409637_Well Construction - GW1_20121210

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2756-A
1. WELL CONTRACTOR:
Dennis N. Fovies
Well Contractor (Individual) Name
N.CDENR
Well Contractor Company Name
1617 Mail Service Center
Street Address
Raleigh NC 27699
City or Town State Zip Code
(919 ) 807-6300
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
SITE WELL ID #(if applicable) CC31 T3
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection 0
Irrigation❑ Other (list use) Monitorina
DATE DRILLED 10/4/12
4. WELL LOCATION:
330 Division Dr. New Hanover Correctional Ire
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Hanova
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑ Valley6eFlat ❑ Ridge ❑Other
LATITUDE 34 026 ' 802.0000 DMS OR DD
LONGITUDE 77 a 92 300.0000 DMS OR W DD
Latitude/longitude source: VGPS ❑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 Correctional la N/A
Facility Name Facility ID# (if applicable)
330 Division Dr_
Street Address
Wilmington
N_C_
City or Town State Zip Code
ALB
Contact Name
1611 Mail Service Rd_
Mailing Address
Raleigh N.C. 27099
City or Town State Zip Code
( 919 J8 707-9000
Area code Phone number
6. WELL DETAILS:
.a. TOTAL DEPTH: 30'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO t/
c. WATER LEVEL Below Top of Casing: 10.8' FT.
(Use "+" if Above Top of Casing)
409637
d. TOP OF CASING IS 3' 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): 2 METHOD OF TEST Air lift
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top 15' Bottom 25' Top Bottom
Top Bottom Top Bottom
: Top Bottom Top Bottom
Thickness/
: 7. CASING: Depth Diameter Weight Material
Top +3'. Bottom 15' Ft. 4" SDR1 i PVC
Top 25' Bottom 30' Ft. 4" SDR11 PVC
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0' Bottom 7' Ft, Bentonite . Mixed/ pourec
Top
Top
Bottom
Bottom
Ft.
Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 15' Bottom 25' Ft. 4" in. .020 in. SST
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth
Top 7' Bottom
Size Material
30' Ft. # 3 Sand
Top Bottom Ft.
: Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom Formation Description
: 0' / 3' Black and tan sand
•
•
•
8'
Tan gray sand
8' / 13' Gray sand wet
13'_/ 18' Gray sand wet
• •
18' / 23' Gray sand wet
•
•
23' / 28'
28' / 30'
12. REMARKS:
Gray sand wet
Grarsa gad v et
Nnv 0
201,
information ProceGsing
Link
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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 PROVIDED TO THE WELL OWNER.
c.' 7
• GNATURE OF C RTIFIED WELL CONTRACTOR DATE
: Dennis N. Foyles
PRINTED NAME OF PERSON CONSTRUCrfiIN H
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
10/4/12