410755_Well Construction - GW1_20130415

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NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #: 4146A
1. WELL CONTRACTOR:
D.T. Chalmers, Jr.
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington North Carolina 28405
City or Town State Zip Code
( 910) - 452-5861
Area code - Phone number
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) DPT-01 (35-40)
3. WELL USE (Check One Box): Monitoring ® Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection 0
Irrigation 0 Other 0 (list use).
DATE DRILLED: March 04, 2013
4. WELL LOCATION:
3rd & A Streets, MCB, Camp Geiger, 28542
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Ztp Code)
CITY: Jacksonville COUNTY: Onslow
TOPOGRAPHIC / LAND SETTING (check appropriate box)
Q.Slop° ❑Valley ®Flat [Midge ❑Other:
LATITUDE'
34.739705 DD
LONGITUDE' 77.45629 DO
Latitude/longitude source: IXI GPS 0 Topo. map
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.)
5. FACILITY (Name of the business where the well is located.)
N/A N/A
Facility Name Facility ID # (if applicable)
3rd & A Streets, MCB, Camp Geiger
Street Address
Jacksonville
City or Town
Ms. Jenni Reed
NC
State
28542
Zip Code
Contact Name
Attn: GF/ EMD/ EQB/ 12 Post Lane
Mailing Address
Camp Lejeune NC
City or Town State
(910)- 451-5068
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 40
28542-0004
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS_(:). 1 ° FT Above Land Surface*
*Top of casing terminated atlor below land surface may require
a varianeein accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): WA METHOD OF TEST: WA
f. DISINFECTION: Type WA Amount: WA
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING:
Thickness/
Depth Diameter Weight Material
Top 0 Bottom 35 Ft. 1 in. Sch.40 PVC
Top Bottom Ft. in.
Top Bottom Ft. in.
8. GROUT:
Top 33
Top
Top
9. SCREEN:
Top
Top
Top
Depth
Bottom
Bottom
Bottom Ft.
Material Method
34 Ft. Bent. Pellets Surface Pour
Ft.
Depth
35 Bottom
Bottom
Bottom
Diameter Slot Size Material
40 Ft. 2 in. Slot .010in. PVC
Ft. in. in.
Ft. in. in.
0. SAND/GRAVEL PACK:
Depth Size Material
Top 34 Bottom 40 Ft. #2 Medium Torpedo Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
/
12. REMARKS:
Formation Description
APR 0 g 201?
SEE
ATTACHED
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H9S EEN PROVIDED TO THE WEL'L OWNER.
_ _ V-L-L3
SIGNATURE OF CERTIFIED WELL CONTRACTOR
D.T. Chalmers, Jr.
PRINTED NAME OF PERSON CO
Ile
NIE
DATE
Submit within 30 days of completion to: Division of Water Quality -Information Processing,
1617 Mall Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
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Revf2/09