403770_Well Construction - GW1_20120326

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NONRESIDENTIAL WELL CONSTRUCTION RECORD
----- Nort1UCa Il na Departnient of Environment and Natural Resources- Division of Water Quality
, �• WELL CONTRACTOR CERTIFICATION # 3423
1. WELL CONTRACTOR:
WILLIAM T. DLIGGiNS
WellContractor(lndividoal) Name
TERRACON CONSULTANTS, INC
Weil Contractor Company Name
5240 GREEN'S DAIRY ROAD
Street Address
RALEIGH NC
City or Town State Zip Code
(919 ) 873-2211
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
OTHER ASSOCIATED PERMIT#(ii applicable) N/A
SITE WELL ID Cif applicable) E i-20 '(-Pz-
3. WELL USE (Check One Box) Monitoring t Municipal/Public D
Industrial/Commercial 0 Agricultural D Recovery 0 injection 0
IrrigatIonD Other 0 (list use)
DATE DRILLED 01/2012
4. WELL LOCATION:
EAGLE ISLAND.
(Street Name, Numbers, Community, Subdivision, Lot No,, Parcel, Zip Code)
CITY: WiLMINGTON
TOPOGRAPHIC / LAND SETTING:
QStope °Valley J Flat ❑Ridge
LATITUDE 36 '
LONGITUDE 75
•
COUNTY NEW HANQ J : Top,
(check appropriate box)
DitOther eve t(ie°4w
" DMS OR 34 .1 TDD
" DMS OR 7-4 (:103 f DD
Latitude/Iongitude source: MPS D"opographic map
(location of well must be shown on a USGS topo map andaftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
�onfinec� ❑isnosal Facility NIA
Facility Name Facility ID# (if applicable)
N/A
Street Address
Art E S AND NC�
City or Town State Zip Code
i7 C tf":6)
_rot f�, �f "lh fo
�I iive
� ve
all g Ad Tess2.6
City or Town
� 4r0, zsl A-6�E0
State
Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:•
b. DOES WELL REPLACE EXISTING WELL? YES u NO LI
c. WATER LEVEL Below Top of Casing: I I— FT.
(Use"+" if Above Top of Casing)
n "!
d. TOP OF CASING IS L. FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance -in accordance with-15A iCA-C1C Ofl8.
e. YIELD (gpm): ,,ILA METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g, WATER ZONES (depth):
27605 :Top 1'L Bottom 7,5-. Top
Top Bottom Top
Top Bottom Top
. Thickness/
7. CASING: Depth Diame er Weight
Top t 2 , - Bottom 2S Ft. 5,t t
: Top Bottom Ft.
: Top Bottom Ft.
: 8. GROUT: Depth Material
: Top 0 , Bottom 1 Ft. p cc
Top Bottom FL
Top Bottom Ft.
9. SCREEN: Depth . Diameter
: Top 1 Bottom 2 C Ft. 2 in.
: Top Bottom Ft. in.
Bottom Ft.
10. SAND/GRAVEL PACK:
• Depth Top j Bottom ,2" 5- Ft.,
: Top Bottom Ft.
: Top Bottom, Ft.
11. DRILLING LOG
: Top Bottom
: 12• S / 18
A9.5 /
•
/
12. REMARKS:
Bottom
Bottom
Bottom
Material
pv c
- Method
Slot Size Material
file.
In.
In. in_
Size Material
Na 2. 5 'Uv_ a
Formation Description
5414 _
CI.
Ai.
SpjP
s j t-?^
MAR I_ 9_ a012.
►nformatloa Prercciising
O
DWQ/8
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
: 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVJ,gE ! ' 0 THE WELL OWNER.
311 2/12
SIGNATURE OF CE'Y IFIED WELL CONTRACTOR DATE
WILLIAM T. DUGGINS
PRINTED NAME OF PERSON CONSTRUCTING 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 GV1l-1 b
Rev. 2/09