HomeMy WebLinkAbout394765_Well Construction - GW1_201106091. WELL CONTRACTOR:
JERRY WATKINS
NONRESIDENTIAL WELL CONSTRUCTION RECORD
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North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2452
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.
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# N/A
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(iif applicable) MW-18
3. WELL USE (Check One Box) Monitoring d Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED 05/23/11 - 05/24/11
4. WELL LOCATION:
3012 MASON STREET 28110
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: MONROE COUNTY UNION
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope oValley ❑Flat ❑Ridge ❑Other
LATITUDE " DMS OR DD
LONGITUDE " DMS OR DD .
Latitude/longitude source: BPS (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.)
COOPER HAND TOOLS N/A
Facility Name Facility ID# (if applicable)
3012 MASON STREET
Street Address
MONROE NC 28110
City or Town State Zip Code
COOPER HAND TOOLS
Contact Name
3012 MASON STREET
Mailing Address
MONROE NC 28110
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 46.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Dt
c. WATER LEVEL Below Top of Casing: 40.0 FT.
(Use "+" if Above Top of Casing)
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 36.0 Ft. 2 INCH SCH ao PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0.0 Bottom 31.0 Ft. PORTLANDBENTONITE SLURRY
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 36.0 Bottom 46.0 Ft. 2.0 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 34.0 Bottom 46.0 Ft. 20-40 FINE SILICA SAND
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Formation Description
0.0 / 5.0 TAN SILT
5.0 / 46.0 ROCK
/
RECCNED
/ JUN 09 2U11
InformotDW rng Unit
12. REMARKS:
BENTONITE_SEAL FROM 31 0 TO 34 0 FEET
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 < N PROVIDED TO THE WELL OWNER.
W 01&05/26/11
SIGNATURE @OF nTIFIED WELL CONTRACTOR DATE
JERRY WATKINS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2/09
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