1 b
Rev. 2/09

AM W-3 R
BORING LOG
THE MARKET STREET CITGO/POP SHOPPE 124
6980 MARKET STREET
WILMINGTON, NC
DRILLED BY: ARM
LOGGED BY: E. Corvette
DATE: 1/15/13
Sample
Depth
Description
Water
Content
Blow Count
0-3"
Mulch and gray brown fine to medium sand.
Slight hydrocarbon odor.
Low
Grab
3"-1'
Gray/brown, medium grained sand. Slight
hydrocarbon odor.
Low
Grab
1'-5'
Dark brown to black, fine to medium grained
sand with gray/brown, silty clay tense at five
feet. Slight hydrocarbon odor.
Low
Grab
5'-8.5'
Dark brown, fine to medium grained sand. No
hydrocarbon odor.
Low
Grab
8.5 -10
Tan to light gray, medium grained sand.
Hydrocarbon odor. .
Moderate
Grab
10'-11.5'
Dark brown to black, massive sand.
Hydrocarbon odor.
Moderate
to High
Grab
11.5-12'
Tan to light gray, medium grained sand. Slight
hydrocarbon odor.
High •
Grab
12'-14'
Dark brown to black, massive sand.
Hydrocarbon odor.
High
Grab

Steel Manhole
Ground Surface
1' Bentonite
Groundwater
Table
AMW-3R
Locking Well Cap
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Concrete/Grout Crown
.13' Total Depth
Applied Resource
Mana9erea7, / C
Hampstead, NC25445
TITLE:
Type II Monitoring WellAsbuilt
JOB:
0359
SCALE:
Not to scale
DATE:
1 /7/ 13
DRAWN BY:
EFC
WELL ID:
AMW-3R