415199_Well Construction - GW1_20130812

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3423A
1. WELL CONTRACTOR:
William T Duggins
Well Contractor (Individual) Name
Terracon
Well Contractor Company Name
5240 Green's Dairy rd
Street Address
raleigh
City or Town
919 ) 873-2211
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NC 27616
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) r4 W
3. WELL USE (Check One Box) Monitoring IVMunicipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED 12/11/12
4. WELL LOCATION:
5210 us 421
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑ Valley Btlat ❑Ridge
LATITUDE 34 '
LONGITUDE 77
COUNTY New Hanover'
(check appropriate box)
❑ Other
"DMS OR 19.5757 DD
" DMS OR 59.0451 DD
Latitude/longitude source: I PS Oropographic 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.)
New Hanover County Landfi I( b5--3Y
Facility Name Facility ID# (if applicable)
5210 US 421
Street Address
• Wilmington NC 28403
City or Town State Zip Code
Andy Mulvey
Contact Name
5210 US 421
Mailing Address
Wilmington NC 28403
City or Town State Zip Code
( 910.Q 508-2960
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 40
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 13✓
c. WATER LEVEL Below Top of Casing: 12.45 FT.
(Use "+" if Above Top of Casing)
' 1 99
d. TOP OF CASING IS 3.02 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):
f. DISINFECTION: Type
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
METHOD OF TEST
Amount
7. CASING: Depth Diameter
Top Bottom 30 Ft. 2 inch shd 40 pvc
Bottom
Bottom
Bottom
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 25
Material
Ft. cement
Thickness/
Weight Material
Top 25 Bottom 27 Ft. bentonite
Top Bottom Ft.
Method
trimmie
pour
9. SCREEN: Depth Diameter Slot Size Material
Top 30 Bottom 40 Ft. 2 in. .10 in. pvc
Top Bottom Ft.
Top Bottom Ft.
10. SAND/GRAVEL PACK:
Depth
Top 27 Bottom 40
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
0 / 40
Ft.
Ft.
Ft.
in. in.
in. in.
Size Material
Formation Description
tan to brown fine to coarse sand
/iligarminn
I f
12. REMARKS:
fl f 0riMn N:IKltt DC` ttAt31.1e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN P,RQVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
PRINTED AME OF PERSON CO eIROCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09