414945_Well Construction - GW1_20130805

1. WELL CONTRACTOR:
John Salmon
ESIDENTIAL WELL CONSTRUCTION RECORD=
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3497-A
Well Contractor (Individual) Name
Coastal Geothermal
Well Contractor Company Name
102 Middle St
Street Address
Jacksonville NC 28546
City or Town State Zip Code
( 910) 353-0926
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10800342
OTHER ASSOCIATED PERMIT#(if applicable) n/a
SITE WELL ID #(if applicable) n/a
3. WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED 7-17-13
TIME COMPLETED 4:00 AM ❑ PM [Se'
4. WELL LOCATION:
CITY: Morehead City
1702 Lois Lane
COUNTY Carteret
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope [Valley grFlat ❑Ridge DOther
LATITUDE 36
LONGITUDE 75
°
" DMS OR 3X.XXXXXXXXx DD
" DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
Matthew Sullivan
Owner Name
148 Huntina Bav Dr.
Street Address
Morehead City
City or Town
(252 ) 240-0922
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 205'
•
•
•
•
g. WATER ZONES (depth):
Top n/a Bottom Top
Top Bottom Top
Top Bottom Top
7. CASING: Depth
Top n/a Bottom
Top Bottom
Top Bottom
8. GROUT: Depth
Top 0 Bottom 205°
Ft.
Ft.
Ft.
Bottom
Bottom
Bottom
6b
Thickness/
Diameter Weight Material
Material
Ft. Bentonite
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Top n/a Bottom Ft. in. in.
Top • Bottom Ft. in. in.
Top Bottom Ft. in. in.
Method
pump/tremie
Diameter Slot Size Material
10. SAND/GRAVEL PACK:
Depth
Top n/a Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 30
30 / 60
60 /170
170 / 205
NC 28557 i/
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES NO Lgf
c. WATER LEVEL Below Top of Casing: n/a FT.
(Use "+" if Above Top of Casing)
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 n/a
f. DISINFECTION: Type n/a Amount n/a
12. REMARKS:
Drilled 8-205' boreholes
Size Material
Formation Description
Sand/shells/silt
Clay -Silty Sand -Shells
Sand silt -shells
Silt-shells/limestone
Fri" t�~ 4 t '�
PR3c stN o UNIT
A
I DO HEREBY CERTIFY TH ; THIS WELL WAS C SACTED IN
ACCORDANCE WITH 15A IC 2C, WELL CONSTRU ON
: STANDA S, AND THAT A COPY C'F-i' RD H S BEEN
PR•VIDTO THE ELL O NER.
7-17-13
ELL CONTRACTOR DATE
John Salmon
: 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 (919) 807=6300
Form GW-1 a
Rev. 2/09