411227_Well Construction - GW1_20130204

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NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2082
1. WELL CONTRACTOR:
Sanford Sweetina
Well Contractor (Individual) Name
Coastal Geothermal
Well Contractor Company Name
102 Middle St.
Street Address
Jacksonville
City or Town
[phone]
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10800230
NC 28645
State Zip Code
OTHER ASSOCIATED PERMIT#8l applicable)
SITE WELL ID#(if applicable)
3. WELL USE (Check One Box) Monitoring D Municipal/Public D
Industrial/Commercial 0 Agricultural Recovery D Injection0
IrrigationD Other lic(list use) Geothermal, Loon
DATE DRILLED 3-3 to 3-18-2011
4. WELL LOCATION:
Bide FC-574
(Street Name, Numbers, Community, Subdivision. Lot No.. Parcel, Zip Code)
CITY: Camp Leieune
COUNTY Onslow
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
❑Slope DValley MiFlat ❑Ridge DOther
LATITUDE 36 ° "DMS OR 3X.X000(X)00( DD
LONGITUDE 75 "DMS OR 7X.XXXXXXXXX DO
Latitudellongitude source: BPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this loam if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Batchelor Enlisted Ouarters
Facility Name
Rldn FC-574
Street Address
Camn Leieune
City or Town
Carl H Raker
Contact Name
Rldn 1005 Michael Rd
Mailing Address
Caron I eierine
City or Town
( 91019 451-2213
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 255'
b. DOES WELL REPLACE EXISTING WELL? YES 9 NO V
c. WATER LEVEL Below Top of Casing: n/a FT.
(Use "+" if Above Top of Casing)
Facility ID# (if applicable)
NC 28547
State Zip Code
NC 28547
State Zip Code
•
41122'r
d. TOP OF CASING IS n/a 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): n/a METHOD OF TEST
f. DISINFECTION: Type n/a Amount
g. WATER ZONES (depth):
Top n/a Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness)
7. CASING: Depth Diameter Weight Material
Top n/a Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
6. GROUT: Depth Material Method
Top 0 Bottom 255' Ft. Bentonite Pump
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top n/a Bottom Ft. in. in.
Top Bottom Ft. • in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top n/a Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /10
10 / 45
45 / 80
80 / 120
120 / 195
195 / 255
12. REMARKS:
Formation Description
Sand Some Clay
Fine Sand
SIR
Limestone (Broken)
Silty Sand
Silty Sand with I imestone Layers
TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
ROVI _: •THE LOWNER.
CERTIFIED ELL CONTRACTOR
DATE
Sanford Sweetina
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information ProcSs ing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone] ail
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Form GW-lb
Rev. 2/09
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