NC0006254_MW-1 Monitoring Well Construction Record (GW-1)_20110208

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WELL CONSTRUCTION RECORD
North Carolina I)eJ3a€tmertt of Environment and Natural Resources- Division of Water Quality
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WELL CONTRACTOR CERTTN I<CATkON V 1 5 ' d
I. WELL DDNTRACTOR;
7014A6(zy,1yam}
Weft Contractor (individual) Name ...... .._._
A E DRILLINGSERVICES. LLG
Well Contractor Company Name
Two Un`li d Wa
Street Address
Greenville SC 29697
City or Town State Zip Code
8t 64.._) 288-1986
Area code Phone number
: S. TOP OF CASING IS 3 , LJ FT- Above Land Surface*
'Top of casing terJnlnated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e- YIELD (gpm): METHOD OF TEST
f DISINFECTION. Typq _ _ Amount_
g. WATER ZONES (depth):
Top LIQ Bottom 1 d, 0 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
2.1WELL INFORMATION: f : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMITS
OTHER ASSOCIATED PERM iT#(it applicab€e) : Tap Bottom Ft.
SITE WELL ID #(if applicable). Al L­' Top Bottom Ft._
3- WELL USE (Check One Sox) Monitoring MunicipallPublic o
IndustriaUCornmercial0 Agricultural[) Recoverya injection 0
Irrigation[) Othero (listuse)
BATE DRILLER �,- {
4. WELL LOCATION:
(Street Name. Numbers. Gorrrmunity. Stfibdivision. Lot No., Parcel, `Z+p Code) `
aTy: RErs:i^ COUNTY �/-(;Iu,, �
TOPOGRAPHIC 1 LAND SETTING- (check appropriate box)
ostope ovalley )SFlat QRidge f301her
LATITUDE 38 ° DMS OR 3XXXXxXXXXX DD
LONGITUDE 75 " DMS OR 7x.xxxxxxxxx DD
Latitudellongitude source: 03PS Dropographic map
(location of well musthe shogun on a USGS topo map andattached to
this form it not using CPS;
5. FACILITY (Name of the business where the well is located.)
Facility Nam Facility €D# (if applicable)
14a:1 \ 1G sJ �{P
.Atreet Address
Ciitt�y or Town State Zip Code
Contact Name
LCL-kn t12 k 5V.,150Cp
ailing Address
V-a\6&�t jc, �13i15"
City gr T07W State Zip Code
S-)a- c)
Area code Phone number
S. WELL DEi`AIL& 1
a. TOTAL DEPTH:
h- DOES WELL REP L ACE MISTING WEL1 ? lES 0 ND]j
c- WATER LEVEL Below Top of Casing: _
(Use '+' if Above Top of Casing)
8. GROUT: Depth Material Method
Tnp_ t3ptiorrJ O Ft.h
Top Bottom Ft.
Top Hottorn-_ Ft.
9. SCREt=N: Depth Diameter Slot Size Material
: TD171 • Bofiarrt Ft _in. A� in. c­
= Top Bottom
Ft. in.
in.
Top Bottom
Ft. in,
tn.
10. SANDIGRAVEL PACK:
Depth
Stze
Material
To p-a,-b-Boltom­LL6_
FLfJ
541,,0
Top Bottom
Ft.
Top Bottou
Ft.
11. DRILLING LOG
Tap Bottom Formation Description
f
J
f3
7
f
f
f
12. REMARKS:
: I DO HEREBY GERTIFY THAT THIS W ELL WAS CONSTRUCTED IN ACCORi1ANCE *RITE!
- 15A NCAC 2C. WELL CONSTRUCTIONSTANOARDS. AND THATA COPYOFTf1JS
: RECORDHAS EENFR ❑TOTHEWELLOSANER-
Si"' ti URE OF CEftirFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THEME
E
5tabmit the originat-to thy: Qt so�.. Form GW-1nef7k�Q9rNW6�f.tt
Rev, 1 tail;
T617 mail Serwice entea:=Raldigli;

Ghent: Sealed Air Corp _ WELL J.D: AdW—1
AEC�y� Project Number,,
O ti� Site Location: Patterson, NC Date Installed: 2/8/2011
Well Location: Coords: Inspector_ M. Dail
MethacL 8040 Geoprobe Contractor: AE Drilling
MONITORING WELL CONSTRUCTION DETAM
Depth from G.S. (feet) E€evation(€eet)
I
Datum
Top of Steel Guard Pike 3' above G.S.
Measuring Point
forsurveying &
Water i_eveis Top of Riser Pipe -3' above G.S.
Lau —Ground Surface (G.S_) p,
emenL Bentunite,
Sentonfte Siutry.
Grout, or Native
Materials
95 % Ceme
5 % Bento
4 %Native
Materia
:r Pipe:
Length g'
Inside Diameter (ID) 2"
Type of Materiat PVC
Stabilized Water Level
of Bentonite
tonite Seal Thickness
of Sand
of Screen
yen:
Length 5'
inside Diameter (ID) 2'
Slot Size
Type of Materiat PVC
sisze of Sand 42
i Pack Thickness 12'
Bottom of Screen
Bottom of Tail Pipe:
Bottom of Borehole
Bor2h01euia„ete, 4.5' Npioved:
Measuring Paint
Signature
NA
2'
2'
4'
6'