413194_Well Construction - GW1_20130429

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2579
1. WELL CONTRACTOR:
DANNY SUMMERS
Well Contractor (Individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
Street Address
STATESVILLE
City or Town
( 704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NC
State
•
t.i �. •..
d. TOP OF CASING IS 0.0 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): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
28625 • Top Bottom Top Bottom
Zip Code : Top Bottom Top Bottom
: Top Bottom Top Bottom
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) IW-3-1 THRU IW-3-18
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery ❑ Injection 52(
Irrigation❑ Other ❑ (list use)
DATE DRILLED 04/09/13 - 04/ 10/ 13
4. WELL LOCATION:
2901 NORTH KERR AVENUE 28412
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WILMINGTON COUNTY NEW HANOVER
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope [Valley wifFlat ❑ Ridge ❑ Other
LATITUDE 34 ° 17 20.8800 "DMS OR
LONGITUDE 77 ° 54 ' 1.6200 " DMS OR
DD
DD
Latitude/longitude source: 3PS ❑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.)
COMPASS GROUP
N/A
Facility Name Facility ID# (if applicable)
2901 NORTH KERR AVENUE
Street Address
WILMINGTON NC 28412
City or Town State Zip Code
COMPASS GROUP USA, INC
Contact Name
2400 YORKMONT ROAD
Mailing Address
CHARLOTTE
City or Town
NC 28217
State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 15.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO p�
c. WATER LEVEL Below Top of Casing: 4.5
(Use "+" if Above Top of Casing)
):nit Within 30 :da
7 Nia:il Service Cent
FT.
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom Ft.
Top Bottom Ft.
: Top Bottom Ft.
: 8. GROUT: Depth Material Method
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size
: Top Bottom Ft. in. in.
: Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
: Top Bottom Ft.
: Top Bottom Ft.
Top Bottom Ft.
.
11. DRILLING LOG
: Top Bottom
0.0 / 15.0
12. REMARKS:
: 18 LOCATIONS
Material
Formation Description
DIRECT PUSH
E�(��LR� �� 5 zai: { . �t 2
t 1 i,s, i ♦ te:: b.4 2 ',,,n i . lr' F... F.J . 'iy- . i..
§JFOR i ION PR CESSNG UNIT
I DO HEREBY CERTIFY THAT THIS WELL
• 15. CAC 2C, WELL : NSTRUCTION ST
D HAS BEEN ' - sVITO THE
S CONSTRUCTED IN ACCORDANCE WITH
DARDS, AND THAT A COPY OF THIS
LL OWNER.
ATURE •F CERTIFIED WELL CONTRACTOR
04/ 18/ 13
DATE
: DANNY SUMMERS I 7
: PRINTED NAME OF PERSON CON .,L
fot-ma
rocessi
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