415165_Well Construction - GW1_20130812

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Christopher Blackmon
Well Contractor Name
4145-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #: N/A
List all applicable veil construction permits (Le. Count, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
°Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
IMunicipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
Non -Water Supply Well:
°Monitoring
Injection Well:
❑Aquifer Recharge
°Aquifer Storage and Recovery
°Aquifer Test
°Experimental Technology
❑Geothermal (Closed Loop)
°Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 7/09/13
5a. Well Location:
Stone Bay - Camp Lejeune
Facility/Owner Name
°Recovery
❑ Groundwater Remediation
❑Salinity Bather
❑ Stonnwater Drainage
❑Subsidence Control
°Tracer
®Other (explain under #21 Remarks)
Wen no N/A
N/A
Facility DD# (if applicable)
Stone Bay Complex, Camp Lejeune, NC 28547
Physical Address, City, and Zip
Onslow
N/A
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degreeshnlnutes/seeonds or decimal degrees:
(if well field, one lat'long is sufficient)
34 34 31.1721 N 77 26 45.5594
W
6. Is (are) the well(s): °Permanent or OTemporaa
7. Is this a repair to an existing well: Yes or ONo
If this is a repair, TII ors known well construction information and explain the nature of the
repair under 421 remarks section or an the back ofthis form.
8. Number of wells constructed:1
For multiple injection or non -water supply wells OA'LI'trith the same construction. you can
submit one form.
9. Total well depth below land surface: 306
For multiple it list all depths ifdifferene (example- 3@200' and 005
10. Static water level below top of easing: N/A (ft.)
/funeer level is above casing, use "+"
11. Borehole diameter: 6 (in.)
12. Well construction method: Mud Rotary
(i.e. auger. rotary, cable, direct push. etc)
(ft.)
FOR WATER SUPPLY WELLS ONLY•
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
For Internal Use ONLY:
415165
14. WATER ZONES
FROM
TO
DESCRIPTION
ft
ft
n.
ft
15. OUTER CASING (for multi -cased wells) OR LINER (8' applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 rt.
306 ft
3/4 in.
HDPE
16. INNER
CASING OR TUBING (geothermal closed -loop)
FROM
TO
DL4METER
THICKNESS
MATERIAL
ft
ft.
in.
ft
ft
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft
ft.
in.
ft.
ft
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft
ft
ft.
ft
ft
ft
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft
ft
ft
ft.
20. DRILLING
LOG (atts
h additional sheets if nece sarv)
FROM
TO
DESCRIPTION (color, hardness, soil/rock npe, grain size. eta)
ft
ft
See Attached
ft.
ft
ft
ft.
ft.
ft
ft
ft
ft
ft
AUG a 7 2013
ft
ft.
21. REMARKS ifdFntr r;1A iON ogifrF:yS?wt'y 11[4i
Geothermal Test Well for Conductivity testing.
22. Certification:
Signature of Certitie Well Cont
ractor
tractor
Date
By signing this form, 1 hereby certth that the ti'ell(s) vas (were) constructed in accordance
with 15A NC4C 02C .0100 or 15,4 NCAC 02C .0200 Well Construcdon Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to p oyide additional well site details or well
construction details. You may also attach additional pa es rf ce p1n r•+n;,a
SUBMITTAL INSTUCTIONS fr FI
24a. For All Wells: Submit this fo S$ ithi(p �(�lad3 $f dil tioril o,L well
construction to the following ((gj Atk L s v 1i7771
Division of Water Quality, tfprntation Processing Unit,
1617 Mail Service CenterAfleigh..1C-3969BT6T'----
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this fonn within 30 days of completion of well
constmction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnlc & Iniection Wells: In addition to sending the form to
the address(es) above. also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

Geothermal Test Well
Boring Log
MCBCL (P-1362 SOF Performance Resiliency Center)
Stone Bay Complex
Camp Lejeune, North Carolina
Drilled By: Applied Resource Management, P.C.
Logged By: James L. Cornette, PG
Date: 7/09/13
Depth
(In.)
Description
Water
Content
o - 12'
Sandy clay. Mottled orange, tan, and white.
Low
12' - 35'
Clay. Gray.
High
35' - 45'
Clay with minor shell bed lenses. Gray.
High
45' - 63'
Sandy, silty, clay. Gray.
High
63' - 90'
Limestone. Light gray. Moderately well indurated. High permeability.
High
90' - 137'
Clayey, sandy, silt. Olive gray.
High
137' - 185'
Silty, sandy, clay. Tannish gray.
High
185' - 194'
Sandy clay. Trace coarse sand grains. Tannish gray.
High
194' - 210'
Limey sandstone. Gray. Moderately well indurated. Moderate permeability.
High
210' - 222'
Limey sandstone. Light gray. Soft. Moderate permeability.
High
222' - 260'
Interbedded limey sandstone and sandy limestone. Light gray. Moderately well to
poorly indurated. Moderate permeability.
High
260' - 268'
Sandy limestone. Light gray. Moderately well indurated. Moderate permeability.
High
268' - 280'
Limey sandstone. Gray to dark gray. Moderately well to well indurated. Moderate
permeability.
High
280' - 292'
Sandy day. Dark brownish gray.
High
292' - 306'
Sandy clay with minor mudstone layers. Dark gray.
High