414487_Well Construction - GW1_20130708

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2111-A
1. WELL CONTRACTOR:
Thomas Bill
Well Contractor. (Individual) Name
Bill s Well Drilling Co., Inc.
Well Contractor. Company Name
800 McArthur Rd
Street Address
Fayetteville
NC
City or. Town State
(910 ) 488-3740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WS0800934
28311
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) Well #2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural El Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 3-23-13
4. WELL LOCATION:
Norwood Ezzell Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Mt Olive couNTYDUDIin
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑Valley IYFlat ❑Ridge DOther
LATITUDE 35 " DMS OR 3.5.14227 DD
LONGITUDE 78 ° " DMS OR -78.02581 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. FACILITY (Name of the business where the well is located.)
Goodson 8 Wells Farms. irb
: d. TOP OF CASING IS +2 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): 800 METHOD OF TEST PUmpinq
: f. DISINFECTION: Type HTH Amount 2lbs
g. WATER ZONES (depth):
Top 260 Bottom 340 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 40 Ft. 20" .375 Steel
: Top +2 Bottom 260 Ft. 12" .375 Steel
: Top 340 Bottom 349 Ft. 12" .375 Steel
: 8. GROUT: Depth Material Method
Top 0 Bottom 40 Ft. Cement Pumped
Top Bottom Ft.
: Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
: Top 260 Bottom 340 Ft. 10 in. .030 in. S.S.
: Top Bottom Ft. - - Ins - T In.
Top Bottom
Ft.
in.
in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 240 Bottom 349 Ft. No. 4 Gravel
Top Bottom- Ft.
: Top Bottom Ft.
11. DRILLING LOG
: Top Bottom
Facility Name Facility ID# (if applicable) /
290 Petti Fnnt Rd
Street Address /
Mt Olive NC 28658 /
City or. Town State Zip Code : /
Bob McCloud
Contact Name
PO Box 7266
/
Mailing Address :•
/
Trenton 8628 /
City or Town State Zip Code
( 910.6 260-0125
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 349
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Imo'
c. WATER LEVEL Below Top of Casing- 51 FT..
(Use "+" if Above Top of Casing)
•
12. REMARKS:
7
Formation Description
See Attached
4.3
r � g
t6 2
�T 1
• I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
: 15A NCAC 2C, WELL CONSTRUCTION,STANDARDS, AND THAT A COPY OF THIS
S REC! RDA + BEEN PROVIDED TO THE WELL OWNER.
"7
1 3-23-13
•
I ATURE OF CERT FIED WELL CONTRACTOR DATE
Thomas Bill
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-lb
Rev, 2/09

BILL'S WELL DRIIIING CO., INC.
800 McArthur Road
Fayetteville, North Carolina 28311
Office [phone] Fax [phone]
[e-mail]
wwvv.billswelldrillingco.com
Goodson & Wells Farms
Drilling Log Lithology
Norwood Ezzell Rd Test Hole #2 - Jackson Farm
From
To
Formation Description
0
15
Mix
15
50
Sand
50
65
Clay
65
80
Mix
80
110
Sand
110
130
Mix
130
140
Mix
140
160
Soft Clay
160
180
Mix
180 jj
__„, 200
Mix
200
220
Sand
220
240
Mix
240
260
Mix
260
280
Mix
280
340
Sand •
340
350
Bottom
Thomas W. Bill
2111-A

BILL'S WELL DRILLING CO., INC.
800 McArthur Road
Fayetteville, North Carolina 28311
Office [phone] Fax [phone]
[e-mail]
www.billswelldrillingco.com
Goodson & Wells Farms
Drilling Log Lithology
Norwood Ezzell Rd Well #2 - Jackson Farm
From
To
Formation Description
0
15
Mix
15
50
Sand
50
65
Clay
65
80
Mix
80
110
Sand
110
130
Mix
130
140
Mix
140
160
Soft Clay
160
180
Mix
180
200
Mix
200
220
Sand
220
240
Mix
240
260
Mix
260
280
Mix
280
340
Sand
340
349
Bottom
Thomas W. Bill
2111-A

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