383248_Well Construction - GW1_20100101

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3328-B
1 WELL CONTRACTOR
Chris Singleton
Well Contractor (Individual) Name
Singleton Environmental, Inc
Well Contractor Company Name
PO Box 2012
Street Address
Enka
City or Town State Zip Code
(828 ) 667-5001
Area code Phone number
2 WELL INFORMATION
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) IVI iP/- 1
3 WELL USE (Check One Box) Monitoring IV Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 5/4/10
4 WELL LOCATION
145 Assembly Drive
(Street Name Numbers Community Subdivision Lot No Parcel Zip Code)
CITY Montreat COUNTY Buncombe
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope [Valley ❑ Flat 146 Ridge ❑Other
38 ' 41 0000 " DMS OR 3x xxxxxxxxx DD
° 18 8 7600 " DMS OR 7x xxxxxxxxx DD
LATITUDE 35
LONGITUDE 82
Latitude/longitude source VOPS LTopographic 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 )
Fmerson Residence
Facility Name
145 Assembly Drive
Street Address
Mr ntrent
City or Town
Sharon I atz
Contact Name
PO Box 1023
Mailing Address
Black Mountain
City or Town
Facility ID# (if applicable)
NC
State Zip Code
NC 28711
State Zip Code
( 828.6
Area code Phone number
6 WELL DETAILS
a TOTAL DEPTH 19
b DOES WELL REPLACE EXISTING WELL? YES Cl NO p/
c WATER LEVEL Below Top of Casing 16.5 FT
(Use "+" if Above Top of Casing)
Top 3
Top
Top
3 3 ra
d TOP OF CASING IS N/A 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) N/A METHOD OF TEST
f DISINFECTION Type Amount
g WATER ZONES (depth)
NC 28728 Top 16 5 Bottom 19 Top
Top Bottom Top
Top Bottom Top
Bottom
Bottom
Bottom
Thickness/
7 CASING Depth Diameter Weight
Top 0 Bottom 4 Ft 2 sch 40
Top Bottom Ft
Top Cottc,m
8 GROUT Depth
Top 0 Bottom 1
Ft
Material
Ft Portland
Top Bottom Ft
Top Bottom Ft
Material
PVC
Method
Pour
9 SCREEN Depth Diameter Slot Size Material
Bottom 19 Ft 2 in 010 in PVC
Ft in in
Ft in in
Top 4
Top Bottom
Top Bottom
10 SAND/GRAVEL PACK
Depth
Bottom 19
Bottom
Bottom
11 DRILLING LOG
Top Bottom
0 / 6 feet
6 / 8 feet
8 / 12 feet
12 / 13 feet
13 / 19 feet
/
/
12 REMARKS
Size Material
Ft #2 Quartz Sand
Ft
Ft
Formation Description
Brown Sand Silt - Fill Material
Thick cobbles and gravel
Brown Silt
Thick Cobbles and gravel.
Brown saarollte -Auaer Refusal
at 19 feet—%
IVIH! ( 1 ZU1U
itiiorrriaiio'n Pr, cussing Unit
onttoring vven tvlvv-
uv,/ NPSUi,}
I DO HEREBY CERTIFY T
15A NCAC 2 . CO , STRU
RECO • `ASi:EE PRO
ELL WAS r ONSTRUCTED IN ACCORDANCE WITH
ION STAND RDS AND THAT A COPY OF THIS
TO THE WELL NER
5/4/10
SI MATURE OF CERTIFIED i L CONTRACTOR DATE
Chris Singleton
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of com'ptetion to: Division of Water Quality - Information P
1617 Mail Service Center, Raleigh, NC 27699-161, Phone [phone] i
JAN 1 6 2013
Form GW-1b
Rev 2/09