WI0700195_Staff Report_20210208

North Carolina Department of Environment and Natural Resources
Division of Water Quality — Aquifer Protection Section
INJECTION FACILITY INSPECTION REPORT
PERMIT NO. WI0700195
DATE OF INSPECTION: 2/8/21
INSPECTOR: R. Sipe
NAME OF PERMITTEE(S) Thomas & Melinda Kay Amsler
MAILING ADDRESS OF PERMITTEE 4510 Moncks Court, New Bern, NC 28562
PHYSICAL ADDRESS OF SITE (if different than above) Same as above
PERSON MET WITH ON -SITE Melinda Kay Amsler; TELE NO. [phone]
WELL(S) STATUS:
XExisting and operating Class V Well
Existing well proposed to be converted to Class V well
Proposed/not constructed
LAT/LONG OF WELL(S) 35.0861N, 77.09W (Inj. Well)
Appx. distance of well to property boundaries: _10 feet (Inj. Well)
Appx. distance of well from foundation of house/structure: _32 feet (Inj. Well)
Appx. distance of well from septic tank/field (if present): _N/A
Appx. distance of well to other well(s) (if present)
Appx. distance to other sources of pollution: _None
125 feet to supply well
Flooding Potential of Site: high moderate Xlow
Comments: Both inj., and supply wells appear to be in adequate structural condition; however, at the time of the
inspection water was coming out of the pressure relief valve of the injection well. The permittee was notified and
stated she would contact her contractor about performing maintenance on the
well.
Injection Facility Insp. Report (Rev. Sept 2009) Page I of 4 Pages

See Attached Map
DRAW SKETCH OF SITE ABOVE (Show property boundaries, buildings, other wells, septic tanks/drain fields, other
potential pollution sources, roads, approximate scale, and NORTH arrow)
GW-1 well records submitted with previous Inspection Report.
Draw Schematic of well above showing TD, casing depth, grout, etc.
Injection Facility Insp. Report (Rev. Sept 2009) Page 2 of 4 Pages

Well Construction Information
Date Constructed: 12/22/2010
Well Contracting Company: _Applied Resource Management, P.C.
Well Driller Name: Jamie Canter
NC Well Cert. No.: 3253-A
Address:_257 Transfer Station Rd., Hampstead, NC 28443
Telephone No.: _(910)270-2919 ; Cell No.:
Email Address:
Proposed Depth of Well(s): _N/A
Total Depth: _80 feet
Total Depth of Source Well, if present:_68 feet
Casing:
Depth: 60 feet; Diameter: 4 inches_; Type (gay. steel, PVC, etc.): _PVC Stick Up: _1.5 feet
Grout
Depth: 25 feet; Type (cement, bentonite, etc.):_Bentonite ; Placement (pumping, press. etc.): _Tremmie
Well ID Plate Present (Y or N): Y ; Heat Pump ID plate present (Y or N): N
Influent spigot (Y or N): Y Effluent spigot (Y or N): Y
Well Sampled? (Y or N): N ; If Yes, Lab Sample ID numbers: N/A
Static Water Level: _3 feet (at installation)
Injection Information (if applicable):
Injection Rate:
GPM
Injection Pressure:
PSI
Injection Volume:
GPD
Temperature- Summer:
F°
Temperature- Winter:
F°
Comments/Notes: See comments
above.
ft
Injection Facility Insp. Report (Rev. Sept 2009) Page 3 of 4 Pages

Injection Facility Insp. Report (Rev. Sept 2009) Page 4 of 4 Pages