415195_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 NC 27616
City or Town
(919 ) 873-2211
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) ,l' W
3. WELL USE (Check One Box) Monitoring (VMunicipal/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 COUNTY New Hanover
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley What ❑Ridge ❑Other
LATITUDE 34 ° " DMS OR 19.2514 DD
LONGITUDE 77 " DMS OR 59.3367 DD
Latitude/longitude source: DGPS ['Topographic 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 Landfill (cS —o
Facility Name Facility ID# (if applicable)
5210 US 421
Street Address
Wilmington NC 28403
City or Town State Zip Code
Andy Meri r- Mtt vcy
Contact Name
5210 US 421
Mailing Address
Wilmington
City or Town
( 910.0 508-2960
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 30
NC 28403
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO tj/
c. WATER LEVEL Below Top of Casing: 10.04 FT.
(Use "+" if Above Top of Casing)
15195
d. TOP OF CASING IS 2.57 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): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom 20 Ft. 2 inch shd 40 pvc
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 15 Ft. cement trimmie
Top 15 Bottom 17 Ft. bentonite pour
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 20 Bottom 30 Ft. 2 in, .10 in. pvc
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 17 Bottom 30 Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 30
/
/
/
/
12. REMARKS:
NW-7
Formation Description
tan to brown fine to coarse sand
sr
it
AUG 12 2013
I DO HEREBY CERTIFY THAT THIS WELL WAS CON CIEDAAL.ACCQRDAN6E=-w w
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATUf E OF CE TI WELL CONTRACTOR
PRINTED NAME OF PERSON CONSTR�C'TING 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-1 b
Rev. 2/09