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Home My WebLink About413525_Well Construction - GW1_20130514WELL CONSTRUCTION RECORD This form can be used for single or multiple wells 1. Well Contractor Information: Bobbie D Fowler Well Contractor Name NCWC 2869-A NC Well Contractor Certification Number Mid -Atlantic Drilling, Inc. Company Name 2. Well Construction Permit #: List all applicable well construction permits (i.e. County, State, Variance, etc) 3. Well Use (check well use): For Internal Use ONLY: 14. WATER ZONES FROM TO DESCRIPTION 4.5 rt 9.5 ft surficial ft ft 15. OUTER CASING (for multi -cased wells) OR LINER (if Hostile) FROM TO DIAMETER pvc sch 40 ap THICKNESS MAT1xt1AL 0 ft. 5 ft. 2 in. 16. INNER CASING OR TUBING (geothermal closeddoop) FROM TO DIAMETER THICKNESS MATERIAL ft. ft in. ft ft in. 17. SCREEN.. Water Supply Well: ❑Agricultural °Geothermal (Heating/Cooling Supply) °Industrial/Commercial °Irrigation °Municipal/Public °Residential Water Supply (single) °Residential Water Supply (shared) Non -Water Supply Well: I21Monitoring - °Recovery Injection Well: °Aquifer Recharge °Aquifer Storage and Recovery °Aquifer Test °Experimental Technology °Geothermal (Closed Loop) °Geothermal (Heating/Cooling Return) °Groundwater Remediation °Salinity Barrier ❑Stormwater Drainage °Subsidence Control °Tracer °Other (explain under #21 Remarks) 4. Date Wen(s) Completed: 4/16.4/18/13 W ell ID# MW-1 to 8 5a. Well Location: NCDOT NA Facility/Owner Name Facility ID# (if applicable) Southwest Quad HWYs 17 BPass & Business Physical Address, City, and Zip Onslow NA County Parcel Identification No. (PIN) 5b. Latitude and Longitude in degrees/ndnutes/seconds or decimal degrees: (if well field, one latdong is sufficient) 34.771776219 N 77.399136873 w see attached 6. Is (are) the weB(s): °Permanent or DTemporary 7. Is this a repair to an existing well: DYes or tJNo If this is a repair, fill out known well construction infarmotion and explain the nature of the repair under #21 remarks section or on the back of this form. 8. Number of wells constructed: `r For multiple injection or non -water supply wells ONLY with the same construction, you can submit one fans. 9. Total well depth below land surface: 8@16 (120 total) (ft) For multiple wells list all depths ifdierent (example- 3Qo i00' and 2(4100') 10. Static water level below top of casing: ',twofer level is above casing, use "+" 11. Borehole diameter: 8 (in.) 12. Well construction method: auger (4 1/4) (ft) (i.e. auger, rotary, cable, direct push, etc.) FOR WATER SUPPLY WELLS ONLY: 13a. Yield (gpm) Method of test: 13b. Disinfection type: Amount: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL 5 it 15 ft 2 in. 0.01 sch 40 PVC ft. ft. in. -18:: GROUT' FROM 2 ft. TO 3 ft. MATERIAL bentonite EMPLACEMENT METHOD & AMOUNT pour 0 ft 2 ft concrete pour ft ft 19. SAND/GRAVEL PACK (if applicable) FROM TO MATERIAL EMPLACEMENT METHOD 3 ft. 15 ft. torpedo pour ft. ft 20. DRILLING LOG (attach: additional sheen dfnecessary) FROM ft. TO ft DESCRIPTION (color, hardness, soit/rack type, grain size, etc.) see attached ft. ft. ft. ft ft. ft. ft. ft MAY 142013 ft ft. ft B. • nl Ipl NY SECTION ,- OPv VROGESSINu 21..REMARKS:'.: Concrete pad w/ stick up protective cover used 22. Certificatio • Signature ofCertifell a Contractor 4/29/2013 Date By signing this form, I hereby ceri& that the wells) was (were) constructed in accordance with 15A NCAC 02C .0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of this record has been provided to the well owner. 23. Site diagram or additional well details: You may use the back of this page to provide additional well site details or well construction details. You may also attach additional pages if necessary, SUBMITTAL INSTUCTIONS 24a. For All Wells: Submit this form within 30 days of completion of well construction to the following: Division of Water Quality, Information Processing Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 24b. For Injection Wells: In addition to sending the form to the address in 24a above, also submit a copy of this form within 30 days of completion of well construction to the following: Division of Water Quality, Underground Injection Control Program, 1636 Mail Service Center, Raleigh, NC 27699-1636 24c. For Water Sunuly & Injection Wells: In addition to sending the form to the address(es) above, also submit one copy of this form within 30 days of completion of well construction to the county health department of the county where constructed. Form GW-1 North Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Jan. 2013 tiresi 7 Z / / 1/ 0 7 2 8 \ §8 Ear AMEC E&I, Inc. 5710 OLEANDER DR WILMINGTON, NC a (910) 452-1185 SOIL BORING LOG JOB NAME NCDOT Jacksonville DRILLING METHOD HSA JOB NUMBER 566774007.0004 LATITUDE 34.770983377 BORING NUMBER PMW-2 LONGITUDE 77.398954845 BORING DATE 4/16/13 AMEC GEOLOGIST William Mabie DEPTH (Feet) SOIL DESCRIPTION USCS SYMBOL NOTES — _5 _ — _ 10 _ _ 15 _ _ 20 0.0' - 2.5° Black silty fine SAND with trace organics 2.5'-5.0' Brown silty fine SAND 5.0'-6.0' Dark to light brown, silty fine SAND 6.0'-9.0' Gray and orange modeled fine sandy CLAY 10.0'-13.0' Dark gray fine sandy SILT 13.0'-14.0' Dark gray sandy SILT 14.0'-17.0' Dark gray silty fine to medium SAND, trace wood fragments Boring Tenninated at 17.0' feet BGS SM SM SM SC SC SC SM Wet NOTES: BGS = Below Ground Surface 0.0'-4.0' Soil descriptions taken from auger cuttings AMEC E&l, Inc. 5710 OLEANDER DR WILMINGTON, NC (910)452-1185 !' SOIL BORING LOG JOB NAME NCDOT Jacksonville DRILLING METHOD HSA JOB NUMBER 566774007.0004 LATITUDE 34.771776219 BORING NUMBER PMW-1 LONGITUDE 77.399136873 BORING DATE 4/17/13 AMEC GEOLOGIST William Mabie DEPTH USCS (Feet) SOIL DESCRIPTION SYMBOL NOTES 0.0'-2.5' Black silty fine SAND (auger) SM _ 2.5'4.0' Brown silty fine SAND (auger) SM 5 4.0'-5.5' 10-7-4, Brown silty fine SAND SM 8.5'-10.0' 1-1-2, No Recovery 10 13.5'-15.0' WOH-WOH-2, Gray CLAY with some fine sand CL 15 _ Boring Terminated at 15.0' feet BGS _20 NOTES: BGS = Below Ground Surface WOH = Weight of Hammer 0.0'-4.0' Soll descriptions taken from auger cuttings AMEC E&l, Inc. 5710 OLEANDER DR WILMINGTON, NC (910)452.1185 SOIL BORING LOG JOB NAME NCDOT Jacksonville DRILLING METHOD HSA JOB NUMBER 566774007.0004 LATITUDE 34.772352926 BORING NUMBER PMW-4 LONGITUDE 77.398817603 BORING DATE 4/17/13 AMEC GEOLOGIST William Mabie DEPTH USCS (Feet) SOIL DESCRIPTION SYMBOL NOTES 0.0'-2.5' Black silty fine SAND, trace organics SM — 2.5'-4.0' Brown silty fine SAND SM _5 4.0'-5.5' 5-9-11, Gray silty fine SAND SM 8.5'-10.0' 5-4-2, Gray silty fine to med. SAND SM 10 13.5'-15.0' 6-7-6, Gray silty fine SAND SM 15 _ Boring Terminated at 15.0' feet BGS _20 NOTES: BGS = Below Ground Surface WOH = Weight of Hammer 0.0'-4.0' Soil descriptions taken from auger cuttings AMEC E&I, Inc. ' e% 5710 OLEANDER DR WILMINGTON, NC (910)462-1186 SOIL BORING LOG JOB NAME NCDOT Jacksonville DRILLING METHOD HSA JOB NUMBER 566774007.0004 LATITUDE 34.771775620 BORING NUMBER PMW-6 LONGITUDE 77.398144324 BORING DATE 4/17/13 AMEC GEOLOGIST William Mabie DEPTH USC3' (Feet) SOIL DESCRIPTION SYMBOL NOTES 0.0'-2.5' Black silty fine SAND SM _ 4.0'-5.5' 1-2-2, Dark gray fine sandy CLAY SC 5 8.5'-10.0' 6-6-6, Gray silty fine SAND SM 10 13.5'-15.0' WOH-WOH-WOH, Gray SILT CL 15 _ Boring Terminated at 15.0' feet BGS _20 NOTES: BGS = Below Ground Surface WOH = Weight of Hammer 0.0'-4.0' Soil descriptions taken from auger cuttings AMEC E&I, Inc. 5710 OLEANDER DR >y WILMINGTON, NC (910) 452.1185 i SOIL BORING LOG JOB NAME NCDOT Jacksonville DRILLING METHOD HSA JOB NUMBER 566774007.0004 LATITUDE 34.771515070 BORING NUMBER PMW-7 LONGITUDE 77.398579873 BORING DATE 4/17/13 AMEC GEOLOGIST _ William Mable DEPTH USCS (Feet) SOIL DESCRIPTION SYMBOL NOTES — 0.0'-2.5' Black to dark brown, silty fine SAND, trace organics SM — 2.5'-4.0' Brown, silty fine SAND SM 6 4.0'-5.5' 2-3-6, Brown silty fine SAND SM _10 8.5'-10.0' 1-2-3, Gray and orange modeled CLAY w/ trace fine sand CL 13.5'-15.0' WOH-1-3, Gray SILT, trace fine sand SM 15 Boring Terminated at 15.0' feet BGS 20 NOTES: BGS = Below Ground Surface WOH = Weight of Hammer 0.0'-4.0' Soil descriptions taken from auger cuttings AMEC E&I, Inc. -. 5710 OLEANDER DR' 1` WILMINGTON, NC (910) 452.1185 SOIL BORING LOG JOB NAME NCDOT Jacksonville DRILLING METHOD HSA JOB NUMBER 566774007.0004 LATITUDE 34.771053928 BORING NUMBER PMW-8 LONGITUDE 77.397904663 BORING DATE 4/17/13 AMEC GEOLOGIST William Mabie DEPTH USCS (Feet) SOIL DESCRIPTION SYMBOL NOTES — 0.0'-2.5' Black silty fine SAND trace organics SM _ 2.5'-4.0' Black fine sandy CLAY CL _5 4.0'-5.5' 1-1-2, Gray CLAY w/ some fine sand CL — 8.5'-10.0' 1-2-2, Gray CLAY, trace fine sand CL 10 13.5'-15.0' 2-2-3, Dark gray clayey fine SAND SM 15 _ Boring Terminated at 15.0' feet BGS _20 NOTES: BGS = Below Ground Surface 0.0'-4.0' Soil descriptions taken from auger cuttings AMEC E&I, Inc. 5710 OLEANDER DR WILMINGTON, NC �► (910)452.1185 !` SOIL BORING LOG JOB NAME NCDOT Jacksonville DRILLING METHOD HSA JOB NUMBER 566774007.0004 LATITUDE 34.770509717 BORING NUMBER PMW-3 LONGITUDE 77.398515737 BORING DATE 4/18/13 AMEC GEOLOGIST William Mabie DEPTH USCS, (Feet) SOIL DESCRIPTION SYMBOL NOTES — 0.0'-2.5' Black to dark gray, silty fine SAND, trace organics SM _ 2.5'-4.0' Gray silty fine SAND SM _5 4.0'-5.5' 3-6-8, Brown silty fine SAND SM — 8.5'-10.0' 2-1-2, Light gray CLAY w/ trace fine sand CL 10 13.5'-15.0' 2-2-3, Light gray fine to med. SAND SM 15 _ Boring Terminated at 15.0' feet BGS _20 NOTES: BGS = Below Ground Surface WOH = Weight of Hammer AMEC E&I, Inc. 5710 OLEANDER DR WILMINGTON, NC ' (910)452-1185 SOIL BORING LOG JOB NAME NCDOT Jacksonville DRILLING METHOD HSA JOB NUMBER 566774007.0004 LATITUDE 34.770677866 BORING NUMBER PMW-5 LONGITUDE 77.397561665 BORING DATE 4/18/13 AMEC GEOLOGIST William Mabie DEPTH USCS (Feet) SOIL DESCRIPTION SYMBOL NOTES 0.0'-2.5' Black silty fine SAND, trace organics SM _ 2.5'-4.0' Black to dark gray clayey fine SAND SC _5 _ 4.0'-5.5' WOH-1-2, Orange and gray modeled fine sandy CLAY CL 8.5'-10.0' 8-4-7, Light gray to brown silty fine SAND SM 10 — 13.5'-15.0' WOH-1-1, Dark gray CLAY w/ trace fine sand CL 15 _ Boring Terminated at 15.0' feet BGS ,-20 NOTES: BGS = Below Ground Surface WOH = Weight of Hammer 0.0'-4.0' Soil descriptions taken from auger cuttings