383425_Well Construction - GW1_20100101

NON RESIDENTIAL 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 NC 28728
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) MW-2
3 WELL USE (Check One Box) Monitoring NNe Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 5/5/10
4 WELL LOCATION
Smokev Park Highway Candler NC
(Street Name Numbers Community Subdivision Lot No Parcel Zip Code)
CITY Candler COUNTY Buncombe
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope oValley elat ❑Ridge ❑Other
LATITUDE 35 ° 32 39 1400 " DMS OR 3x xxxxxxxxx DD
LONGITUDE 82 ° 41 0 9500 " DMS OR 7x xxxxxxxxx DD
Latitude/longitude source Q 3PS propographic 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 )
Boone's Corner #2
Facility Name Facility ID# (if applicable)
Smokev Park Hiahwav
Street Address
Candler
NC
City or Town State Zip Code
Sharon 1 ate - Martin & Slaale Geosciences
Contact Name
118F Cherry Street
Mailing Address
Black Mountain
City or Town
( 828.15 669-3929
Area code Phone number
6 WELL DETAILS
a TOTAL DEPTH 28
NC 28711
State Zip Code
b DOES WELL REPLACE EXISTING WELL? YES ❑ NO L /
c WATER LEVEL Below Top of Casing 18 FT
(Use "+" if Above Top of Casing)
d TOP OF CASING IS N/AN 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
g WATER ZONES (depth)
Top 18 Bottom 28
Top Bottom
Top Bottom
7 CASING Depth
Top 0 Bottom 13
Top Bottom
Top Bottom
8 GROUT Depth
Top 0 Bottom 1 5
Amount
Top Bottom
Top Bottom
Top Bottom
Thickness/
Diameter Weight Material
Ft 2 Sch 4( PVC
Ft
Ft
Material Method
Ft Portland Pour
Top Bottom Ft
Top Bottom Ft
9 SCREEN Depth Diameter
Top 13 Bottom 28 Ft 2
Top Bottom Ft
Top Bottom Ft
Slot Size Material
in 010 in PVC
in In
in in
10 SAND/GRAVEL PACK
Depth Size
Top 3 Bottom 28 Ft #2
Top Bottom Ft
Top Bottom Ft
11 DRILLING LOG
Top Bottom
0 / 1 feet
1 / 28 feet
12 REMARKS
Material
Quartz Sand
Formation Description
8" concrete/ 4"aravel
Brown Saprolite o
u
o 8
rrl
C
onttoring VVeII NIVV-
SIGNATURE OF CERTIFI
NSTRUCTED IN ACCORDANCE WITH
RDS AND THAT A COPY OF THIS
L OWNER
5/6/10
ELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
0
Submit within 30,days of completion to.,Division of 1Nater,Quality,- Information PrOdessing,_ Rev 2/09
ri ,g f Form GW-lb
1617 Mail Ser'vice'Centerr, Raleigh, NC 27699-161, Phone [phone]
JAN 16 2013