411602_Well Construction - GW1_20130211

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3324A
1. WELL CONTRACTOR:
Joe Zuncich
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) MW-1
3. WELL USE (Check One Box) Monitoring Cl Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 1/2/13
4. WELL LOCATION:
2031 Eastwood Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Hanove
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
DSlope ❑ Valley Flat ❑Ridge DOther
LATITUDE 34 0 13 17.8700 " DMS OR
LONGITUDE 77 ° 49 i 1.1600 DMS OR
Latitude/longitude source: grGPS [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.)
DD
DD
?1602
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): NA METHOD OF TEST NA
f. DISINFECTION: Type NA Amount NA
: g. WATER ZONES (depth):
: Top 7.89' Bottom 18.5' Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
• Thickness/
:7. CASING: Depth Diameter Weight Material
Top 0 Bottom 3.5 Ft. 2" SCH4( PVC
▪ Top Bottom Ft.
: Top Bottom Ft.
8. GROUT: Depth Material Method
: Top 1 Bottom 2 Ft. Bentonite
Top 0.2 Bottom 1 Ft. Neat Cement
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top 3.5 Bottom 18.5 Ft. 2" in.
: Top Bottom Ft. in.
: Top Bottom Ft. in. in.
Slot Size Material
0.010in. PVC
in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top 2 Bottom 18.5 Ft. Coarse
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
: Top Bottom
NA NA•
Facility Name Facility ID# (if applicable)
2031 Eastwood Road
Street Address
Wilminaton NC
City or Town State Zip Code
Joe Zuncich. Applied Resource Mat. PC
Contact Name
P . Q . Box 882
Mailing Address
Hampstead NC 28443
City or Town State Zip Code
( 910,16 270-2919
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 18.5
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO rit
c. WATER LEVEL Below Top of Casing: 7.89 FT.
(Use "+" if Above Top of Casing)
•
/
/
/
/
/
/
/
• 12. REMARKS:
Material
Sand
Formation Description
See attached boring Togs.
r as sat r.
14.
rEE,) 2c13
41-4
FEB (0 01 7011
information Processing Unit
uwuiBOG
• I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTT D-IN ACCORDANCE WITH
: 15A NCAC 2C WELL CONSTRUC II • N STANDARDS, AND T A COPY OF THIS
RECOR. J: EEN PRO • THE WELL OWNER.
•
: SIG * TURE OF CER
.
D WELL CONTR CTOR DATE
•P
INTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - infarmatiorPProcessing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1 b
Rev. 2/09

MW-1
BORING LOG
NKC PROPERTIES
3021 EASTWOOD ROAD
WILMINGTON, NORTH CAROLINA
DRILLED BY: J. Zuncich
LOGGED BY: J. Zuncich
DATE: 1/2/13
Sample
Depth
Description
Water
Content
Blow Count
0-0.5'
Concrete
Not
Applicable
Not
Applicable
0.5'-2'
Tan to Tight brown, silty, very fine grained
sand.
Low
Grab
2'-4'
Tan to light gray, silty to very fine grained
sand. No hydrocarbon (HC) odor.
Low
Hydraulic
Push
5'-7 '
Gray and orange, very fine to fine grained
sand. No HC odor. Soil sample collected.
Low
Hydraulic
Push
10'-12'
Light gray and orange, silty clay. No HC odor.
Soil sample collected.
High
Hydraulic
Push
15'-17'
Brown orange, fine grained sand. No HC
odor.
High
Hydraulic
Push

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Steel Manhole
Ground Surface
1' Bentonite
1
Locking Well Cap
Concrete/Grout Crown
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16.5' Sand
TITLE:
3.5' Riser
15' Screen
• •• • ••!•
r • _ •
18.5' Total Depth
Type If Monitoring Well Asbuilt
JOB:
12181
SCALE:
Not to scale
DATE:
1/30/13
DRAWN BY:
EFC
WELL ID:
MW1