413180_Well Construction - GW1_20130429

04/10/13
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
MARK GETTYS
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
28625
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) AS-1
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other ['(list use) AIR SPARGE
DATE DRILLED 04/09/13
4. WELL LOCATION:
5314 OLEANDER DRIVE 28403
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WILMINGTON COUNTY NEW HANOVER
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑ Va11ey i'Flat ❑Ridge ❑Other
LATITUDE 34 ° 12 ' 27.3700 "DMS OR DD
LONGITUDE 77 ° 51 49.1000 " DMS OR DD
Latitude/longitude source: Q3PS :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.)
RIM - 6261 N/A
Facility Name
5314 OLEANDER DRIVE
Street Address
WILMINGTON
City or Town
CONOCO PHILLIPs
Contact Name
420 SOUTH KEELER AVENUE
Facility ID# (if applicable)
NC 28403
State Zip Code
Mailing Address
BARTLESVILLE OK 74003
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 25.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO (l
c. WATER LEVEL Below Top of Casing: 6.0 FT.
(Use "+" if Above Top of Casing)
2345
• i• 131SO
d. TOP OF CASING 1S 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):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0.0 Bottom 20.0 Ft. 2 INCH SCH 40 PVC
Top Bottom Ft.
: Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0.0 Bottom 16.0 Ft. PORTLAND BENTONITE SLURRY
Top Bottom Ft.
: Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 20.0 Bottom 25.0 Ft. 2.0 in. .010 in. PVC
: Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top 18.0 Bottom 25.0 20-40 FINE SILICA SAND.
: Top Bottom
Top Bottom
11. DRILLING LOG
Ft.
Ft.
Ft.
Size Material
: Top Bottom Formation Description
0.0 5.0 BROWN SAND
5.0
/
/
/
1
/
25.0
BLACK SAND
P p 9 9 11 9
•
•'r. P'.'`I;i�" ;r4.f'i,a. .,t��-^''f �' ` �i 3�i 6 is
•
12. REMARKS:
BENTONITE SEAL FROM 16.0 TO 18.0 FEET
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15 A C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
BEEN OVIDDJO THE W: OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTODATE
▪ MARKGETTYS iyM'oM. "*a kiae pid;�;
PRINTED NAME OF PERSON