412553_Well Construction - GW1_20130408

1 tlONRESI ENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
JOHNNY BURR
Well Contractor (Individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
Street Address
STATESVILLE NC 28625
City or Town State Zip Code
(704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WM0800984
OTHER ASSOCIATED PERMIT#(ifapplicable) WV0800073
SITE WELL ID #(if applicable) MW-8R
3. WELL USE (Check One Box) Monitoring Sr Municipal/Public ❑
IndustdaVCommercial ° Agricultural 0 Recovery 0 Injection ❑
Irrigation° Other 0 (list use)
DATE DRILLED 03/06/13
4. WELL LOCATION:
407 SOUTH MARINE BLVD 28540
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: JACKSONVILLE COUNTY ONSLOW
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope °Valley liFlat ❑Ridge ❑Other
LATITUDE 34 ^ 45 . 5.3400 "DMS OR DD
LONGITUDE 77 26 ' 51.6400 " DMS OR DD
Latitude/longitude source: (BPS ['Topographic map
(location of well must be shown on a USGS topo map andattached to
this fort if not using GPS)
5. FACILITY (Name of the business where the well is located.)
ONSLOW OIL
N/A
Facility Name Facility ID# (if applicable)
407 SOUTH MARINE BLVD
Street Address
JACKSONVILLE NC 28540
City or Town State Zip Code
WORSLEY FAMILY HOLDINGS
Contact Name
123 SHIPYARD BLVD
Mailing Address
WILMINGTON
City or Town
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 12.0 FEET
b. DOES WELL REPLACE EXISTING WELL?
NC 28412
State Zip Code
YES ° NOLg+
c. WATER LEVEL Below Top of Casing: 3.0
(Use "+" if Above Top of Casing)
FT.
3098
I2553
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
f. DISINFECTION: Type N/A
g. WATER ZONES (depth):
Amount
N/A
N/A
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0.0 Bottom 2.0 Ft. 2 INCH SCH40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0.0 Bottom 1.0
Et. PORTLAND BENTONITE
Top Bottom Ft.
Top Bottom Ft.
Method
SLURRY
9. SCREEN: Depth Diameter Slot Size Material
Top 2.0 Bottom 12.0 Ft. 2.0 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 1.5 Bottom 12.0 Ft. 20-40
Top Bottom Ft.
Material
FINE SILICA SAND
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0.0 / 0.5
0.5 / 1.0
1.0 / 2.0
Formation Description
ASPHALT
GRAVEL
ORANGE SANDY CLAY
2.0 / 2.4 ASPHALT
2.4 1 3.0 GRAVEL
3.0 / 7.0 GRAY CLAY
7.0 / 12.0 GRAY SAND
mktt
/ 3 AP8
12. REMARKS: f N'`
BENTONITE SEA! FROM 1 0 TO FEET
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STAY • RDS, AND THAT A COPY OF THIS
RECORD S6 ENPROVIm DTO THE OWNER.
SIG
HNNY BURR
03/11/13
RTIFIED WE L CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
mtt withll 30 days o
1617 Mall Service Centerz
c >I
0:.Division df Water Quality
699 161 Phone [phone]g,,.
nfonnatlon Processing,;•.
Form GW-1 b
Rev. 2/09